Patient Access to Care and Outcomes with Neurosurgical Expansion in a Competitive Market

Authors

• Jennifer O. Coker, University of LynchburgFollow

Specialty

Neurosurgery

Advisor

Salzer, Lawrence

Abstract

ABSTRACT

This manuscript reviews the relationships among regional healthcare-system structures, competitive-market dynamics, and social determinants of health (SDOH), examining how these factors correlate with patient access to subspecialty neurosurgical care and subsequent patient-reported outcome measures (PROMs). When neurosurgical resources are poorly distributed and regional competition is low, patients face significant delays in care, creating "neurosurgical deserts" in rural areas that impair recovery and quality of life. "Neurosurgical deserts" are defined as areas with insufficient neurosurgical workforce density and support clinical infrastructure to meet patient population demands. Conversely, in regions with greater access to care, market competition encourages local hospitals to expand service lines and improve quality metrics. To address physician shortages driven by an aging neurosurgeon workforce, integrating advanced practice providers (APPs), such as physician assistants (PAs) and nurse practitioners (NPs), has become a necessity, not a luxury. Utilizing APPs in inpatient and outpatient settings maintains efficient patient volume, enhances multidisciplinary teamwork, and streamlines discharges, ultimately reducing costs tied to unplanned readmissions.

While workforce optimizations enhance operational capacity, systemic barriers driven by SDOH continue to dictate post-discharge success. Socioeconomic status, income inequality, and insurance coverage heavily influence local referral pathways; consequently, socioeconomically disadvantaged patients often experience worse postoperative outcomes due to limited recovery resources and inadequate follow-up. Current literature remains limited by its reliance on retrospective registry databases and single-institution designs that lack real-time metric tracking and standardized PROM data, particularly within pediatric neurosurgery. Future research must shift toward prospective, longitudinal, multicenter studies that link daily PROMs directly to patient-access data across diverse populations. Ultimately, healthcare leaders must prioritize strategic workforce integration and regional resource redistribution to eliminate care deserts and optimize long-term neurosurgical outcomes.

Recommended Citation

Coker JO. Patient Access to Care and Outcomes with Neurosurgical Expansion in a Competitive Market. University of Lynchburg Doctoral Project Assignment Repository. 2026; 8(3).