• Posted September 14, 2023

Across America, Many Who Need a Neurologist Live Too Far From Care

Many Medicare patients can't get help close to home for brain and nervous system issues.

Nearly 1 in 5 Medicare recipients in the United States live at least 50 miles from their neurologist.

“Our study found a substantial travel burden exists for some people with neurologic conditions, including people living in areas with fewer neurologists and rural areas,” said study author Dr. Brian Callaghan, head of the American Academy of Neurology's Health Services Research Subcommittee.

“We also found that people who traveled long distances were less likely to return for a follow‐up visit with a neurologist," Callaghan said in an academy news release.

Data came from more than 563,000 people on Medicare (average age: 70) who saw a neurologist at least once during the one-year study. More than 17% traveled long distances to their neurologist, averaging 81 miles one way and 90 minutes travel time.

Those who had neurologists closer to home traveled an average 13 miles to appointments. Average travel time: 22 minutes.

“Travel distance can be a serious barrier to care for people with chronic neurologic conditions,” said Dr. Carlayne Jackson, president of the American Academy of Neurology.

“The American Academy of Neurology is committed to improving access to high-quality neurologic care because consistent access to specialized care from a neurologist is essential to help people manage their symptoms and minimize risks of dangerous complications and side effects," she said in the release.

About 40% of study participants with brain and spinal cord cancers; 30% with ALS, and 23% with MS traveled long distances to appointments.

Patients in areas with the fewest neurologists -- about 10 for every 100,000 Medicare recipients -- were three times more likely to travel a long distance than people living in areas with the most neurologists, 50 per 100,000 Medicare beneficiaries.

People in rural areas were five times more likely to travel long distances than people in urban areas.

Those who traveled long distances to see their primary care physician had triple the odds of long-distance travel to see a neurologist.

Preferences also factor in.

Nearly one-third of participants bypassed the nearest neurologist by 20 miles or more, the study found. About 7% of people crossed state lines for neurologic care.

“It is possible some people bypass the nearest neurologist as a matter of preference for a particular physician or they may need to travel farther to reach neurologists with shorter wait times,” Callaghan said.

Among 165,000 participants who visited a neurologist for the first time within the study's first three months, 62,000 had at least one follow-up visit with the same neurologist. Those who traveled long distances were 26% less likely to have a follow-up visit compared to those without long-distance travel.

“Our results suggest that policymakers should investigate feasible and affordable ways to improve necessary access to neurologic care, especially in areas with low availability of neurologists and in rural communities,” said study author Chun Chieh (Anna) Lin of Ohio State University. “Interventions such as telemedicine can improve access to care. Future research should examine the differences in health outcomes between people who must travel long distances for care and those who do not.”

The study was conducted prior to the COVID-19 pandemic. Future research should look at the impact of telemedicine, the authors said.

Researchers were able to measure travel only for patients who completed neurologist visits, not those who were unable to see the doctor. The results may not be the same for people not covered by Medicare.

Study findings were published Sept. 13 in the online issue of Neurology.

More information

The U.S. National Library of Medicine has more on neurologic diseases.

SOURCE: American Academy of Neurology, news release, Sept. 13, 2023