Southern Medical Journal最新文献

{"title":"Geographic Distribution of Plastic Surgeons in Tennessee: A County-Level Analysis of Workforce Availability.","authors":"Emmanuel Giannas, Barite Gutama, Vignesh Chennupati, Franklin Gergoudis, William C Lineaweaver, Jordi Puente Espel","doi":"10.14423/SMJ.0000000000002016","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000002016","url":null,"abstract":"<p><strong>Objective: </strong>Access to surgical specialists often is influenced by the geographic distribution of the workforce. Limited data describing the plastic surgery workforce in Tennessee exist. This study aimed to describe the county- and region-level distribution of the plastic surgery workforce in Tennessee.</p><p><strong>Methods: </strong>A cross-sectional descriptive study was conducted. State- and county-level population estimates were obtained from US Census data. The names and practice locations of board-certified plastic surgeons were obtained from the American Medical Association physician directory and validated via the American Board of Plastic Surgery online database. Descriptive statistics were used to summarize surgeon counts and county-level and regional densities.</p><p><strong>Results: </strong>The number of plastic surgeons practicing in Tennessee was 137. Sixty plastic surgeons (43.8%) practiced in the Nashville metropolitan area, and 36% of the state population lived in counties without direct access to plastic surgery services. The statewide plastic surgery workforce density was 1.98 plastic surgeons per 100,000 population. Washington County had the highest surgeon density at 4.29 plastic surgeons per 100,000 followed by Knox County, with 4.14 plastic surgeons per 100,000 population.</p><p><strong>Conclusions: </strong>Plastic surgeons in Tennessee are concentrated in metropolitan regions, with limited availability across the state. More than one-third of the state's population lives in counties without direct access to plastic surgery services. The results of this study highlight potential disparities in access to plastic surgery care for residents of rural counties in the state of Tennessee, which account for the majority of the state's territory.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 10","pages":"609-613"},"PeriodicalIF":0.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Maternal Buprenorphine Use and Fetal Head Circumference.","authors":"Brooke Benton, Thomas Snead, Shreya Visvanathan, Holeh Heydari, David Alexander Condra, Lori Moore, Nicole Lewis, Aleksandr Fuks, Martin Olsen","doi":"10.14423/SMJ.0000000000002021","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000002021","url":null,"abstract":"<p><strong>Objective: </strong>The objective of this study was to evaluate the effect of intrauterine buprenorphine exposure during pregnancy on fetal head circumference.</p><p><strong>Methods: </strong>This retrospective cohort study reviewed fetal ultrasound reports. Fetal anatomic surveys were typically performed at approximately 20 weeks' gestation. Patients administered medication-assisted treatment (MAT) for opioid use disorder commonly had follow-up estimated fetal weight scans at approximately 32 weeks' gestation due to risks of intrauterine growth restriction. A retrospective review of ultrasound reports for three groups of patients was performed. The very-low-dose (VLD) group (127 patients) was taking ≤2 mg buprenorphine in their third trimester; the traditional dose (TD) group (103 patients) received higher-dose MAT that was consistent with current recommendations. The control group, no buprenorphine use, included 212 patients. One-way analysis of variance and Tukey's multiple comparison tests were used for statistical analysis. The effect size was measured using ω² [Formula: see text].</p><p><strong>Results: </strong>At the initial anatomy scan, no significant differences between groups were observed for head circumferences. By the third trimester growth scan, TD fetuses had significantly smaller head circumference percentiles compared with controls (<i>P</i> = 0.045). The estimated fetal weight percentile was lower in both buprenorphine groups compared with controls (VLD group vs controls, <i>P</i> = 0.021; TD group vs controls, <i>P</i> = 0.006), with TD fetuses showing the largest difference. Although TD head circumference percentiles were different from the controls, no significant differences were observed between the VLD group and either the TD group or controls for head circumference percentiles.</p><p><strong>Conclusions: </strong>Previous studies have shown decreased head circumference in newborns in association with maternal MAT. This is the first study to provide ultrasound confirmation of decreased head circumference in fetuses exposed to buprenorphine. VLD buprenorphine may be associated with more favorable fetal growth measures compared with a TD. Interventions during pregnancy, including lowest effective dose treatment, may preserve fetal brain growth and improve long-term neurodevelopmental outcomes.