Challenges and Opportunities in the Future Landscape of Neurological Care

The future of neurological care—such as insights on the changing relationship between patients and providers, the expanding needs of neurologists, and the impact of new therapies on patients with Alzheimer disease—was explored in a presentation at the 2025 NeuroNet Pro Annual Summit.

“In 1990, about 15% of Americans were affected by neurological disorders,” said keynote speaker Rahul Sangal, McKesson, Senior Director, Provider Strategy. “But if we fast forward 30 years to today, 1 in 3 Americans have some kind of neurological disorder.”

Sangal noted that predicted trends indicate that by 2050, 42% of Americans will be affected by a neurological disorder.

“That patient burden is simply too extreme to avoid external, intense scrutiny from payers, legislators, and other organizations,” Sangal said. “Those influences are about to accelerate dramatically and lead to a few key trends that we need to talk about in neurology.”

Key trends included the large and growing patient population seeking neurological care, the diversification of service, the emergence of consolidation, and clinical innovation.

Similar to many medical specialties in the US, there is about 20% more demand for neurologists than there are available. However, Sangal noted that what is far more insidious is the high rates of physician burnout.

“At about 53%, neurologists report the highest rates of burnout of any specialty outside of primary care in America,” Sangal said.

The elevated level of burnout may stem from the reality that 30% of neurologists spend 20 hours a week on administrative tasks, such as prior authorizations. The disparate levels of care supply and patient demand also leads to burnout for staff and nurses, and turnover of hiring new employees is costly and time-consuming.

“I've heard from multiple neurologists just this month who are closing up shop because the reality of practicing in this environment is not sustainable,” Sangal shared. “And it's not just providers that are suffering. Patients are experiencing adverse outcomes from this situation as well.”

In 2024, patients had to wait an average of 45 days to be seen by a specialty neurologist. Wait time to meet with a neurologist is one of the most important metrics for patient satisfaction. Extended wait times may create inflated expectations for neurologists to meet and can create mistrust between patients and providers.

“There has been a somewhat surprising response from neurology in general to that challenge,” Sangal said. “Faced with more patients who trust them less and expect them to do more for their care journey, a subset of neurologists have actually embraced that mandate and started to take on a little bit more. So, as there are more patients than has ever been, about 1 in 8 neurologists have looked at that situation and thought, ‘Bring it on. Let me find out what else I can do for patients.'”

To meet increasing demand, neurologists are pursuing service line diversification. Since 16% of neurologists have a primary subspecialty, the field is fragmented. Sangal encouraged a collective movement toward collaboration among neurologists to provide integrated, accelerated care across subspecialties.

As the average American neurologist orders 500 imaging scans a year, imaging is key to the future of neurology. However, practices may struggle to afford imaging equipment and to retrofit their facilities to accommodate machinery. Currently, only about 30% of neurologists offer in-office infusion services. Sangal emphasized that infusion may also be key to increasing financial stability and providing more integrated care.

Private equity is also showing an increased interest in neurology and takes into consideration opportunities for increasing operational efficiency, necessary capital, and the potential emergence of new revenue streams.

“The highly fragmented nature of neurology is both a positive and a negative from a private equity consolidation point of view,” Sangal said. “It's incredibly difficult, time-consuming, and expensive to invest the time and energy necessary to roll up a large number of small practices to create a platform. But if you can be the first mover to make that happen, the returns are extreme.”

Private equity is investing in clinical innovations, expecting substantial growth in neurology over the next 5 years but also anticipating cost containment measures from payers and legislators. This presents an opportunity for neurologists to have a stronger voice in delivering effective and accessible care at the right price point through value-based care models.

By 2030, approximately 73% of neurology care is predicted to be patient-administered, emphasizing the importance of patient adherence and accessibility. There is predicted growth in most neurology subspecialties, with some experiencing significant increases while others may see minimal growth. Despite ongoing innovation and new products in neurology, a relatively small number of drugs will account for a significant portion of spending in the field.

“There is a 500-pound gorilla in the room in the form of Alzheimer disease,” said Sangal. “Innovation will take place across neurology…but Alzheimer treatments are expected to go 3 times faster than any other disease in neurology over the next 5 years.”

In response to the projected shifts in the neurology landscape, Sangal announced the January 2025 publication of a playbook, created by McKesson in collaboration with NeuroNet and various health care professionals, to provide guidance on Alzheimer disease management with the goal of improving patient outcomes.

Today, the field of neurology faces a growing number of patients with increasingly complex care needs, leading to a demand for neurologists to explore new ways of working together and providing innovative services. This shift in the industry is attracting new players interested in consolidating the market and taking advantage of the rapid growth in neurology, fueled by the excitement surrounding the development of new therapies and clinical innovations in the field.

“There is a real opportunity for neurology to change the conversation, to rectify some of the mistakes of the past, and help create a new experience for patients and providers that's not only sustainable but meaningful in terms of the difference in the quality of life it can give to everybody impacted by neurological disorders,” Sangal said in closing.

Reference

Sangal R. Session A - keynote: neurology leading the way in community based therapy. Presented at: NeuroNet Pro Annual Summit 2025; January 31, 2025; Nashville, TN