Geographic Heterogeneity in Epilepsy Specialist Distribution

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

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.

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.

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