Osteopathic Surgeons Disproportionately Serve Rural Communities

Alexander VS, Jacobsen N, Wong R, Vogel AD, et al. Surgical Care in Rural and Underserved Populations: National Analysis of Attending Surgeons. J Am Coll Surg. July 2026.

Rural communities face worsening access to surgical due to hospital closures and workforce shortages. Although osteopathic physicians have historically practiced in rural settings, their contribution to the contemporary rural surgical workforce remains poorly defined.

The authors performed a cross-sectional analysis of 74,404 US attending surgeons across seven specialties using the 2023 Centers for Medicare & Medicaid Services Doctors and Clinicians database. Practice addresses were linked to 2020 Rural-Urban Commuting Area codes, Area Deprivation Index quintiles, and census tract population density. Rural practice (defined as a mean Rural-Urban Commuting Area score of 4 or higher) was modeled using multivariable logistic regression adjusted for specialty, graduation cohort, sex, Census division, and state urbanization, with state-clustered standard errors.

Rural practice was more common among DO surgeons than among MD surgeons (18.3% versus 9.7%; risk difference, 8.6 percentage points; 95% CI, 7.6–9.6). Across all specialties, DO surgeons practiced in more socioeconomically deprived communities. 

After adjustment, DO surgeons had twice the odds of practicing in rural areas compared with MD surgeons (OR, 2.05; 95% CI, 1.85–2.28). Rural areas had 13.8 surgeons per 100,000 residents versus 23.6 per 100,000 residents in metropolitan areas. Surgeons graduating in 2010 or later had approximately half the odds of practicing in rural areas compared with those graduating in 1979 or earlier (adjusted OR, 0.48; 95% CI, 0.42–0.56).

Osteopathic surgeons disproportionately practice in rural and socioeconomically disadvantaged communities, highlighting an important workforce component for maintaining access to surgical care in rural areas. The declining likelihood of rural practice among more recent training cohorts raises concerns about the future rural surgical workforce.