Long travel distances, excessive wait times, doctor shortages—Medicare beneficiaries face hurdles to see neurologists

According to a study published recently in Neurology, the medical journal of the American Academy of Neurology (AAN), almost one in five people on Medicare travel 50 or more miles one way to see a neurologist. Patients who require specialized neurologic care for diseases including brain cancer, amyotrophic lateral sclerosis (ALS), and multiple sclerosis (MS), travel long distances the most often.

Neurologists are doctors who specialize in diagnosing and treating diseases of the brain and the central nervous system. Since our brains and nervous system are part of the normal aging process, neurological issues are more common as we get older. In fact, according to a review of studies, aging is the main risk factor for most neurodegenerative diseases, including Alzheimer’s disease (AD) and Parkinson’s disease (PD). The findings also showed that 10% of people aged 65 years or older have AD, and it becomes more common with increasing age.

The prevalence of neurological and nervous system issues in people 65 and older makes the need for better neurological options for Medicare patients even more important.

“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 and chair of the American Academy of Neurology’s Health Services Research Subcommittee Dr. Brian C. Callaghan, of the University of Michigan Health in Ann Arbor, said in a news release. “We also found that people who traveled long distances were less likely to return for a follow‐up visit with a neurologist.”

The wide-ranging study included over 563,000 participants on Medicare, at an average age of 70, who saw a neurologist at least once during the one-year study. For the study, 14,439 neurologists provided care to participants in over 1.2 million office visits.

The findings showed that more than 96,000 people, or 17%, traveled long distances (defined as 50 or more miles each way), with an average of 81 miles each way and an average travel time of 90 minutes. Those who traveled long distances had a 26% decreased chance of 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 Lin, Ph.D., MBA, of Ohio State University in Columbus and a member of the American Academy of Neurology. “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.”

An increase in telehealth for neurological services

This study was conducted in 2018, prior to the COVID-19 pandemic, and Lin suggested that future studies examine how telemedicine during the pandemic impacted travel times.

The pandemic did lead to an increased use of telemedicine services for neurologists. In fact, without any other options than virtual care, neurologists determined that 21 of the 23 elements of the single-element neurological examination could be done through telehealth, according to the American Medical Association.

One was the cardiovascular part of the exam since there is not a remote stethoscope of fingers to feel pulses. The second was the ophthalmoscopic examination, as there is not a remote ophthalmoscope, according to Dr. Neil Busis, associate chair of technology and innovation in the neurology department at New York University Langone Health.

The most recent telehealth survey conducted by the American Medical Association showed that the pandemic had indeed led to increased use of telemedicine by neurologists. The survey showed that, per week, on average, neurologists saw 36% of their patients via telehealth. However, at least 75% of telemedicine visits were with established patients, suggesting that most patients still see neurologists in person for the initial visit.

The national shortage of neurologists

The critical neurologist shortage affects the travel times for Medicare patients, as well as the standard of care.

While the nationwide physician shortage is affecting all specialties, the demand for neurologists is growing even faster due to several factors. One is the medical advances in treating neurological disorders including migraines, multiple sclerosis, and epilepsy. Another is the growing population of Americans over the age of 65. Estimates show that over the next 7 to 27 years, cases of Parkinson’s and dementia will double, and strokes are expected to increase by 20%.

An April 2023 study suggested that the current estimated 11% shortfall of neurologists will increase to 19% by 2025, resulting in longer wait times.

According to a news release from the American Academy of Neurology, undervalued in-person neurologist visits by the Medicare system are one of the reasons there is a shortage of neurologists. “Without fair and stable reimbursement, medical students and residents who have substantial education debt often are forced to seek more financially rewarding specialties than neurology.”

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