Muscle & NerveMismatch Between the Distribution of Neuromuscular Specialists and Myasthenia Gravis Patients in the US Medicare Fee-for-Service Population

ℹ️ Observational Association Only Evidence

Investigators analyzed Medicare fee-for-service data to compare the prevalence of myasthenia gravis (MG) among adults over age 65 with the distribution of board-certified neuromuscular physicians (BCNMPs) across the United States. Between 2012-2013 and 2018-2019, identified MG cases increased from 29,038 to 35,691 while BCNMPs increased from 585 to 806 nationally. The overall ratio of MG patients per specialist improved from 49.5 to 44.3, but substantial geographic variation persisted. Six states lacked any BCNMPs during both study periods, although national access improved overall.

Clinical Considerations

• MG prevalence increased across all geographic regions studied.
• The South consistently demonstrated the highest MG-to-specialist ratios, suggesting greater workforce pressure relative to patient burden.
• The Northeast demonstrated the lowest patient-to-specialist ratios and the largest improvement over time.
• East South Central was the only census division where MG cases per specialist worsened over time.
• Investigators note that modern MG management has become increasingly complex, with seven FDA-approved immunotherapies entering the treatment landscape since 2018.
• The analysis focused on Medicare fee-for-service beneficiaries and may underestimate the total national MG population.

Practice Applications

• Workforce distribution may become increasingly important as novel MG therapies require specialized expertise, monitoring, and treatment infrastructure.
• Regional specialist shortages could contribute to disparities in access to advanced therapies, clinical trials, and subspecialty care.
• Telehealth may partially improve access but may not fully address treatment delivery challenges for infusion-based and specialized therapies.
• Findings support continued evaluation of neuromuscular workforce planning, geographic distribution, and access strategies.