More than 15 million Americans live in counties without a general surgeon, while almost 10 million reside in areas that have no specialty surgeon, according to a new study from the American College of Surgeons (ACS) and the University of North Carolina.
The county-level study examines federal data and provider identification records to map the availability of surgeons across all U.S. counties and 12 specialties using a single underlying data source. The organizations released the analysis alongside an interactive tool that allows users to examine surgical workforce patterns in individual communities.
The study found that specialty surgeons are absent from 30% of U.S. counties, while nearly 40% have no general surgeon. Among the country’s critical access hospitals, 434 are located in rural counties where no full-time surgeon was found. Although every one of the 306 hospital referral regions spanning multiple counties had at least one general surgeon, the availability of surgeons varied considerably among regions and specialties.
The researchers described the findings as a near-current snapshot of surgeon availability based on data through April 2025. They said the information could help policymakers, health systems, medical training programs and specialty organizations respond to growing or unmet demand for surgical services.
Thomas Tsai, the ACS medical director for health policy research and a study coauthor, said the aging U.S. population is expected to increase demand for surgical procedures, including interventions that can help preserve quality of life later in adulthood. He cautioned that the existing surgical workforce may not be large enough to accommodate that growing need.
Tsai also noted that Americans may undergo as many as 20 diagnostic or therapeutic treatments throughout their lives, ranging from relatively minor interventions such as endoscopies to major operations including cardiac procedures and joint replacements. He said the ability to deliver advanced surgical care is an important strength of the U.S. healthcare system, but maintaining that capability will require both an expanded surgeon workforce and sustainable reimbursement for practices serving rural and underserved communities.
Across the 12 specialties included in the analysis, the researchers counted over 201,000 practicing surgeons nationwide, equivalent to 59.2 surgeons per 100,000 residents. However, workforce density differed dramatically by location, ranging from just under 21 surgeons per 100,000 people in Harlingen, Texas, to just over 250 per 100,000 in Rochester, Minnesota.
Some individual specialties showed even greater geographic concentration. Transplant surgery, for example, accounted for only 0.3 surgeons per 100,000 people nationally and had no representation in 179 hospital referral regions.
The researchers emphasized that the geographic concentration of specialized surgeons should not automatically be interpreted as an inappropriate distribution of providers. Instead, some of that pattern reflects deliberate regionalization intended to maintain surgical quality.
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Healthcare access can depend heavily on where a person lives. Communities without locally based surgical specialists may require patients to travel longer distances for consultations, procedures, follow-up appointments, or emergency treatment.
The geographic distribution of medical professionals is influenced by several factors, including population size, hospital infrastructure, training opportunities, compensation, and the availability of professional and educational resources. Smaller and rural communities can face greater challenges attracting and retaining specialized healthcare workers.
Long travel distances can also create practical difficulties for patients. Transportation costs, time away from work, childcare responsibilities, and limited access to reliable transportation can make it harder for some people to obtain timely treatment. These challenges can become especially important when follow-up care requires multiple visits.
Healthcare organizations have explored several approaches to improve access in underserved areas. Rural training programs can expose medical trainees to smaller communities, while telehealth can help connect patients with specialists for consultations and follow-up care. Regional partnerships between hospitals can also support referrals when advanced procedures are not available locally.
Another important consideration is emergency care. Hospitals serving areas with limited specialist coverage may need strong referral arrangements and transportation systems to move patients to facilities capable of providing complex treatment. Effective coordination between local hospitals, larger medical centers, emergency services, and clinicians can help reduce delays.
