Geographic Heterogeneity in Epilepsy Specialist Distribution.

Background And Objectives: Geographic location significantly affects health care access. This descriptive study quantifies the supply of epilepsy-certified physicians across the United States.

Methods: We performed a cross-sectional study using data from the American Board of Psychiatry and Neurology's verifyCERT system to identify active epilepsy-certified physicians as of October 24, 2024. Physician locations were matched to county-level Federal Information Processing Standard codes and assigned Area Deprivation Index (ADI) scores and Urban Influence Codes. We aggregated physicians at regional, state, and county levels and calculated patient-to-physician ratios using state-level estimates of active epilepsy cases.

Results: Of 2,284 physicians with epilepsy certification, 2,169 were active. There were zero epilepsy-certified physicians in Montana, and only 1 in each of Arizona, Vermont, and Wyoming. California, New York, and Texas had the highest physician supply. The South had the highest number of epilepsy cases and highest patient-to-physician ratios. Most epilepsy physicians were in metropolitan areas, but many of these counties lacked any epilepsy-certified physicians. Counties with more physicians had lower ADI scores, reflecting worse access to care in areas with higher levels of socioeconomic deprivation.

Discussion: Our study highlights geographic heterogeneity in supply of epilepsy-certified physicians. The distribution of epilepsy subspecialists should inform interventions that improve quality of care.