A 26-day wait is a software problem

The shortage

The math was broken before she ever thought of leaving

The national workforce analysis found neurology already 11% short in 2012 and projected the gap to widen to 19% by 2025 1Ref 1Dall TM, Storm MV, Chakrabarti R, et al. (2013).Supply and demand analysis of the current and future US neurology workforce.US neurologist shortfall was already 11% in 2012 (supply 16,366 vs ~18,180 demanded) and was projected to widen to 19% by 2025 (supply 18,060 vs demand 21,440), with ~520 additional FTE neurologists needed from 2014 due to ACA coverage expansion alone.. Rationing happens in the waiting room: the average new-patient physician appointment across fifteen major metros took 26.0 days in 2022, up a quarter since 2004 2Ref 2AMN Healthcare / Merritt Hawkins (2022).2022 Survey of Physician Appointment Wait Times and Medicare and Medicaid Acceptance Rates.Average wait for a new-patient physician appointment in 15 major metros was 26.0 days in 2022, up 8% from 24.1 days in 2017 and up 24% from 21 days in 2004; specialty averages: dermatology 34.5, OB/GYN 31.4, cardiology 26.6, family medicine 20.6, orthopedic surgery 16.9 days.Industry recruiting-firm survey (1,034 physician offices, 15 metro markets), not peer-reviewed; figures verified from AMN Healthcare's official press release. Neurology is not among the five surveyed specialties — use the all-specialty average, not a neurology-specific figure.. In her subspecialty the arithmetic turns absurd — 416 certified headache subspecialists for more than thirty million Americans with migraine, roughly 73,500 patients per specialist, with six states fielding none at all 3Ref 3Mauser ED, Rosen NL (2014).So many migraines, so few subspecialists: analysis of the geographic location of United Council for Neurologic Subspecialties (UCNS) certified headache subspecialists compared to United States headache demographics.Only 416 UCNS-certified headache subspecialists practiced in the US (2012) against an expected migraine population of 30,594,362 people aged 12+ — roughly 73,500 migraine patients per subspecialist — with six states having no headache subspecialist at all..

The visit never needed the building

Her academy already wrote the permission slip

The American Academy of Neurology's own evidence review concluded that teleneurology expedites care, increases access, reduces cost, and improves diagnostic accuracy and outcomes across headache, epilepsy, movement disorders, MS, and more 4Ref 4Hatcher-Martin JM, Adams JL, Anderson ER, et al. (2020).Telemedicine in neurology: Telemedicine Work Group of the American Academy of Neurology update.AAN work-group evidence review across concussion, dementia, epilepsy, headache, movement disorders, MS, neuromuscular disease, and inpatient consults concluding that telemedicine expedites care, increases access, reduces cost, and improves diagnostic accuracy and health outcomes (with stroke already having strong established evidence).— and the Academy's formal position calls for telehealth access regardless of location, with equitable reimbursement 5Ref 5American Academy of Neurology (Hatcher-Martin JM, et al.) (2021).American Academy of Neurology Telehealth Position Statement.AAN's formal position supports patient access to telehealth regardless of location, insurance coverage of telehealth, equitable provider reimbursement, and simplified state licensing — predicting telehealth will remain essential to neurologic care.. The neurologic exam that truly needs hands gets an in-person slot; the follow-up, the titration, the headache diary review — the bulk of a cognitive specialty — travels fine.

The middlemen

What actually consumes a neurologist

Prior authorization first. A scoping review of twenty studies on PA for neurologic medications found delay of care the most common patient consequence (in 60% of studies), with increased disease activity second 6Ref 6Gotlieb E, Joseph B, Blank L, Jetté N (2026).Barriers and Consequences of Prior Authorization for Neurologic Medications: A Scoping Review.Scoping review of 20 studies on prior authorization for neurologic medications: the most frequent patient consequences were delays in care (60% of studies) and increased disease activity (25%); time burden was the leading consequence for clinicians (35%) and administrators (15%).Published online December 8, 2025; print February 2026. — these are MS relapses and migraine days, not abstractions. Systemwide, practices run 40 prior authorizations per physician per week, burning 13 hours of combined staff time; 95% of physicians report PA delaying necessary care and 26% have seen it cause a serious adverse event 7Ref 7American Medical Association (2026).2025 AMA Prior Authorization Physician Survey.Practices complete an average of 40 prior authorizations per physician per week, consuming 13 hours of physician/staff time weekly; 40% of physicians have staff who work exclusively on PA; 95% report PA delays access to necessary care; 79% report patients abandoning treatment due to PA; 26% report PA led to a serious adverse event; 80% say PA increases physician burnout; only 33% believe the June 2025 insurer reform pledge will make a meaningful difference.Industry survey (web-based, fielded December 2025, N=1,000 physicians: 400 primary care/600 specialists, Medscape panel; released May 13, 2026), not peer-reviewed.. Then the documentation grind: about 60% of US neurologists report at least one burnout symptom, with clerical workload an independent risk factor — and autonomy the strongest protective one 8Ref 8Busis NA, Shanafelt TD, Keran CM, et al. (2017).Burnout, career satisfaction, and well-being among US neurologists in 2016.Approximately 60% of US neurologists reported at least one symptom of burnout (1,671 respondents of 4,127 surveyed; 40.5% response rate); amount of clerical work, hours worked, and nights on call were associated with greater burnout risk, while job autonomy and meaningful work reduced it..

The turn

Remove the middlemen, not the medicine

Her direct practice runs telehealth-native on Gale: patients book against real availability with the price shown first; the scribe drafts the note during the visit; the PA paperwork is assembled by the platform and routed to her only for the judgment calls; billing is verified ahead and collected without the chase. The software is free; Gale earns the billing cost plus 15% of that cost, on paid claims only. The country is not short of neurologists so much as short of neurologist-hours that survive the system — the 26-day wait is a software problem wearing a workforce costume.

References

Every number above, sourced