More than 200,000 surgeons practice across the US, but their distribution tells a more complicated story about the nation’s surgical workforce.
Nearly one-third of US counties have no identified surgeon in any of 12 surgical specialties, according to a new national analysis published in the Journal of the American College of Surgeons (JACS). More than one-third have no identified general surgeon.
Those findings illustrate a challenge that cannot be captured by national workforce numbers alone; where surgeons practice can be as important as how many are practicing.
A new interactive tool from the ACS is designed to make those geographic differences visible. Developed in collaboration with the Program on Health Workforce Research and Policy at the Cecil G. Sheps Center for Health Services Research at The University of North Carolina at Chapel Hill, the ACS Surgical Workforce Mapping Tool allows surgeons, policymakers, health systems, researchers, and the public to examine the distribution of surgeons by specialty and geography.
“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 a coauthor of the JACS 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.”
National Numbers Can Mask Local Differences
Concerns about the size and distribution of the surgical workforce have grown as an aging population increases demand for surgical care and rural and underserved communities continue to face challenges recruiting and retaining surgeons.
National projections provide one perspective on that challenge. A separate national analysis presented at Clinical Congress 2026 projected a shortfall of 27,940 surgeons by 2038, with gaps between supply and demand expected to be greater in rural areas. The study, which examined 10 surgical specialties, had not yet been peer reviewed at the time of presentation.
But national estimates cannot show whether surgeons are practicing in the communities where they are needed.
Previous workforce studies also have frequently examined individual specialties, relied on different data sources, or reported workforce numbers primarily at the national or state level, making direct comparisons among specialties and communities difficult.
The new JACS analysis sought to create a more consistent picture.
Researchers used April 2025 data from the National Plan and Provider Enumeration System to identify 201,394 surgeons across 12 surgical specialties. The specialties were classified using definitions developed by the ACS with input from representatives of more than a dozen surgical societies.
The researchers then examined surgeon distribution across several geographic units, including counties, Hospital Referral Regions, and Core-Based Statistical Areas.
Nationally, they identified 59.2 surgeons per 100,000 people. Obstetrics and gynecology, general surgery, and orthopedic surgery were the three largest specialty groups, together accounting for nearly 57% of the surgeons included in the analysis.
The geographic analysis, however, revealed a different dimension of the workforce.
Of 3,144 US counties, 951, or 30%, had no identified surgeon in any of the 12 specialties. Those counties are home to 9.6 million people.
For general surgery alone, 1,180 counties, or 38%, had no identified general surgeon. Approximately 15.1 million people live in those counties.
“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.
Geographic Scale Matters
The analysis also demonstrates why defining a surgical workforce shortage can be complicated.
While 1,180 counties had no identified general surgeon, every one of the country’s 306 Hospital Referral Regions had at least one.
Hospital Referral Regions are larger geographic areas that represent where patients generally travel for major surgical and cardiovascular procedures. A region can therefore contain multiple counties, including rural communities located considerable distances from the surgeons practicing elsewhere within the region.
As a result, measuring the workforce at the Hospital Referral Region level could suggest surgical care is available across the country, while county-level data reveal communities where no surgeon is locally identified.
The overall rate of surgeons also varied approximately 12-fold among Hospital Referral Regions. Harlingen, Texas, had 20.8 surgeons per 100,000 people, compared with 250.4 per 100,000 in Rochester, Minnesota.
Those differences have potential implications as policymakers consider how surgical shortage areas should be defined.
The Ensuring Access to General Surgery Act of 2026 (HR 7198), for example, would direct the Health Resources and Services Administration to develop a methodology for identifying general surgery shortage areas that considers surgeon supply, surgeon-to-population ratios, and geographic service areas.
The new analysis demonstrates that the geographic boundaries used in such a methodology could significantly affect which communities are identified as having limited surgeon availability.
Distribution Differs by Specialty
The appropriate distribution of surgeons is unlikely to look the same across every specialty.
Some specialties closely followed the geographic distribution of the US population, while others were considerably more concentrated.
Transplant surgery was among the clearest examples. With 882 surgeons identified nationally, transplant surgery had a rate of 0.3 surgeons per 100,000 people and was absent from 179 of the country’s 306 Hospital Referral Regions.
