Highlights
New neurology access was not fast: among 114,034 commercially insured enrollees, the mean wait time after a primary care or emergency department visit was 49.7 days and the median was 25.0 days, with a wide spread of delays.
Adjusted wait times were shorter for women and for patients whose presenting neurologic condition was stroke, dizziness or vertigo, or traumatic brain injury, but longer for multiple sclerosis.
Geography and insurance design mattered. The Northeast had the longest waits, consumer driven health plans had the shortest waits, and the local density of neurologists was not associated with shorter waits.
Background
Timely access to neurology care is a recurring clinical and policy problem. Neurologic complaints such as new weakness, dizziness, seizures, headaches, progressive numbness, and cognitive change often require rapid evaluation to distinguish benign from urgent disease. Delays can prolong symptoms, increase anxiety, delay diagnosis, and, in conditions such as stroke or traumatic brain injury, potentially affect outcomes.
Despite the importance of ambulatory specialty access, real-world data on how long patients wait to see a neurologist in the United States have been limited. That gap is especially relevant because specialty shortages, network restrictions, administrative barriers, and regional variation can all affect whether a patient is seen promptly. The present study focuses on the commercially insured population, where access should, in theory, be less constrained than in populations facing greater financial barriers, yet substantial delays may still occur.
Study design
Data source and cohort
This was a retrospective, repeated cross-sectional study using 2019-2023 data from the Merative MarketScan Commercial Database, which includes approximately 20 million annual US enrollees. The analysis included 114,034 enrollees who had a new neurology office visit, a primary care or emergency department visit within the prior 365 days, and continuous enrollment. This design targeted patients for whom a neurology visit followed a recent point of entry into the healthcare system.
Outcome and modeling approach
The primary outcome was wait time in days from the prior primary care or emergency department visit to the new neurology visit. The investigators reported mean, standard deviation, median, and interquartile range, and then modeled wait times using generalized estimating equations with clustering within metropolitan statistical areas. Models adjusted for demographic, insurance, clinical, and geographic variables.
Key findings
Overall wait time burden
Across the study period, the average wait time to a new neurology visit was 49.7 days with a standard deviation of 65.4 days, while the median was 25.0 days with an interquartile range of 9 to 62 days. This pattern suggests a right-skewed distribution: many patients were seen within a few weeks, but a substantial minority waited much longer, pulling the mean upward.
For clinicians, the median is particularly informative here because it reflects the typical experience better than the mean in the presence of very long waits. A 25-day median means that half of commercially insured patients still waited nearly a month after a primary care or emergency department visit before seeing neurology.
Sex differences
In adjusted analyses, female patients had shorter estimated wait times than male patients by 7.0 days (95% CI -7.8 to -6.2). The study did not establish why this difference existed. Possible explanations include differences in symptom presentation, referral urgency, diagnostic pathways, patient help-seeking behavior, or access to appointments in practices that triage by condition rather than strictly by referral order. Because the data are claims-based, these hypotheses cannot be confirmed.
Differences by neurologic condition
Wait times also varied by the condition associated with the neurology visit. Compared with the reference group, estimated waits were shorter for stroke by 8.2 days (95% CI -9.5 to -6.9), dizziness or vertigo by 7.8 days (95% CI -10.4 to -5.1), and traumatic brain injury by 6.5 days (95% CI -8.0 to -5.1). In contrast, multiple sclerosis was associated with longer waits of 4.0 days (95% CI 2.0-6.1).
These patterns are clinically plausible. Stroke, dizziness, and traumatic brain injury may trigger more urgent referral behavior because they can represent acute or potentially disabling neurologic disease. Multiple sclerosis, by contrast, may reflect a chronic disease-management pathway with competing subspecialty demand, longer follow-up queues, or appointment slots reserved for established patients. Still, the analysis cannot determine whether the longer waits in multiple sclerosis reflect access barriers, scheduling practices, or differences in referral timing.
Geographic variation and market characteristics
The Northeast Census region had the longest waits, with an adjusted increase of 4.6 days (95% CI 3.3-6.0). This is important because it underscores that regional access problems are not limited to lower-resource settings. High overall healthcare utilization, dense referral networks, and constrained appointment capacity may coexist in some regions, producing longer waits even where specialist availability appears relatively high.
