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As part of our monthly clinician spotlight, NeurologyLive® highlighted multiple sclerosis expert Marisa McGinley, DO, the staff neurologist at Cleveland Clinic’s Mellen Center for MS.
Marisa McGinley, DO
(Credit: Cleveland Clinic)
Neurologists are highly trained medical professionals who play a critical role in the healthcare system in helping patients of all ages manage their conditions that can affect every aspect of their lives. Each month, NeurologyLive® shines a spotlight on the work of one neurologist, highlighting contributions to their specific field.
There is a well-known shortage of neurologists relative to the number of patients with neurological disorders. This shortage disproportionately affects Black and Hispanic individuals, leading to significant disparities in access to care and clinical outcomes. For patients with multiple sclerosis (MS), timely access to a comprehensive multidisciplinary team and early disease-modifying treatments is crucial for improving long-term prognosis.
A team of researchers, led by Marisa McGinley, DO, recently published a cross-sectional analysis on geographic access to neurologists and MS centers across US census tracts.1 The study utilized Medicare data to determine neurologist locations, the 2020 American Community Survey 5-year estimates, the 2010 rural-urban commuting area codes, and MS center locations as defined by the Consortium of Multiple Sclerosis Centers. This comprehensive approach aimed to assess geospatial access to neurologists and MS centers, while also examining demographic and community characteristics related to this access.
Out of 70,858 census tracts, 388 had no neurologists within a 60-minute drive, and 17,837 had no MS centers within 60 miles. Geographic access to neurologists was significantly lower in rural areas (–80.49%; 95% CI, –81.65 to –79.30) and micropolitan areas (–60.50%; 95% CI, –62.40 to –58.51) compared with metropolitan areas. In addition, census tracts with a higher proportion of underrepresented minorities, uninsured people, and disabled individuals experienced the lowest access to neurologists.
More recently, McGinley, a staff neurologist from the Mellen Center for MS Treatment and Research at the Cleveland Clinic, had a conversation with NeurologyLive to discuss what motivated her as a neurologist to specialize in treating MS. She also talked about some of the primary challenges in the field of MS care according to her clinical perspective. Furthermore, McGinley talked about how she balances patient care with research responsibilities as a neurologist and expressed her passion for improving access to neurological care.
As a neurologist, my main role is to care for patients with neurological conditions. I primarily treat patients with MS and related conditions including neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). In my role, I care for patients across the spectrum of their condition from diagnosis and throughout their lifetime. It is a privilege to develop long-lasting relationships with patients. In this role, my goal is to provide holistic care for patients that include diagnosis, treatment with disease-modifying therapies, monitoring, symptomatic care, and referral to multidisciplinary rehabilitation and other specialists. Another significant portion of my job focuses on research aimed at improving access to neurological care.
As a neurologist, I see patients in the office along the continuum of the MS journey. My days include a mix of seeing new patients with a concern for a new MS diagnosis and patients who have an established diagnosis for many years. In addition to my patient care, I also engage in research, which includes working with other researchers and seeing patients for clinical trials.
I have always wanted to be a doctor, but my strong interest in neurology started when I was in college. I had a family member diagnosed with MS, which exposed me to the very important role that the neurologist plays in the diagnosis and management of a lifelong condition. I saw how terrifying receiving an MS diagnosis in your 20’s can be for the patient and also the family. There is so much uncertainty about the long-term effects and how someone will respond to treatment. It was this experience that made me passionate about being part of this journey for patients. I really value the long-term relationship with these patients and the potential to make a significant difference through the use of current treatments, but also the potential to make an impact on future treatment options and care models.
The most rewarding aspect of my job is building relationships with patients. I love getting to know my patients both in regards to how their MS affects them and who they are as a person. I also deeply value being involved in research. Research allows me to address areas of MS care that we do not have all figured out. I am especially passionate about finding ways to improve access to neurological care so that patients irrespective of where they live, or their background can receive exceptional care.
Watercolor Cleveland Clinic Mellen Center
(Credit: Marisa McGinley, DO)
I would say the 2 biggest challenges we face in the field of MS are the treatment of progressive MS and improving access to neurological care. It is incredibly frustrating to hear stories from patients that there were no neurologists in their area and they had to travel hours to see me for a diagnosis. There is a known shortage of neurologists and even further limitations when a neuroimmunologist is needed. Beyond the shortage of neurologists, there are also barriers to receiving MS care including MRIs and disease-modifying therapies. These problems are not unique to MS and there is a need to develop healthcare models that provide equity access to care for all patients. I am hopeful that tools like telemedicine will reduce some of these barriers, but it is also important for us to work with patients to identify barriers to receiving care to develop effective interventions to improve access at all stages of the condition.
It can be frustrating when we do not currently have treatments to address certain aspects of MS, but it is important for patients to know what we are doing to address these needs. I will frequently discuss trials for progressive MS and symptomatic treatments that we can look forward to having in the future. It is also important to know that to advance the field we need both patients and clinicians to be open and willing to participate in research so that we can make changes together.
I enjoy spending time with my son who has taught me so much about sharks and the ocean. I also enjoy spending time running and learning how to paint with watercolor.
In February 2024, McGinley sat down with NeurologyLive in an interview to discuss some of the negative downstream effects limited access to neurologists and MS care centers have on patients with MS. She spoke specifically on the importance of timely diagnosis and early intervention, as well as the considerable need for multidisciplinary specialists that alleviate the workload of general neurologists.
Transcript edited for clarity. Click here for more coverage on multiple sclerosis.
National MS Society Clinical Fellowship Opportunity: The Society offers a one year, post-residency MS clinical fellowship program that is aimed to train neurologists or physiatrists who specialize in MS clinical care. This 12-month program allows fellows to have the opportunity to perform new patient consultations and follow-up assessments under an MS specialist physician. Also, fellows will partake in multidisciplinary team activities, lectures, and professional meetings, leading to the acquisition of skills and knowledge necessary to provide quality care for patients with MS. If you are interested in applying or would like to learn more about the Society's fellowship opportunities, click here.
