When Lawrence D. first started having sporadic episodes of déjà vu followed by hours of mild confusion, he became concerned and informed his family physician. He was told that if it did not occur in his office, he could not offer any insight. Several months later, Lawrence had a generalized tonic clonic seizure and was admitted to the hospital where he was seen by a neurologist and diagnosed with epilepsy.
Commonly, neurologic disorders are difficult to diagnose in the absence of a specialist. Multiple sclerosis and Parkinson disease often go unrecognized and untreated for years in communities without neurologists. According to a workforce study ,1 people with neurologic illness wait an average of 30 days to get an appointment with a neurologist. With the looming physician shortage, these wait times will increase substantially. Access for the 1 in 6 people with neurologic disease will be markedly reduced. Nevada and Wyoming are predicted to have the fewest neurologists, while the northeast will have the most. Although telemedicine by itself cannot fix the physician shortage, it can provide a means to ameliorate the geographical disparities in access to neurologic care. Areas with more neurologists, like the northeast, may utilize telemedicine to provide services to areas without access. A large proportion of neurologic patients are immobile, and utilizing telemedicine to care for patients in their homes and in their communities would defray hours of travel and expenses . 2 Now may be the time for a subset of neurologists to dedicate their careers to remote assessment of patients. If we provide neurology expertise to underserved regions via telemedicine, then we could diagnose and treat patients like Lawrence earlier and prevent hospital admissions. Telemedicine is an underutilized but important way that the diminishing supply of neurologists can provide specialty expertise and care nationwide.
- Dall RM, Storm MV, Chakrabarti R, et al. Supply and demand analysis of the current and future US neurology workforce. Neurology 2013;81:470-478.
- Dávalos ME, French MT, Burdick AE, Simmons SC. Economic Evaluation of Telemedicine: Review of the Literature and Research Guidelines for Benefit–Cost Analysis.Telemedicine and e-Health 2009;15:933-948