Millions of Americans Reside in Counties Lacking General Surgeons

More than a third of U.S. counties lack a general surgeon, a situation that can have life-threatening consequences in medical emergencies, according to a new analysis published Sept. 28 in the Journal of the American College of Surgeons. The study found that 38% of U.S. counties, encompassing roughly 15 million Americans, have no general surgeons.

These findings underscore the significant challenges facing rural healthcare systems. In addition to the absence of general surgeons, 30% of counties have no surgeons across 12 different specialties. Even many rural counties with critical access hospitals are without a full-time surgeon.

"Access to surgeons is the keystone for the broader rural health care ecosystem," said Dr. Thomas Tsai, medical director for health policy research at the American College of Surgeons and a co-author of the study. He noted that many surgeons in rural areas serve multiple roles beyond elective procedures.

Tsai raised questions about the implications of this shortage: "What kind of surgical care is being deferred? How far are people being transferred to receive the care that they need? What does that represent in terms of a burden to patients? And what does this mean in terms of costs to the health care system?"

The study also suggests that the implementation of H.R. 1, known as the One Big Beautiful Bill Act, which includes Medicaid cuts, could exacerbate the problem by forcing additional hospitals to close.

Regional disparities in surgeon availability are significant. Rochester, Minnesota, with the Mayo Clinic, has 250 surgeons per 100,000 residents, while Harlingen, Texas, has only 20. This uneven distribution affects access to care nationwide.

Contributing to the shortage is a training pipeline that is not meeting demand, particularly as the U.S. population ages and requires more medical procedures. A separate projection by the American College of Surgeons anticipated a deficit of nearly 28,000 surgeons by 2038.

Tsai suggested that increasing training opportunities for surgeons in rural areas could encourage them to establish practices and remain in underserved regions. He also pointed to potential solutions like the use of robotic surgeries via telehealth, a practice being explored internationally but facing regulatory hurdles in the U.S.

While rural areas have relatively accessible primary care through telehealth and advanced practice providers, access to specialized surgical care remains a significant barrier. "As the population ages and patients have more and more complex conditions, what they will need increasingly is actual access to surgeons and surgical specialists to address their surgical issues," Tsai stated.