A network-based cross-sectional study of geographic access to Medicare-participating neurosurgeons

Timely access to neurosurgical care is essential to reduce morbidity and mortality, yet the U.S. neurosurgical workforce has declined, particularly in rural regions. Prior estimates of access have relied on straight-line distance, which may not reflect real-world travel constraints. We performed a network-based cross-sectional geographic analysis of 4,371 Medicare-participating neurosurgeons using 2023 Medicare data and ArcGIS Pro to generate one-hour drive-time service areas based on road networks. Census data were overlaid to estimate population coverage. Across the United States, approximately 24 million people, representing 7.17% of the population, live more than a one-hour drive from the nearest participating neurosurgeon. The states with the highest proportions of underserved residents were in Wyoming (55.4%), Montana (53.8%), and Alaska (46.2%), while several Northeastern and Midwestern states had fewer than 3% underserved. Although most Americans have reasonable neurosurgical access, millions remain geographically isolated, highlighting persistent disparities in neurosurgical care access.