The average wait time for a first-time neurology appointment in the US is nearly 50 days for patients with commercial health insurance, with delays varying by sex, age, diagnosis, insurance type, and geography, a large retrospective study found.

Contrary to previous reports, there was no significant association between local neurologist supply and appointment wait times.

The shortest wait times were reported in patients with acute conditions such as stroke, dizziness or vertigo, and traumatic brain injury (TBI), while those with chronic disorders such as multiple sclerosis (MS) and movement disorders waited longer. Patients in the Northeast also experienced longer delays.

Wait times were slightly shorter than previously reported estimates in patients with Medicare — approximately 55 days on average — suggesting persistent access delays across payer types.

"Our study found that when looking at wait times to see neurologists, it is not a simple supply and demand issue," study author John P. Ney, MD, MPH, FAAN, assistant professor of neurology at Yale School of Medicine in New Haven, Connecticut, said in a statement. "These results show we still need a better understanding of why some patients wait longer than others."

The study was published online April 29 in Neurology.

A Closer Look at Wait Times

Previous studies have suggested long delays in initial neurology visits, with some patients waiting as long as 10 months. While some research has suggested a neurologist shortage may be a contributor, information about other possible barriers is lacking.

To address that issue, researchers conducted an observational, retrospective repeated cross-sectional analysis using 2019-2023 data from the Merative MarketScan Commercial Database, which includes approximately 20 million insured US enrollees annually.

The final cohort included 114,034 people (mean age, 42.1 years; 65.6% women) with continuous coverage who had a first outpatient neurology visit after seeking treatment in a primary care or emergency department (ED) setting within the preceding year. Time between those visits was used as a proxy for referral-to-appointment wait time.

The majority of patients lived in the South (42.1%), and the most common diagnoses upon initial neurology visit included headache, neuromuscular disorders, axial pain, epilepsy, dementia/cognitive disorders, movement disorders, stroke/cerebrovascular disease, dizziness/vertigo, MS/neuroinflammatory disorders, and TBI.

Who Waits Longer?

The mean wait time for the first neurology appointment was 49.7 days, with a median of 25 days. Most patients were seen within about 1 month, although a substantial subset experienced wait times longer than 2 months, which raised the average.

Patient wait times were shortened by 8.2 days in cases with stroke/cerebrovascular disease, 7.8 days with dizziness/vertigo, 6.5 days with TBI, 3.7 days with epilepsy, and 2.2 days with headache (all P < .0001), compared to those without these conditions.

Women had significantly shorter adjusted wait times than men, averaging 7.0 fewer days (P < .0001). Shorter wait times were also associated with a higher proportion of non-Hispanic White residents, increasing age, and consumer-driven and high-deductible health plans.

By contrast, wait times were 4 days longer for MS/neuroinflammatory disorders (P = .0001) and about 2 days longer for movement disorders (P < .0001). Longer wait times were also reported in referrals from primary care vs ED (33 days vs 19 days) and for residents in the Northeast, who waited 4.6 days longer than those in the West (P < .0001). 

The number of neurologists per metropolitan statistical area was not significantly associated with wait time, with each additional neurologist per 100,000 enrollees improving wait times by only minutes.

Study limitations included reliance on administrative claims data, which lacked clinical detail, exact referral timing, disease severity, and patient preference.

Opportunities for Improved Access

The findings challenge the longstanding assumption that problems with access to neurological care are primarily driven by a lack of neurologists, Allison L. Weathers, MD, a board-certified neurologist at the Cleveland Clinic in Cleveland, Ohio, wrote in an accompanying editorial.

"The one factor that seems to have little or no associated effect is the actual supply of neurologists," she said, noting that similar findings were previously reported in Medicare claims data.

While Weathers cautioned that the claims-based design cannot establish causation or capture exact referral dates, disease severity, or patient preferences, the study does highlight opportunities to improve access, including streamlined referral pathways from primary care, reduced insurer administrative burden, and targeted strategies to address why men experienced longer wait times than women.

"If we want to improve access to care for our patients, we should be further incentivizing clinical care, making seeing new patients both more efficient and more rewarding, and pursuing innovative and comprehensive solutions to the problem," she concluded.

The study was supported by the Department of Veterans Affairs. Disclosure information for study authors is available in the original study publication. Weathers reported no relevant financial disclosures.