The Southern Medical Journal (SMJ) is the official, peer-reviewed journal of the Southern Medical Association. It has a multidisciplinary and inter-professional focus that covers a broad range of topics relevant to physicians and other healthcare specialists.

SMJ // Article

Original Article

Distribution of the Georgia Pulmonology Workforce: A Rural-Urban Analysis

Authors: Shervin Eskandari, BS, Dev Shah, BS, William E. Long, BS, Natasha M. Savage, MD, Shaheen Islam, MD, William J. Healy, MD

Abstract

Objectives: Although healthcare disparities between rural and urban populations are documented, access to pulmonary subspecialty care in rural regions is not well characterized. This study aimed to quantify rural-urban disparities in access to pulmonology, pulmonary critical care medicine (PCCM), and sleep medicine physicians in Georgia.

Methods: The Georgia Composite Medical Board's 2024 Physician Workforce Database was used to identify pulmonologists, PCCM, and sleep medicine physicians and their primary office location. County-level data were obtained using the US Census. The 2023 Rural-Urban Continuum Codes were used to classify counties as metropolitan (codes 1–3) or nonmetropolitan (codes 4–9). Physician density was calculated per 100,000 residents and per 100 mi2. Travel burden was calculated as the linear distance from each county centroid to the nearest physician practice.

Results: A total of 122 pulmonologists, 204 PCCM physicians, and 49 sleep medicine physicians were identified across Georgia’s 159 counties (74 metropolitan and 85 nonmetropolitan). Nonmetropolitan counties contained only seven pulmonologists, 16 PCCM physicians, and two sleep medicine physicians. Most physicians practiced in counties classified as code 1 (most urbanized), which also had the lowest travel burden. Metropolitan counties had an average of 0.67 pulmonologists, 1.06 PCCM physicians, and 0.20 sleep medicine physicians per 100,000 residents, compared with 0.20, 0.41, and 0.07/100,000 residents in nonmetropolitan counties (P < 0.001). In addition, travel burden to the nearest physician was significantly greater in nonmetropolitan counties across all three subspecialties (P < 0.001).

Conclusions: There are significant rural-urban disparities in access to pulmonary subspecialty care in Georgia, with severe shortages in rural counties.

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References

1. Barreto T, Jetty A, Eden AR, et al. Distribution of physician specialties by rurality. J Rural Health 2021;37:714–722.
 
2. Raju S, Brigham EP, Paulin LM, et al. The burden of rural chronic obstructive pulmonary disease: analyses from the National Health and Nutrition Examination Survey. Am J Respir Crit Care Med 2020;201:488–491.
 
3. Croft JB, Lu H, Zhang X, et al. Geographic accessibility of pulmonologists for adults with COPD: United States, 2013. Chest 2016;150:544–553.
 
4. US Census Bureau. 2020 decennial census: demographic and housing characteristics, Table P2. https://data.census.gov. Accessed February 20, 2025.
 
5. US Census Bureau. 2020 decennial census: 118th Congressional District summary file, Table P2. https://data.census.gov. Accessed February 20, 2025.
 
6. Centers for Disease Control and Prevention. Health, United States – physicians. https://www.cdc.gov/nchs/hus/topics/physicians.htm#references. Accessed March 20, 2025.
 
7. Croft JB, Wheaton AG, Liu Y, et al. Urban-rural county and state differences in chronic obstructive pulmonary disease – United States, 2015. MMWR Morb Mortal Wkly Rep 2018; 67:205–211.
 
8. Dwyer-Lindgren L, Bertozzi-Villa A, Stubbs RW, et al. Trends and patterns of differences in chronic respiratory disease mortality among US counties, 1980-2014. JAMA 2017;318: 1136–1149.
 
9. Walensky RP, McCann NC. Challenges to the future of a robust physician workforce in the United States. N Engl J Med 2025;392:286–295.
 
