U-M Researcher Authors Study on Neurology in Urban, Rural Areas

People who live in rural areas may be less likely to receive specialty care for certain neurologic conditions, according to a new study from a team that includes a researcher from the University of Michigan in Ann Arbor.
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brain scans stock photo
According to a study authored by a U-M researcher, people who live in rural areas are less likely to receive care for neurological conditions. // Stock photo

People who live in rural areas may be less likely to receive specialty care for certain neurologic conditions, according to a new study from a team that includes a researcher from the University of Michigan in Ann Arbor.

The study was funded by the American Academy of Neurology and is published in the Dec. 23 online issue of Neurology, the academy’s medical journal.

“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,” says Dr. Brian C. Callaghan of U-M, author of the study and a fellow of the American Academy of Neurology. “Our research found that some areas of the country have up to four 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.”

Researchers identified 13,627 neurologists practicing in the regions where study participants lived. In the areas with the fewest neurologists, there was an average 10 for every 100,000 people. In areas with the most, this number jumped to 43 for every 100,000 people.

Callaghan also noted that the proportion of people receiving specialty care from a neurologist in rural areas varied by condition. People with specific, less common conditions such as Parkinson’s disease and multiple sclerosis were just as likely to see a neurologist in rural areas than in urban ones, while people with less specific neurological symptoms that are more common such as dementia, pain, dizziness or vertigo, or sleep disorders, were more likely to see a neurologist in urban areas than in rural areas.

Researchers reviewed one year of data for 20 percent of people enrolled in Medicare and identified 2.1 million people with at least one office visit for a neurologic condition. They recorded the number of times people had an office visit with a neurologist during the year and compared it to how many times people had office visits with other health care providers for a neurologic condition.

The scientists also found that the prevalence of neurologic conditions was not different across regions. Nearly one-third of people had at least one office visit for a neurologic condition.

Overall, 24 percent of people with a neurologic condition were seen by a neurologist. In more rural areas, this number was 21 percent, compared to 27 percent in the areas with the most neurologists. Most of the difference was made up of people with dementia, back pain, and stroke. For dementia, 38 percent of people in rural areas saw a neurologist, compared to 47 percent in more urban areas. For stroke, 21 percent of people in rural areas saw a neurologist, compared to 31 percent in urban areas.

More than 80 percent of people with Parkinson’s disease received care from a neurologist regardless of where they lived. The numbers were similar for multiple sclerosis.

“It is important that all people have access to the best neurologic care,” says Dr. James C. Stevens, president of the American Academy of Neurology. “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. 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.”

A limitation of the study is that researchers looked at neurologic visits only for people with Medicare. Results may not be applicable to younger people with private insurance.

The American Academy of Neurology has more than 36,000 members and is based in Minneapolis.

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