I am in the same situation. I have, for the course of the MG so far, been 110 miles away from my neuro. I live in a small, basically clueless town. However, I have made it work.

Here's how:

1. I found a GOOD primary care doctor who I could trust, and who seemed to be reasonably knowledgeable about MG. His knowledge has increased over the years.

2. My neuro works WITH my PCP. They communicate when needed (which hasn't been often.) They each know the drugs I use and are comfortable with those.

3. I became very knowledgeable about MG. The times I have had to be hospitalized locally, I have discussed my issues with the staff in the ER and have been able to make sure things were done right until my PCP took charge. My dh knows enough as well to keep mistakes from being made if I am unable to communicate (which has happened).

4. I learned not to go into the local hospital with an attitude of "they are all so stupid!" Can you imagine trying to help a client who felt that about you? Give them a chance, educate them. You might be surprised!

Good luck!