More than a third of U.S. counties — affecting about 15 million people — have no general surgeons, and 30% lack surgeons across 12 specialties, a new study finds. Rural hospitals, including many critical access facilities, often operate without full‑time surgical staff, forcing transfers and delaying care. Workforce shortfalls, stark regional imbalances (from about 250 surgeons per 100,000 in Rochester, MN, to 20 per 100,000 in Harlingen, TX), and policy or regulatory changes could worsen access unless training and telehealth solutions are expanded.
Millions Live in U.S. Counties Without a Surgeon — Rural Care Faces Growing Crisis
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Time matters in medical emergencies. Prompt access to a surgeon after an appendix rupture or a serious car crash can be the difference between life and death.
A new analysis published Sept. 28 in the Journal of the American College of Surgeons finds that more than a third of U.S. counties now have no general surgeons at all — a gap that threatens emergency care and the broader rural health system.
How Widespread Is the Shortage?
Investigators report that 38% of U.S. counties — home to roughly 15 million Americans — have no general surgeons. Even more striking, 30% of counties lack a surgeon across 12 different surgical specialties. Many rural counties that still operate hospitals, including facilities designated as critical access hospitals, do not have a full‑time surgeon on staff.
Regional Imbalances and Workforce Strain
Surgeon supply varies dramatically across the country. In some specialties, density is as much as 12 times higher in one region than another. For example, Rochester, Minnesota — home to the Mayo Clinic — has about 250 surgeons per 100,000 people, while Harlingen, Texas, has roughly 20 per 100,000.
"Access to surgeons is the keystone for the broader rural health care ecosystem," says Dr. Thomas Tsai, Medical Director for Health Policy Research at the American College of Surgeons and a co‑author of the study.
Workforce trends compound the challenge: separate projections from the American College of Surgeons estimate the U.S. could face a shortage of nearly 28,000 surgeons by 2038 as demand grows with an aging population.
Why Rural Areas Lose Surgeons
Training and retention are central issues. Most surgical training occurs in large urban centers, and fewer graduates choose or remain in rural settings. Experts say medical education must expand rural‑focused training pipelines so surgeons are more likely to establish long‑term practices outside major cities.
Potential Solutions and Barriers
Technology offers promise: clinicians abroad are experimenting with tele‑enabled and robotic surgery to extend specialist reach. In the U.S., regulatory and reimbursement hurdles have slowed such adoption. Meanwhile, rural communities have improved access to primary care through telehealth and advanced practice providers, but specialty surgical services remain hard to obtain.
Policy changes could widen the gap. The analysis warns that proposals such as H.R. 1 — the so‑called One Big Beautiful Bill Act — which includes cuts to Medicaid in some drafts, could force more hospital closures and further erode access in vulnerable communities.
Questions for Patients and Policymakers
The study raises urgent questions: what surgical care is being deferred; how far must patients travel for needed operations; what burdens do transfers place on families; and what are the broader cost implications for the health system? Addressing surgeon distribution, training, and regulatory barriers will be critical to ensuring timely surgical care for rural Americans.
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