The front cover story of the February edition of Neurology Today is “Wait times for first neurologist visit very widely study finds”.
The study that they're referring to was a study published in Neurology in the beginning of January 2025. The study found that nearly one in five patients referred to a neurologist had to wait 90 days or more before their visit with the neurologist. The median wait time was about 34 days.
Now, I think if you talk to a lot of patients and neurologists, they would be surprised that it's only one in five patients have to wait 90 days. It sure seems like what we're hearing from patients is that many, many, many, if not maybe even most of them have to wait several months before they get in to see a neurologist.
The data for this study comes from over 160,000 Medicare beneficiaries with the data being drawn from the years 2018 to 2019. So this may skew the results a little. A lot of neurological diseases affect young people who are not on Medicare. Headaches and migraines, multiple sclerosis, traumatic brain injury, even some neuromuscular diseases can be more common in young people. Their wait times might not be captured in the Medicare pool.
Also, the years of data collection here predated the COVID-19 pandemic. I think intuitively it would make sense that since the pandemic, the supply of neurologists has gone down. Perhaps the demand for neurologists has gone up, and these wait times might be much longer than pre-pandemic.
How can we fix this?
It may seem like the most simple answer would be just have more neurologists. That's a very complex problem, though. First of all, we don't have a thousand neurologists just sitting in a back room waiting to be released into the wild. To train more neurologists involves medical schools, involves residency programs, and involves reimbursement for the training of the residents. It's a very complex problem, so we're definitely years away from having a larger supply of neurologists.
The article touches on some creative things that clinics are doing to help shorten wait times. Most patients who see a neurologist are referred to by their primary care physician, usually within the same hospital system or healthcare system. Usually these referrals are done electronically, but often times the referral is for something vague.
“My patient needs to see a neurologist for a neurological concern.
Many systems are starting to streamline their electronic referral protocols so that primary care doctors have to be a little bit more specific. What is it exactly the patient needs? They're also building in order sets so that tests can be done before the patienteven sees a neurologist so they can really hit the ground running.
Now, I can see a couple of drawbacks to this. One is that there's going to have to be a system to essentially prioritize certain neurological diseases over others. And when you start doing that, you start picking winners and losers. And that can be very problematic.
A drawback to ordering tests before a patient sees a neurologist is, of course, maybe you're ordering the wrong tests. It's quite possible that MRI is ordered under a certain protocol, but when the neurologist sees the patient, they would have wanted it in a different protocol. Now the patient has to get another MRI. So you can see that this could lend to a lot of waste of time and resources and money.
Some health systems are creating hybrid clinics. A neurologist comes into a primary care clinic for quick consults and bread and butter issues. A neurologist is there and can be brought into the room, examine the patient and give an opinion right there on the spot rather than having the patient wait.
This seems like it could address a lot of problems faster, but now you are taking a neurologist out of their already very busy outpatient clinic. Removing them a day to see other patients in a primary care clinic then makes their own patients have to wait longer to see them.
Some health systems have created a hybrid clinic kind of going the other way where the primary care doctor comes into the neurology clinic, follows a neurologist around, sees how the neurologist manages and works up some neurological conditions so that they can take care of that in the clinic without a referral to a neurologist.
Now the drawbacks: One is, again, you have to take a primary care physician out of their already very busy clinic to now follow a neurologist. They're probably not being reimbursed for that day. The patients in the primary care clinic will then have to wait an additional day before they're seen by their own doctor. That might not be real appealing for patients and physicians.
It also puts a lot more work on the plates of primary care physicians. They already have to be extremely knowledgeable in cardiovascular, pulmonary, renal, and gastrointestinal diseases, among many others, and now we're asking them to take on more knowledge and more know-how for neurological diseases. The more we learn about neurology, the more sophisticated the diagnostics are, the more complex the treatment protocols are. I think it would be a lot to ask primary care doctors to take on the role of even minor or bread-and-butter neurological issues.
And then many systems are developing hub and spoke models and this is where a neurologist is located in a centralized location and then supervises nurse practitioners and physicians assistants at several spoke locations either in rural areas where access to health care might be poor, or even in urban areas where people might have a hard time even getting out of the house. Now, you have to have an infrastructure for this. You have to have suitable audiovisual mediums. You have to have plenty of staff, nurse practitioners and physician's assistants, being able to staff all these spoke locations. And you have to have a neurologist who's willing to give up clinical care for more of a supervisory role.
The solution nobody is talking about
I think all of these are really good ideas, but the one thing that the article does not discuss is direct specialty care.
Direct specialty care is when a specialist such as a neurologist, a rheumatologist, even a pediatrician, remove themselves from the burdens and shackles of large hospital groups and insurance companies. These practices are generally fee for service that are charged directly to the patient. In exchange, the patient gets more time with the physician, more one-on-one time, better quality of time, more dedicated attention, and much, much, much shorter wait times.
My practice, NeuroNow, is a direct specialty care practice. My wait times are generally less than two weeks. Oftentimes, I can get somebody in within a couple days for a brand new patient evaluation. Furthermore, I have the time in my schedule to be able to speak with all my potential patients on the phone prior to the visit so i can get a better understanding of what they're looking for and I can answer questions they have about me. We can make sure it's the right fit before we go forward.
I think direct specialty care is going to be emerging more and more in this country amongst many specialties as a viable option for patients. I could have a whole discussion on how it improves burnout and quality of life and work-life balance for physicians, but I'm telling you after doing this for two and a half years, patient satisfaction is very, very high.
I do think it's good to be creative and innovative when we come up with solutions to the problem of long wait times to see a neurologist.
And yes, hub and spoke models, hybrid clinics, and streamlining order sets and referrals are all really good ideas, but we have to talk about the very innovative model of direct specialty care.
Time is Brain
In stroke care, we have a phrase, “Time is Brain.” Meaning that if you're having a stroke, it is imperative to get to an emergency facility as soon as possible. That's the best way a stroke can be treated with emergent therapies.
I think the same mentality can apply to many neurological diseases. Somebody with multiple sclerosis is prone to relapses cannot be waiting months and months before they see a neurologist. Somebody with crippling migraines who can barely get out of bed is losing productivity and is having a terrible quality of life.
These things must be dealt with much, much faster than the traditional healthcare system can deliver. This is something I'm very passionate about. If you have any questions about direct specialty care, any comments, or you want to learn more about my practice, NeuroNow, you can reach out to me. Leave a comment in the comment section, and follow us or leave a comment on any of our social media platforms.
Thanks for listening, and I'll see you next time.
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