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 10","pages":"614-619"},"PeriodicalIF":0.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Creating Core Internal Medicine Residency POCUS Curriculum by Partnering With the Emergency Department.","authors":"Paul Park, Paul Koscumb, Nadia Ahmed, Jeremy Carter, Elizabeth Davis, T Preston Hill","doi":"10.14423/SMJ.0000000000002023","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000002023","url":null,"abstract":"<p><strong>Objectives: </strong>Diagnostic point-of-care ultrasound (POCUS) increasingly is recognized as a valuable bedside assessment tool; however, the most commonly cited barrier to starting a POCUS curriculum in Internal Medicine residency has been the lack of in-house experts. We propose collaborating with the emergency department because all of their faculty are POCUS trained during residency.</p><p><strong>Methods: </strong>At the University of Texas Medical Branch, we partnered with the emergency department to create a hands-on core rotation starting in 2023 for all postgraduate year-1 residents to improve their skills, knowledge, and confidence with diagnostic POCUS. The residents watched didactic videos in addition to working with faculty and ultrasound technicians one to one for 2 weeks on live patients.</p><p><strong>Results: </strong>The efficacy of the curriculum was evaluated using a pre- and postcourse knowledge quiz, a confidence survey, and a skills assessment. Out of 40 residents, 24 completed the written knowledge quiz and confidence survey, and 14 completed the skills assessment. Overall, the data showed significant improvement in all three evaluation methods.</p><p><strong>Conclusions: </strong>The success of starting a new POCUS curriculum depends heavily on the ability of the program to recruit expert educators, and that degree may vary by institution. We believe this study shows one way that success may be achieved.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 10","pages":"627-631"},"PeriodicalIF":0.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Decreasing 72-Hour Readmission Rates Among Patients with Sepsis.","authors":"Rowan Burns, Liela Meng, Mirinda Ann Gormley, Stella Self, Nathan Hudepohl","doi":"10.14423/SMJ.0000000000002018","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000002018","url":null,"abstract":"<p><strong>Objectives: </strong>Sepsis survivors are susceptible to health complications, substantially increasing the risk of emergency department (ED) and hospital readmissions. Few evaluations, however, have assessed the effectiveness of interventions targeted at decreasing readmissions among patients with sepsis. This study evaluated the effectiveness of a targeted intervention to decrease 72-hour ED readmission rates in patients with sepsis or pyelonephritis in a large ED in the US South.</p><p><strong>Methods: </strong>This retrospective cohort study investigated 72-hour readmission rates from January 1, 2020 to December 31, 2023 for adults with an ED diagnosis of sepsis or pyelonephritis. An intervention to decrease ED readmissions was implemented on May 4, 2021. Monthly readmission rates were calculated as the proportion of patients readmitted within 72 hours of discharge following an ED visit with a discharge diagnosis of sepsis or pyelonephritis. Interrupted time series analysis was used to assess the differences in trends of monthly readmission rates prepolicy implementation, during policy implementation, and postpolicy implementation.</p><p><strong>Results: </strong>Of 39,818 patients, 4907 (12.3%) had 72-hour readmissions. Preintervention, 72-hour readmissions increased by 0.00054 per admission per month (<i>P</i> = 0.30). At implementation, there was an immediate drop of 0.0017 in the monthly readmission rate (<i>P</i> = 0.75), and in postimplementation period, the trend reversed, with a sustained decrease of 0.00112 readmissions per admission per month (<i>P</i> = 0.04). There were sustained decreases in readmissions per admission per month of 0.00061 (<i>P</i> = 0.25) and 0.0033 (<i>P</i> = 0.02) for pyelonephritis and sepsis, respectively.</p><p><strong>Conclusions: </strong>This intervention was associated with a sustained decrease in readmissions per month for septic individuals seen in the ED. The authors did not report any financial relationships or conflicts of interest.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 10","pages":"648-652"},"PeriodicalIF":0.