Editor’s note: The 14 ACS Advisory Councils, which act as liaisons between surgical societies and the Regents, periodically submit articles highlighting notable initiatives within their respective specialties.
This week’s issue features a submission from the Advisory Council for Rural Surgery.
Rural surgeons represent a small but essential segment of the US healthcare workforce and are essential to the health of nearly 60 million Americans by providing lifesaving and time‑sensitive care in communities with limited access to specialty services. Despite their critical role, rural surgeons face amplified risks for burnout and professional isolation due to workforce shortages, high clinical responsibility, and limited organizational support.
As such, surgeon wellness in rural settings emerged as a workforce sustainability and patient safety issue, not solely an individual concern.
Burnout among surgeons remains prevalent, with systematic reviews reporting rates between 30% and 60%, driven by long work hours, high patient responsibility, and insufficient institutional support. These pressures are magnified in rural hospitals, where surgeons often practice without subspecialty backup, take frequent call, and serve as the sole provider for emergency and elective surgical care. National rural workforce analyses demonstrate that rural areas have dramatically fewer physicians per capita than urban settings, meaning the loss or reduced capacity of even one surgeon can jeopardize surgical services, hospital finances, and community access to care.
Surgeon well-being is strongly influenced by workplace culture, access to support, and the ability to process adverse events, complications, and day‑to‑day stressors inherent to surgical practice. For rural surgeons—who often practice without nearby colleagues, subspecialty backup, or robust departmental infrastructure—these stressors are magnified. The emotional impact of complications or poor outcomes may go unspoken, increasing isolation and risk of cumulative distress.
Recognizing this, the ACS has prioritized surgeon well-being as foundational to patient safety, professional fulfillment, and sustainable surgical systems.
Peer support has emerged as a key evidence‑based strategy to address surgeon distress, particularly following adverse events, complications, litigation, or moral injury. Peer support programs provide confidential, non‑judgmental assistance from trained surgical colleagues who understand the realities of practice. Surgeons consistently report higher trust and preference for peer support compared with traditional employee assistance programs, which are often perceived as less relevant or accessible.
Importantly, peer support is both feasible and effective in rural settings. Implementation of structured peer support programs such as RISE (Resilience in Stressful Events) in rural hospital systems has demonstrated reductions in anxiety and burnout, alongside early improvements in resilience, psychological safety, and awareness of support resources. These findings show that peer support can strengthen organizational culture even in resource‑limited environments.
At the national level, the ACS Surgeon Well‑Being Coalition has formalized this approach through the Peer Support Program Playbook, released earlier in 2026. Developed by a multidisciplinary coalition of surgical organizations, the Playbook provides a structured, surgeon‑specific framework to help hospitals and departments design, implement, and sustain confidential peer support programs.
The Playbook outlines the rationale for peer support, defines core program components, includes a peer support business plan template, and highlights real‑world case examples, including ACS‑supported models such as Colleague Connection. Importantly, it is intended for organizations committed to addressing professional stressors common in surgical practice, aligning well with the needs of rural surgeons coping with isolation and high responsibility.
Sustaining rural surgery requires moving beyond recruitment alone to intentional investment in surgeon wellness. Peer support—particularly when guided by national standards such as the ACS Peer Support Program Playbook—offers a scalable, evidence‑informed solution to mitigate burnout, support surgeons after adverse events, and preserve access to essential surgical care in rural communities.
