Mismatch Between the Distribution of Neuromuscular Specialists and Myasthenia Gravis Patients in the US Medicare Fee-for-Service Population.

INTRODUCTION/AIMS: There is a mismatch between clinical need and access to neurologists across the US. Myasthenia gravis (MG) incidence and prevalence are increasing, particularly in US patients older than 65 years, raising concern for access to neuromuscular specialists that represent only 4% of neurologists. We sought to compare the prevalence of MG patients over 65 years of age to the number of board-certified neuromuscular physicians (BCNMP) across the US.

METHODS: Utilizing Medicare fee-for-service Parts A/B coverage non-HMO claims data, MG cases were ascertained using a validated algorithm. Number of BCNMP per state was determined using American Board of Psychiatry and Neurology and American Board of Physical Medicine and Rehabilitation resources. MG prevalence, BCNMP number, and ratios of cases per BCNMP were calculated by state, census division and region for 2012-2013 and 2018-2019. Ratios between periods were tested using Poisson regression.

RESULTS: The number of MG cases increased from 29,038 in 2012-2013 to 35,691 in 2018-2019. BCNMP increased from 585 in 2012-2013 to 806 in 2018-2019. At the national level, the ratio of Medicare MG cases per BCNMP improved from 49.5 in 2012-2013 to 44.3 in 2018-2019. The south region had highest ratios at both timeframes, while the northeast had the lowest ratios. Six states had no BCNMP at both timeframes.

DISCUSSION: While the number of BCNMP has increased nationally, supply and demand may be unequally distributed. Regions across the US demonstrate disparate ratios of MG cases per BCNMP.