A national analysis reveals a widespread general surgeon shortage across rural communities and critical access hospitals.
RT’s Three Key Takeaways:
- Widespread Surgical Deserts: More than 15 million Americans live in 1,180 US counties that lack a practicing general surgeon, according to findings from the American College of Surgeons (ACS) and the University of North Carolina at Chapel Hill.
- Vulnerable Rural Facilities: Researchers identified 475 hospitals and surgical facilities in counties without an identified full-time surgeon, 434 of which are critical access hospitals that serve as vital lifelines for emergency and inpatient care.
- Regional Disparities: Surgeon supply varies by up to twelvefold across US hospital referral regions, highlighting an urgent need for federal workforce and reimbursement policies to support clinical coverage in underserved communities.
More than 15 million Americans reside in one of the 1,180 US counties without a general surgeon, and 951 counties have no surgeon across 12 surgical specialties, according to a national study presented at the ACS Clinical Congress 2026 and published in the Journal of the American College of Surgeons (JACS).
The research, developed collaboratively by the ACS and the Cecil G Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill, mapped surgeons across 12 specialties and all 3,144 US counties using a single data source to establish direct comparisons across regions. The study was accompanied by the launch of the ACS Surgical Workforce Mapping Tool, an interactive platform designed to give clinicians, hospital leaders, and policymakers county-level insight into local surgical supply.
“For a patient, the question is not how many surgeons the country has; it is whether there is one available where they live,” said Thomas C Tsai, MD, MPH, FACS, medical director for health policy research in the ACS division of advocacy and health policy and co-author of the study. “National averages can obscure substantial differences from one community to another. This study highlights a need to assess whether our national health workforce and reimbursement policies are supporting the ability of patients to access the right care at the right time and the right place.”
Rural Healthcare Facilities Face Acute Deficits
According to the analysis of federal data from April 2025, there were 201,394 surgeons practicing across the US, translating to a national average of 59.2 surgeons per 100,000 people. However, the study shows that geographic distribution remains severely uneven.
The analysis found that the 951 counties lacking any surgeon among the 12 tracked specialties represent 30% of US counties and are home to 9.6 million people. Furthermore, the 1,180 counties without a general surgeon represent 38% of all US counties and house 15.1 million residents.
When researchers overlaid provider registries with federal facility files, they discovered that 475 hospitals and surgical facilities operate in counties without an identified full-time surgeon. Among these facilities, 434 are critical access hospitals, which small rural communities rely on for immediate emergency triage, inpatient admissions, and acute care management.
“The Surgical Workforce Mapping Tool gives policymakers, health systems, and communities a practical tool to understand their local surgical workforce and identify gaps in access to care,” said Erin P Fraher, PhD, MPP, director of the Carolina Health Workforce Research Center at the UNC Sheps Center and lead author of the study, in a news release.
Regional Variation and Policy Implications
Although all 306 hospital referral regions in the nation contained at least one general surgeon, the authors noted that these multi-county designations can mask severe travel burdens for rural residents. Across all specialties, workforce availability ranged from 20.8 surgeons per 100,000 people in Harlingen, Texas, to 250.4 surgeons per 100,000 people in Rochester, Minnesota.
Specialty care demonstrated even greater geographic concentration. For example, transplant surgery registered at 0.3 surgeons per 100,000 people nationally and was entirely absent from 179 of the country’s 306 hospital referral regions. While the authors acknowledged that complex subspecialties are often intentionally regionalized to maintain surgical quality, basic surgical coverage remains an unmet need in hundreds of communities.
“Mapping the surgical workforce is the first step to crafting a thoughtful growth strategy,” said Patricia L Turner, MD, MBA, FACS, executive director and chief executive officer of the American College of Surgeons, in a news release. “These data will help guide investments in surgical training and support for surgeons in underserved communities, with the goal of improving patients’ access to care.”
According to the ACS, these findings arrive as federal legislators examine solutions such as the Ensuring Access to General Surgery Act of 2026 (HR 7198). The proposed legislation would direct the Health Resources and Services Administration (HRSA) to establish a formal methodology for designating general surgery shortage areas based on local supply and geographic service areas, potentially steering graduate medical education funding and retention incentives toward high-need healthcare markets.
