Neurology Wait Times After Primary Care or Emergency Department Visits Among the Commercially Insured Population in the United States

BACKGROUND AND OBJECTIVES: Despite the importance of timely access to ambulatory specialty care, data regarding wait times to neurologists are largely lacking. This study examines wait times, and drivers of wait times, for new neurology office visits among commercially insured persons in the United States. METHODS: We conducted a retrospective, repeated cross-sectional study using 2019-2023 data from the Merative MarketScan Commercial Database of approximately 20 million annual US enrollees. Enrollees with a new neurology visit, a primary care or emergency department (ED) visit in the prior 365 days, and continuous enrollment were included. The outcome was wait time in days for a new neurology visit following a primary care or ED visit. Mean (SD) and median (interquartile range [IQR]) wait times were reported by sex, race, neurologic condition, insurance type, and geographic region. Wait times were modeled using generalized estimating equations, clustering within metropolitan statistical areas (MSAs), and adjusted for demographic, insurance, clinical, and geographic variables. RESULTS: Between 2019 and 2023, 114,034 enrollees met our inclusion criteria, the mean age was 42.1 (SD = 16.1), and 65.6% were female. The average wait time for a new neurology visit was 49.7 days (SD = 65.4), and the median wait was 25.0 days (IQR = 9-62). Estimated wait times were shorter for female patients, compared with male patients (-7.0 days; 95% CI -7.8 to -6.2), and for stroke (-8.2 days; 95% CI -9.5 to -6.9), dizziness or vertigo (-7.8 days; 95% CI -10.4 to -5.1), and traumatic brain injury (-6.5 days; 95% CI -8.0 to -5.1) and longer for multiple sclerosis (+4.0 days; 95% CI 2.0-6.1). The Northeast Census region had the longest waits (+4.6 days; 95% CI 3.3-6.0). The proportion of non-Hispanic White race within a MSA was associated with reduced wait times (-0.2 days per MSA percent White; 95% CI -0.2 to -0.1). Enrollees with consumer driven health plans had the shortest wait times (-2.4 days; 95% CI -3.6 to -1.2). Neurologist density/100,000 enrollees was not associated with wait time (0.0 days: 95% CI -0.01 to 0.00). DISCUSSION: Wait times for new neurology appointments vary by sex, neurologic condition, insurance type, and geographic level variables.