At the metropolitan statistical area level, the proportion of non-Hispanic White race was associated with shorter wait times, at -0.2 days per percentage point White (95% CI -0.2 to -0.1). This is an ecological association, meaning it describes the composition of the local area rather than an individual patient effect. It may reflect broader structural differences in neighborhood resources, practice distribution, insurance markets, or transportation access. It should not be interpreted as a biological or purely individual-level race effect.
Perhaps the most policy-relevant null finding was that neurologist density per 100,000 enrollees was not associated with wait time (0.0 days; 95% CI -0.01 to 0.00). In other words, simply having more neurologists in a market did not translate into measurably shorter waits. This suggests that access is shaped not only by headcount, but also by how practices are organized, how appointments are triaged, how insurers steer patients, and whether capacity is effectively open to new patients.
Insurance design
Enrollees with consumer driven health plans had the shortest wait times, by 2.4 days compared with the reference insurance type (95% CI -3.6 to -1.2). The mechanism is not obvious. Consumer driven plans may be associated with different patient populations, referral behavior, network structures, or scheduling patterns. The result is interesting but should be interpreted cautiously, because plan choice can correlate with income, health status, and employer characteristics.
Clinical and health system interpretation
The central message of this study is that access to outpatient neurology is not uniformly quick, even for commercially insured patients. A median wait of 25 days is long enough to matter for patients with disabling symptoms, suspected cerebrovascular disease, new neuropathy, or uncontrolled headaches. The nearly 50-day mean also signals a substantial tail of patients waiting much longer than the median.
The null association with neurologist density deserves special attention. Workforce counts are often used as a proxy for access, but they may miss the real bottlenecks. A market may have a seemingly adequate number of neurologists while still facing long waits because of subspecialty shortages, administrative requirements, practice consolidation, limited new-patient slots, uneven tele-neurology adoption, or referral patterns that channel patients into a small number of high-demand clinics.
From a systems perspective, the findings suggest that increasing supply alone may not be sufficient unless it is paired with operational changes. Examples include better triage of urgent referrals, protecting access for new patients, expanded use of tele-neurology for appropriate cases, and closer coordination between primary care, emergency departments, and neurology practices. These interventions may be especially relevant for chronic neurologic diseases such as multiple sclerosis, where continuity and timely follow-up are essential.
Limitations
Several limitations temper the conclusions. First, the study is restricted to commercially insured enrollees, so it may not generalize to Medicare, Medicaid, uninsured patients, or populations with different referral barriers. Second, claims data do not capture clinical urgency, symptom severity, patient preferences, appointment availability at the time of referral, or whether the visit occurred in person or via telemedicine.
Third, the analysis includes only patients who ultimately obtained a neurology visit, which means it cannot estimate the experience of patients who never got seen. Fourth, race-related findings were analyzed at the metropolitan statistical area level, raising the possibility of ecological fallacy. Fifth, the study measures the time from a primary care or emergency department visit to the neurology visit, not necessarily the time from referral order to appointment, which may differ in real-world workflows.
Finally, repeated cross-sectional claims analyses are excellent for describing patterns but cannot determine causality. The observed associations with sex, region, insurance type, and area composition should therefore be viewed as signals for further investigation rather than definitive explanations.
Conclusion
In this large claims-based study of commercially insured US patients, the typical wait for a new neurology appointment after a primary care or emergency department visit was about 25 days, with substantial variation by diagnosis, sex, region, and plan type. The absence of an association with neurologist density suggests that access depends on more than the number of specialists alone.
For clinicians, the findings support proactive triage and early referral for potentially urgent neurologic symptoms. For health systems and payers, they highlight the need to address scheduling capacity, referral pathways, and market-level barriers if the goal is truly timely neurology care.
Funding and clinicaltrials.gov
Funding was not reported in the abstract. ClinicalTrials.gov registration was not applicable because this was a retrospective, claims-based observational study.
References
1. Laffargue EK, Van Der Goes DN, Wilson AM, Parziale SD, Sico JJ, Ney J. Neurology Wait Times After Primary Care or Emergency Department Visits Among the Commercially Insured Population in the United States: 2019-2023. Neurology. 2026-04-29;106(10):e218008. PMID: 42054604.