But geographic concentration alone should not be interpreted as evidence of a workforce problem. Highly specialized services such as transplantation often are intentionally regionalized to concentrate expertise, infrastructure, and sufficient patient volume. The researchers noted that future workforce benchmarks will need to account for population needs and the potential benefits and risks of regionalization rather than apply the same geographic standard to every surgical specialty.
Rural Facilities Highlight Another Workforce Question
Overlaying surgeon locations with hospitals and ambulatory surgical centers identified another potential concern.
Researchers found 475 healthcare facilities in counties with no identified surgeon in the study. Nearly all were hospitals, and 434 were Critical Access Hospitals.
The finding does not mean that surgical care is unavailable at those facilities. Surgeons may provide services through staffing arrangements that are not fully captured by the data, including locum tenens coverage, or may be recorded at practice locations in other counties.
But the findings raise questions about how surgical needs are being met in communities that depend on these facilities and where additional workforce research may be needed.
The issue is particularly relevant for rural communities, where the loss or departure of a small number of surgeons can substantially affect local surgical capacity and the broader healthcare infrastructure. The findings also raise questions the map itself cannot answer: How far are patients traveling for surgical care? Is care being delayed or deferred? What burdens do those patterns place on patients and health systems?
Mapping Surgeons Who Practice in Multiple Communities
Another distinguishing feature of the analysis is how it accounts for surgeons with multiple practice locations.
Approximately 17% of surgeons in the study reported more than one location. Assigning those surgeons entirely to their primary location could overestimate the workforce available in one community while overlooking care they provide elsewhere.
To account for that issue, researchers used North Carolina physician licensure data on practice hours to develop a weighting approach. A surgeon’s primary practice location was assigned 60% of the clinician’s count, with the remaining 40% divided among secondary locations.
That methodology allows the map to represent surgeons practicing across multiple communities without counting one clinician as multiple surgeons.
Putting the Data to Work
The resulting ACS Surgical Workforce Mapping Tool makes the data available through an interactive national map.
Users can select individual surgical specialties and view the number and rate of surgeons per 100,000 people by county, Hospital Referral Region, or metropolitan and micropolitan area. Selecting or hovering over an area provides information about its population and surgical workforce.
Users also can overlay hospital and ambulatory surgical center locations and download custom maps for reports, presentations, policy discussions, and other uses. In addition to the customizable interactive map, a series of more than 2,000 pre-rendered static maps—with or without hospital and ASC overlays—are available for download on facs.org.
Potential applications extend beyond identifying areas with relatively few surgeons. Health systems, training programs, specialty societies, researchers, and policymakers could use the data when considering where to expand graduate medical education, establish rural training rotations, support loan-repayment or other recruitment programs, or expand telehealth options for perioperative care.
The data also may help communities compare their workforce with surrounding areas and examine which specialties are locally available.
“Mapping the surgical workforce is a starting point for strengthening it,” said Patricia L. Turner, MD, MBA, FACS, Executive Director and CEO of the ACS. “These data can help guide investments in surgical training and support for surgeons in underserved communities, with the goal of improving patients’ access to care.”
A Starting Point, Not a Definition of Access
The researchers caution that the map should not be interpreted as a definitive measure of whether a community has adequate surgical care.
The underlying National Plan and Provider Enumeration System is maintained for billing purposes rather than workforce measurement. Specialty and practice-location information is self-reported and may not always reflect where a surgeon actually provides care.
The data also cannot measure operative volume, surgical capacity, case mix, board certification, the ability to provide urgent services, patient travel time, population health needs, or whether an individual surgeon practices at a particular hospital.
Those limitations mean the absence of an identified surgeon in a county does not necessarily mean residents have no access to surgical care, just as the presence of a surgeon does not establish that a community’s surgical needs are being fully met.
Instead, the map provides a common national framework for asking more targeted questions.
For communities seeking to understand their surgical workforce, policymakers considering where to direct resources, and researchers studying access to care, seeing where surgeons practice is an important place to start.
And as workforce pressures continue to evolve, a more detailed picture of those geographic differences could help ensure that discussions about the nation’s supply of surgeons focus not only on how many surgeons the US has, but where patients can find them.
For more information, visit the ACS Surgical Workforce Mapping Tool section on facs.org.
