Health Care Disparities Include Access to Neurology in Rural Areas

A new study published in Neurology found that distribution of neurologists across the US varies by region in ways that do not reflect the distribution of neurologic conditions. Specifically, people in rural areas may be less likely to receive care from neurologists, particularly for stroke, dementia, and back pain. The distribution of neurologists ranged from 10 to 43 neurologists for every 100,000 people.

A year of data from 20% of Medicare enrollees identified 2.1 million people with neurologic conditions and reviewed the number of times those individuals say any physician or a neurologist specifically. Across the US, 24% of people with a neurologic condition were seen by a neurologist at least once. In more rural areas, this dropped to 21% and in urban areas with more neurologists, 27% of those with a neurologic condition saw a neurologist at least once. 

The largest differences were seen for dementia, back pain, and stroke. For dementia, 38% of people in more rural areas saw a neurologist, compared to 47% in more urban areas. For stroke, 21% of people in more rural areas saw a neurologist, compared to 31% in more urban areas. 

“Neurologists in the United States are not evenly spread out, which affects whether patients can see a neurologist for certain conditions like dementia and stroke,” said Brian C. Callaghan, MD, MS, University of Michigan. “Our research found that some areas of the country have up to 4 times as many neurologists as the lowest served areas, and these differences mean that some people do not have access to neurologists who are specially trained in treating brain diseases.”

“Not surprisingly, more neurologists tend to work and live in metropolitan areas, but this study underlines the need to ensure that rural areas also have a supply of neurologists to meet demand,” said James C. Stevens, MD, FAAN, president of the American Academy of Neurology. “One way to give people more access to neurologic care is with telemedicine, which has been used successfully during the COVID-19 pandemic. Remote office visits by computer or telephone are one way to extend neurological service to people in underserved areas.”