Twenty-five of 46 South Carolina counties are classified as Medically Underserved Areas (MUA). This designation identifies medically underserved areas and populations on the basis of demographic data. To qualify for this designation, the population is scored on four criteria: - percentage of population below the poverty level;
- percentage of population over 65;
- infant mortality rate and
- primary care physicians per 1,000 population.
Twenty-five of the 46 counties of South Carolina are designated as Health Professional Shortage Areas (HPSA). This designation is based on a population-to-primary care physician ration of at least 3,500:1. When combined with other data on access barriers such as insurance coverage, poverty, and language, the HPSA designations represent a key component in measuring access. In addition, it is evident is that there are very few physicians in rural counties. The reasons for this include large patient panels resulting in overwork, poor patients resulting in low physician compensation, and lack of opportunity for continuing medical education resulting in professional isolation. Neurologists in South Carolina:
Neurologists in South Carolina are mainly located around the population centers in the state. Twenty-two out of 46 counties do not have a neurologist. As a result, the recognition, diagnosis and management of Parkinson’s disease fall under the purview of the primary care physician. The economics of neurological practice (most income is derived from the diagnosis of disease with the performance of neurological tests and procedures) also suggest that Parkinson’s disease patients may receive consultation, but generally not ongoing chronic care. With approximately one neurologist for 35,000 inhabitants in South Carolina, the issue is one of misdistribution more than a shortage of personnel. We have also mapped where patients in the Movement Disorders Clinic Registry live. It is apparent that the referrals to the MUSC Movement Disorders Program mainly come from areas with neurologists, who frequently refer to tertiary care centers. In areas where there are only primary care practitioners, one sees many fewer referrals to neurological consultation, suggesting that a lack of proximity to a neurologist also represents a barrier to specialized care. | 