10. Mohr NM, Collier J, Hassebroek E, et al. Characterizing critical care physician staffing in rural America: a description of Iowa intensive care unit staffing. J Crit Care 2014;29: 194–198.
 
11. Ramesh T, Klompas M, Yu H. Improving rural intensive care infrastructure in the USA. Lancet Respir Med 2024;12:268–269.
 
12. Ma S, Guan X, Kang SL, et al. Disparities in spatial access to sleep health care in the United States: a population-based geospatial analysis. J Am Med Dir Assoc 2024;25:105274.
 
13. Sarode R, Nikam PP. The impact of sleep disorders on cardiovascular health: mechanisms and interventions. Cureus 2023;15:e49703.
 
14. Cowie MR, Linz D, Redline S, et al. Sleep disordered breathing and cardiovascular disease: JACC state-of-the-art review. J Am Coll Cardiol 2021;78:608–624.
 
15. US Census Bureau. 2020 decennial census: demographic and housing characteristics, Table P1. https://data.census.gov. Accessed February 20, 2025.
 
16. US Census Bureau. 2023 American Community Survey. ACS 5-year estimates, Table B19013. https://data.census.gov. Accessed February 20, 2025.
 
17. US Department of Agriculture, Economic Research Service. Rural-Urban Continuum Codes. https://www.ers.usda.gov/data-products/rural-urban-continuum-codes. Accessed February 20, 2025.
 
18. Razzaghi H, Wang Y, Lu H, et al. Estimated county-level prevalence of selected underlying medical conditions associated with increased risk for severe COVID-19 illness – United States, 2018. MMWR Morb Mortal Wkly Rep 2020;69:945–950.
 
19. Wheaton AG, Liu Y, Croft JB, et al. Chronic obstructive pulmonary disease and smoking status – United States, 2017. MMWR Morb Mortal Wkly Rep 2019;68:533–538.
 
20. Benavidez GA, Zahnd WE, Hung P, et al. Chronic disease prevalence in the US: sociodemographic and geographic variations by Zip Code Tabulation Area. Prev Chronic Dis 2024;21:E14.
 
21. Alzghoul H, Khan A, Gause S, et al. Future practice plans of internal medicine fellowship graduates: a focus on pulmonary and critical care medicine. Proc (Bayl Univ Med Cent) 2025; 38:235–240.
 
22. Keitz SA, Aron DC, Brannen JL, et al. Impact of clinical training on recruiting graduating health professionals. Am J Manag Care 2019;25:e111–e118.
 
23. Serchen J, Johnson D, Cline K, et al. Improving health and health care in rural communities: a position paper from the American College of Physicians. Ann Intern Med 2025;178:701–704. .
 
24. MacDougall H, Woldegerima S, Henning-Smith C, et al. Recruitment and retention of rural health professionals in Minnesota. Health Serv Res 2025;60:e14453.
 
25. Baldomero AK, Melzer AC, Kunisaki KM, et al. Geographic disparities by rural-urban status and drive time to care in tobacco treatment for COPD. JAMA Netw Open 2025;8:e2528898.
 
26. Baldomero AK, Kunisaki KM, Wendt CH, et al. Drive time and receipt of guideline-recommended screening, diagnosis, and treatment. JAMA Netw Open 2022;5:e2240290.
 
27. Burdick KJ, Rees CA, Lee LK, et al. Racial & ethnic disparities in geographic access to critical care in the United States: a geographic information systems analysis. PLoS One 2023; 18:e0287720.
 
28. Fredriksson Sundbom M, Sangfelt A, Lindgren E, et al. Respiratory and circulatory insufficiency during emergent long-distance critical care interhospital transports to tertiary care in a sparsely populated region: a retrospective analysis of late mortality risk. BMJ Open 2022;12:e051217.
 
29. Arredondo K, Touchett HN, Khan S, et al. Current programs and incentives to overcome rural physician shortages in the United States: a narrative review. J Gen Intern Med 2023;38(Suppl 3): 916–922.