Insights from Epilepsy Healthcare Providers Amid a Neurologist Shortage during the COVID-19 Pandemic

Abstract

Objective: The global COVID-19 pandemic has profoundly affected healthcare. Puerto Rico (PR) faces a growing shortage of healthcare specialists that, compounded by the COVID-19 pandemic, has disrupted access to epilepsy care. This study assessed the impact of the pandemic and the exodus of healthcare specialists on epilepsy care from the perspective of healthcare providers. Methods: We conducted a systematic search to identify neurologists practicing in PR during the study period using multiple sources, including government databases, professional associations, and publicly available online directories, with license verification performed through the Puerto Rico Department of Health. In addition, we distributed a survey on epilepsy care from January through May 2023 to obtain
responses from actively practicing healthcare providers. Results: In our cross-referenced search (N = 163), 23.9% of neurologists identified in PR appeared to be inactive or were untraceable, suggesting possible migration from the island. Active neurologists were unevenly distributed, with the highest concentrations in the metropolitan area and notably fewer practitioners in western and southern municipalities. Among the survey respondents providing epilepsy care, 75% were neurologists, and 58.3% provided both outpatient and inpatient care to people with epilepsy (PWE). Barriers to care included fear of viral infection (66.7%) and lack of access to technology (50%). Among PWE, COVID-19 infection was reported by 75% of healthcare providers, and one-third noted unmet patient care needs in their practices. Conclusion: The pandemic has exacerbated existing barriers to care for PWE and the shortage of healthcare specialists in PR, underscoring the need to reform public policy and improve access to services across the island.