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Trade-off between diversity and provision of specialized healthcare in US cities

Nature Cities volume 2, pages 980–989 (2025)Cite this article

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Abstract

There is consensus that urban residents have better access to healthcare than rural residents in the USA, yet this knowledge is based mostly on primary care services. Here we put forward a multidimensional examination of healthcare access to 75 medical specialties in 898 US cities. Leveraging urban scaling theory, economic geography and network science, we confirm the expectation that residents in large cities have access to a more diverse range of specialists. Concurrently, we register a surprising sublinear scaling of the prevalence of most specialty providers: the larger the city, the less the provision of specialized healthcare per capita and per unit area. We propose that the trade-off between diversity and provision is related to economic clustering in the healthcare sector and high patient loading of providers in large cities. These findings suggest the need for city-specific strategies to address emerging inequalities in healthcare services.

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Fig. 1: Urban scaling for the number of healthcare providers in 75 unique medical specialties for 898 US cities.
Fig. 2: Maps of number of healthcare providers per capita in the USA.
Fig. 3: Diversity of the number of healthcare providers of 75 unique medical specialties in the USA.
Fig. 4: Dependence between the breadth of the 75 medical specialties in the USA and their exponents from urban scaling analysis.

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Data availability

Datasets that are allowed to be shared are available via GitHub at https://github.com/dynamicalsystemslaboratory/Healthcare-Disparities-in-the-United-States/.

Code availability

Scripts that are allowed to be shared are available via GitHub at https://github.com/dynamicalsystemslaboratory/Healthcare-Disparities-in-the-United-States/.

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Acknowledgements

We acknowledge support from National Science Foundation grant numbers ECCS-1928614 and DUE-2129076 (both granted to M.P.). We thank A. Boldini, R. Barak Ventura, P. De Lellis, S. Macrì, O. Nov, R. Succar and T. Yabe for constructive input.

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Authors and Affiliations

  1. Center for Urban Science and Progress, Tandon School of Engineering, New York University, Brooklyn, NY, USA

    Tian Gan, Tanisha Dighe & Maurizio Porfiri

  2. Department of Mechanical and Aerospace Engineering, Tandon School of Engineering, New York University, Brooklyn, NY, USA

    Tian Gan & Maurizio Porfiri

  3. Department of Biomedical Engineering, Tandon School of Engineering, New York University, Brooklyn, NY, USA

    Maurizio Porfiri

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  1. Tian Gan
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  2. Tanisha Dighe
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  3. Maurizio Porfiri
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Contributions

T.G. and M.P. designed research; T.G. and M.P. performed research; T.G. and T.D. analyzed data; T.G. led software; M.P. acquired funding; T.D. led data curation; M.P. provided resources and supervision; T.G. handled visualization; and T.G. and M.P. wrote the paper.

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Correspondence to Maurizio Porfiri.

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Gan, T., Dighe, T. & Porfiri, M. Trade-off between diversity and provision of specialized healthcare in US cities. Nat Cities 2, 980–989 (2025). https://doi.org/10.1038/s44284-025-00326-7

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