Survey of the Availability of Neurology Services on Hawai'i Island.

Patients in rural communities face significant health disparities including disparities in many subspecialties of medicine. Hawai'i Island is a largely rural island and is the second most populous island in the state of Hawai'i. Of the identified physician shortages across the state, neurology ranks among the highest on Hawai'i Island. Given this shortage, this study sought to assess Hawai'i Island primary care physicians' perceptions and experiences with accessing and delivering neurological care. Physicians practicing on Hawai'i Island were sent an anonymous online survey between April 2025 and September 2025 assessing need for neurology care. To ensure that only primary care physician responses were recorded, eligibility for the survey was determined by whether respondents indicated they were a currently practicing primary care physician on Hawai'i Island in the first question. Of the 28 eligible respondents, 19 (68%) reported that 10-50% of their patients have neurological complaints or diagnoses. Twenty respondents (71%) reported that they may decline to refer to a neurologist due to difficulties accessing neurological care. Respondents varied in their comfort with managing neurological conditions, preferring to refer to a neurologist for neuromuscular and movement disorders, epilepsy/seizures, and multiple sclerosis, while preferring to self-manage back pain, headaches/migraines, and dizziness/vertigo. Neurological patients comprise a large percentage of the patients that Hawai'i Island primary care physicians see and, because of shortages, patients may not be receiving necessary neurological care. Long-term efforts should be focused on increasing accessibility to neurological care on Hawai'i Island.