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115174","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of Bismuth-Based Quadruple Therapy Compared with Clarithromycin-Based Triple Therapy for <i>Helicobacter pylori</i> Infection in a Predominantly Hispanic Population.","authors":"Jesus Guzman, M Ammar Kalas, Alejandro Robles, Jerzy Sarosiek, Nawar Hakim, Alok Dwivedi, Marc J Zuckerman, Sherif E Elhanafi","doi":"10.14423/SMJ.0000000000002020","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000002020","url":null,"abstract":"<p><strong>Objectives: </strong><i>Helicobacter pylori</i> infection affects approximately 4.4 billion people worldwide, with significant prevalence variations based on geographic location, ethnicity, and socioeconomic factors. This study aimed to compare the effectiveness of bismuth-based quadruple therapy and clarithromycin-based triple therapy in a predominantly Hispanic population along the US-Mexico border and assess the impact of changes in the American College of Gastroenterology guidelines recommendations on the management of <i>H pylori</i>.</p><p><strong>Methods: </strong>This retrospective cohort study included adult patients treated for <i>H pylori</i> infection between January 2009 and March 2022 at a tertiary care hospital on the US-Mexico border. The inclusion criteria included confirmed <i>H pylori</i> infection, treatment with clarithromycin-based triple therapy or bismuth-based quadruple therapy, and documented eradication testing. The data collected included demographics, treatment details, socioeconomic factors, and eradication outcomes. Statistical analyses included unpaired <i>t</i> tests, χ² tests, and multinomial logistic regression. Relative risk and odds ratios were calculated to evaluate treatment efficacy and associated factors.</p><p><strong>Results: </strong>Of 5489 patient records reviewed, 936 were included. In adjusted analyses, patients treated with bismuth-based quadruple therapy had higher eradication rates compared with clarithromycin-based triple therapy (91.5% vs 83.3%, relative risk =1.11, 95% confidence interval 1.05-1.17, <i>P</i> < 0.001). Following the 2017 American College of Gastroenterology <i>H pylori</i> guidelines, the use of bismuth quadruple therapy increased significantly (24.6% vs 11.2%, <i>P</i> < 0.001). Socioeconomic factors such as insurance status and educational level were associated with the likelihood of follow-up eradication testing and treatment success.</p><p><strong>Conclusions: </strong>Bismuth quadruple therapy had higher eradication rates in a predominantly Hispanic population along the US-Mexico border. Insurance status and socioeconomic factors continue to affect treatment access and eradication testing.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 10","pages":"653-660"},"PeriodicalIF":0.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antibiotic Stewardship in Nonoperative Facial Trauma: Necessary or Not?","authors":"Juan Ignacio Isaac, Jose A Castro Garcia","doi":"10.14423/SMJ.0000000000002019","DOIUrl":"10.14423/SMJ.0000000000002019","url":null,"abstract":"<p><strong>Objective: </strong>Closed facial fractures are common and often treated nonoperatively. Routine systemic antibiotic prophylaxis is controversial because infection rates are low and antibiotics can cause harm. We assessed whether prophylactic antibiotics reduce infectious complications in closed, nonoperative facial fractures.</p><p><strong>Methods: </strong>A systematic review was conducted of adults with closed, nonoperative facial fractures (emergency department, inpatient, intensive care unit). PubMed, Scopus, and Google Scholar were searched from inception through September 19, 2025. Studies compared systemic prophylaxis versus none and/or ≤24 hours versus >24 hours.</p><p><strong>Results: </strong>Seven US studies comprising 3274 patients met the inclusion criteria. Across studies, fracture-related infection rates were low and were not reduced by prophylactic antibiotics. In the largest prospective multicenter cohort, Mian et al reported a 30-day facial fracture-associated infection rate of 1.0%, with no significant benefit for ≤24 hours or >24 hours of prophylaxis compared with none (adjusted odds ratio 1.24-1.32). Orbital and zygomatic cohorts reported no infectious complications regardless of prophylaxis strategy. In sinus-involving and intensive care unit cohorts, fracture-site infection and sinusitis were rare; most infectious events were pneumonia or ventilator-associated pneumonia rather than facial fracture-specific infections. Longer antibiotic exposure was associated with isolated cases of <i>Clostridioides difficile</i> colitis.</p><p><strong>Conclusions: </strong>Available evidence does not support routine systemic prophylaxis for uncomplicated closed, nonoperative facial fractures. The strongest inference applies to patients without another indication for antibiotics. Current data do not identify fracture-specific subgroups in whom prophylaxis improves outcomes; accordingly, management should emphasize local care, return precautions, and structured follow-up.