Just over 15 million people live in a county with no general surgeons, and nearly 10 million in a county with no specialty surgeons, according to a new analysis from the American College of Surgeons (ACS) and the University of North Carolina shared Monday.
The county-level review of provider identification records and other federal data is the first to map 12 specialties and every American county from a singular data source, and comes alongside the release of an interactive tool to review local surgical workforce information.
In addition to the lack of specialty surgeons in 30% of counties and general surgeons in 38% of counties, the analysis showed that 434 of the country’s critical access hospitals are local in rural counties with no recorded full-time surgeon. And though each of the country’s 306 multi-county hospital referral regions had at least one general surgeon, workforce supply ranged substantially across individual and collective specialties.
The researchers said their findings are a snapshot of near-current (as of April 2025) surgeon supply that stakeholders—policymakers, health systems, training programs and specialty societies— can look to as they work to meet unmet or rising demand for care.
“With an aging U.S. population, there will be a growing need for surgical procedures, many of which maintain a patient’s quality of life as they age. However, the surgical workforce may not be sufficient for the growing demand for surgical care for our aging population,” Thomas Tsai, M.D., the ACS’ medical director for health policy research and a coauthor on the study, told Fierce Healthcare.
“Research suggests that an average American may undergo as many as 20 diagnostic and therapeutic procedures over the course of their life, factoring in minor procedures such as endoscopies to major operations such as heart surgery or joint replacements,” he continued. “The ability to provide innovative surgical care is a feature and not a flaw of the U.S. healthcare system, and we need the resources to both expand the supply of surgeons in the U.S., and also to sustain viable surgical practices through adequate reimbursement in rural and underserved areas.”
The researchers’ analysis describes surgeon supply relative to the population of a state, hospital referral region or county. Though the 201,394 practicing surgeons nationwide and across 12 specialties translate to 59.2 surgeons per 100,000 people, they also found as few as 20.8 surgeons per 100,000 residents in Harlingen, Texas to as many as 250.4 per 100,000 people in Rochester, Minnesota.
Within singular specialties, the researchers noted that most specialized fields were particularly concentrated or not present. Transplant surgery, for instance, reflected 0.3 surgeons per 100,000 people nationwide and was fully absent from 179 hospital referral regions.
That said, while access to care is a concern across the study’s findings, researchers cautioned against viewing such concentration as “inappropriate distribution” so much as “deliberate regionalization” to ensure quality.
“There is strong evidence of a volume-outcome relationship for surgical quality and outcomes with high-volume centers generally associated with better quality and outcomes,” Tsai said. “For certain specialized procedures, there may be a need to regionalize surgical care into centers of excellence in order to improve outcomes, so broad access to specialized surgical care may need to be balanced with an imperative to refer complex surgical care to tertiary or quaternary referral centers.”
The researchers noted that their data does not directly describe areas like surgical capacity, operative volume or served patients, and specifically called for more research into how the rural providers with few recorded surgeons may have their demands met by locum tenens or other types of staffing arrangements.
Some types of highly specialized surgeons such as colorectal surgeons are categorized as general surgeons, reducing the total count of those delivering broader surgical care. And, though surgeons working at ambulatory surgical centers are captured, there are some types of medical offices where surgical care is delivered that are missed under the researchers' methodology.
Though the analysis and tool can’t independently spot workforce shortages or surpluses in more local areas, its outlining of variations and trends could help guide interventions such as targeted graduate medical education expansions, new rural training rotations and loan-repayment programs, researchers wrote. ASC, in a release highlighting the data, called on lawmakers to pass legislation that would require the federal government to identify general surgery shortage areas that incorporates surgeon supply and geographic service areas.
Tsai said the diverse needs and composition of different communities will call for a healthy workforce of both private practice and health system-employed surgeons. As such, government and employers alike should be prioritizing actions and policies that will bolster the placement of new and existing surgeons where their services are needed.
“Training programs should be established in surgeon shortage areas to ‘train in place’ in the communities that have the most need,” the ACS policy head said. “We need to eliminate restrictive covenants and non-compete clauses that restrict surgeons from being able to relocate their practices to meet the demand for surgical care. Especially in an era of declining reimbursement to physicians and the growth of corporate medicine and large health systems, we need to ensure that healthcare employers such as hospitals are providing the adequate support of surgeon employees to be able to recruit and retain surgeons.”
The study was unveiled Monday at the ACS Clinical Congress 2026 meeting and published in the Journal of the American College of Surgeons.