A new study published in Muscle & Nerve found that many older Americans living with myasthenia gravis (MG) may not have easy access to the specialists best equipped to manage their condition.
While general neurologists often care for people with MG, neuromuscular specialists have additional expertise in diagnosing and treating complex neuromuscular diseases. The study found that even though the number of board-certified neuromuscular physicians has increased nationally in recent years, access to these specialists varies by region.
Researchers analyzed Medicare Fee-for-Service claims data from 2012-13 and 2018-19, comparing the number of people over 65 with MG to the number of board-certified neuromuscular physicians in each state, census division and region.
During the study period, the number of identified Medicare patients with MG increased from 29,038 to 35,691. At the same time, the number of board-certified neuromuscular physicians increased from 585 to 806 nationwide. This means that overall, the number of patients with MG per each specialist decreased, from 49.5 to 44.3.
However, the availability of specialists varied widely depending on where patients lived. The South had the highest ratio of patients with MG per neuromuscular specialist during both study periods, indicating there were fewer specialists available compared to the number of patients needing care. In contrast, the Northeast had the lowest ratios and showed the greatest improvement, decreasing from 36.0 patients with MG per specialist in 2012-13 to 29.8 in 2018-19.
The East South Central division, which includes Alabama, Kentucky, Mississippi and Tennessee, was the only region where the ratio of MG patients per specialist increased over time, suggesting that specialist availability did not keep pace with growing patient numbers.
Six states had no board-certified neuromuscular physicians during at least one of the study periods, including Alaska, Delaware, Idaho, South Dakota, Wyoming and Rhode Island.
The researchers noted that these geographic differences may become increasingly important as MG treatment continues to evolve. Since 2018, several new immunotherapies have been approved for MG, but these treatments often require specialists familiar with their use, monitoring requirements and administration.
“As treatment regimens increase in complexity and cost, mismatch between neuromuscular experts and MG patients may lead to disparities in care,” the researchers wrote.
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While telehealth may help extend specialist expertise to more people with MG, the authors said it cannot fully address barriers to accessing therapies that require specialized facilities and trained providers.
“We hope these data inspire strategies to equalize the density of neuromuscular specialists and to provide a basis for future studies to assess how geographic variations in [board-certified neuromuscular physician] density influence healthcare access and patient outcomes,” they concluded.
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