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 10","pages":"637-642"},"PeriodicalIF":0.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Medical Student Publications in the Pass/Fail Licensing Examination Era.","authors":"Em Long-Mills, Xiaolan Qiu, David L Eldridge, Dmitry Tumin","doi":"10.14423/SMJ.0000000000002017","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000002017","url":null,"abstract":"<p><strong>Objectives: </strong>The transition of the US Medical Licensing Examination Step 1 to pass/fail scoring has intensified concerns about a research \"arms race\" among medical students seeking advantage in the residency application process. Over three graduating cohorts of medical students (classes of 2022-2024), the study aimed to determine whether medical students have increased participation in published scholarship and whether medical student publications exhibited diminishing quality, as measured by citations, authorship position, and publication type.</p><p><strong>Methods: </strong>Data from a registry of recently enumerated medical providers (to identify newly matched US residents) were linked to publication data from the PubMed and Scopus databases.</p><p><strong>Results: </strong>Based on a sample of 28,926 Doctor of Medicine (MD) graduates and 7983 Doctor of Osteopathic Medicine (DO) graduates, there was a slight increase in publication (from 43% to 48% of MD graduates and from 24% to 31% of DO graduates, comparing the classes of 2022 and 2024). Analysis of 44,055 unique publications attributed to MD and DO graduates in all three cohorts revealed no meaningful changes in publication type, author position, or citations per year.</p><p><strong>Conclusions: </strong>Medical student publications have grown at a slow rate and with minimal changes in quality metrics. These results suggest that prioritizing quality over quantity of research activities during medical school remains a sound strategy for the research component of residency applications.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 10","pages":"632-636"},"PeriodicalIF":0.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Choosing Wisely, Using Wisely: Diagnostics, Defining the Disease Stage, and Deciding about Breast Cancer Treatment.","authors":"Hilde M Buiting","doi":"10.14423/SMJ.0000000000002014","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000002014","url":null,"abstract":"<p><p>Among breast cancer patients, diagnostics differs depending on the disease stage that patients are in because in every disease stage other forms of diagnostics can be considered to be more precise. Whereas some forms of diagnostics are particularly effective in early-stage breast cancer identification, others are more effective in late-stage identification. This perspective looks at new oncologic diagnostic developments that may engender an emotional rollercoaster ride among metastatic breast cancer patients and their close relatives and healthcare professionals. The text touches upon the impact that new diagnostics can have on treatment approaches, especially if those diagnostic outcome measures could change the disease stage from curable (stage III) to incurable (stage IV). A multidisciplinary approach in which diagnostics, pathology, the view of the treating doctor, and the patient's voice are included probably guarantees the best possible treatment and care for breast cancer patients in these so-called gray oncologic areas. This perspective refers to new diagnostic oncologic developments that may sometimes create an emotional rollercoaster ride among metastatic breast cancer (MBC) patients and their close relatives and healthcare professionals. It touches upon the impact that new diagnostics can have on treatment approaches, especially if diagnostic outcome measures can change the disease stage from curable (stage III) to incurable (stage IV). The text specifically touches upon a gray area in oncology in which a proportion of patients could be cured, such as with oligometastatic disease (OMD).</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 10","pages":"661-662"},"PeriodicalIF":0.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149115090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Practitioner Perspectives on Mandatory Fitness Evaluations before Firearm Purchase in South Carolina.","authors":"Aaron J Deyo, Richard L Frierson, Kaustubh G Joshi","doi":"10.14423/SMJ.0000000000002022","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000002022","url":null,"abstract":"<p><strong>Objectives: </strong>Rates of firearm-related deaths from suicide and homicide have continued to rise during the last several years. This has prompted large-scale debate over the role of mental illness in gun violence and the need to investigate strategies for reducing harm. Many countries require either some form of mental health evaluation or a simple doctor's note on mental fitness before purchasing a firearm. This study focuses on practitioner attitudes toward this practice in South Carolina and looks to examine the primary factors that may interfere with implementing mandatory fitness evaluations before firearm purchase. Our specific aim was to assess the level of concern that practitioners had with 12 barriers that were identified by the research team as potentially problematic for conducting fitness screenings for gun ownership. Comfort with performing these evaluations also was assessed, including differences in attitudes and comfort level based on the specialty of the practitioner.</p><p><strong>Methods: </strong>A survey was created and dispersed to regional providers in the fields of Family Medicine, Internal Medicine, and Psychiatry. The survey contained questions assessing provider beliefs on the capability and feasibility of fitness evaluations for firearm purchase, comfort in performing such evaluations, and the level of concern with 12 potential barriers to performing evaluations using a Likert scale.</p><p><strong>Results: </strong>A total of 794 individuals received the survey, with a response rate of 18.9% (150) and a completion rate of 17.4% (138). The majority of respondents (84.7%) believed that implementing mandatory fitness evaluations before firearm purchase is a good idea; however, fewer than half (48%) believed that it is feasible. The most concerning barriers were related to the unreliability of an applicant's self-reporting, concerns over liability, and a large abundance of firearm sales.</p><p><strong>Conclusions: </strong>Findings from this study indicate that although most respondents viewed mandatory fitness evaluations as a good idea, the act of implementing them was viewed to be less feasible for a variety of factors. Most of the barriers presented were met with at least a moderate level of concern. Although a common practice in many other countries, the United States presents unique challenges when it comes to the potential for implementing mandatory fitness evaluations. This is the first known study to gather practitioners' perspectives on this process. More research is needed on investigating solutions for reducing gun violence and whether the use of fitness evaluations is a viable tool.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 10","pages":"620-626"},"PeriodicalIF":0.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nephrology Workforce Distribution and Chronic Kidney Disease Burden in Georgia: A Statewide Analysis.","authors":"Shervin Eskandari, Avneesh Prabakar, Tej Murudkar, Dev Shah, Sharad Virmani, William J Healy","doi":"10.14423/SMJ.0000000000002024","DOIUrl":"https://doi.org/10.14423/SMJ.0000000000002024","url":null,"abstract":"<p><strong>Objective: </strong>Healthcare disparities between rural and urban regions highlight barriers to care, yet access to nephrology services in nonmetropolitan areas remains poorly characterized. This study evaluates the distribution of nephrologists and dialysis centers across Georgia and examines how these patterns relate to county-level chronic kidney disease (CKD) prevalence.</p><p><strong>Methods: </strong>The Georgia All-Payer Claims Database estimated CKD prevalence, the Centers for Medicare & Medicaid Services Dialysis Facility Care Compare database identified dialysis centers, and the Georgia Composite Medical Board Physician Workforce Database located nephrologists. Using 2023 Rural-Urban Continuum Codes, counties were classified as metropolitan (codes 1-3) or nonmetropolitan (codes 4-9). Physician and facility density were calculated per population and land area, and travel burden was estimated using distances from county centroids to the nearest nephrology resource.</p><p><strong>Results: </strong>A total of 347 nephrologists and 360 dialysis centers were identified across Georgia. Nonmetropolitan counties had higher CKD prevalence than did metropolitan counties (7.02% vs. 6.26%, <i>P</i>=0.002) and lower nephrologist density per 100,000 residents (0.7 vs. 1.8, <i>P</i><0.001) and per 100 mi² (0.06 vs. 1.29, <i>P</i><0.001). In addition, nonmetropolitan counties had fewer dialysis centers per 100 mi² (0.22 vs. 1.25, <i>P</i><0.001). Nonmetropolitan counties experienced longer travel distances to the nearest nephrologist (15.85 vs. 8.19 miles, <i>P</i><0.001) and dialysis center (9.30 vs. 6.46 mi, <i>P</i>=0.011).</p><p><strong>Conclusions: </strong>There are significant disparities in CKD burden and access to nephrology care in Georgia. Rural counties experience higher disease prevalence but a reduced availability of specialist services.</p>","PeriodicalId":22043,"journal":{"name":"Southern Medical Journal","volume":"119 10","pages":"603-608"},"PeriodicalIF":0.9,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}