Fifteen million Americans now live in a county with no general surgeon at all, and getting help for a burst appendix or a broken hip means a long drive first.
Quick Take
- A new national study found 1,180 U.S. counties have no general surgeon, affecting 15.1 million people.
- Nearly 10 million people live in one of 951 counties with no surgeon in any of 12 surgical specialties.
- Every hospital referral region in the country has at least one general surgeon, but those regions span many counties.
- Researchers project the nation will be short almost 28,000 surgeons by 2038.
A Coast-to-Coast Map Reveals the Gaps
The American College of Surgeons and the University of North Carolina’s Cecil G. Sheps Center mapped surgeon locations across every county in the country. They looked at 12 surgical specialties using provider data from April 2025. The findings, published September 28 in the Journal of the American College of Surgeons, show a country where surgical care depends heavily on where a person happens to live.
Out of 3,144 counties, 1,180 have zero general surgeons. That is more than a third of the entire country. Those counties are home to 15.1 million people, meaning anyone needing an appendix removed or a hernia repaired has to travel outside their home county just to find a surgeon.
The problem runs deeper than general surgery. Researchers checked for surgeons across 12 specialties combined, including orthopedic, vascular, and neurological surgery. They found 951 counties, or roughly 30 percent of the nation, with no surgeon in any of those specialties. That leaves 9.6 million Americans without a single specialty surgeon nearby.
Why County Lines Can Hide the Real Picture
Every one of the country’s 306 hospital referral regions has at least one general surgeon somewhere inside it. Referral regions are large, multi-county areas built around where patients travel for major surgery. So having a surgeon somewhere in the region does not mean one is actually close to home. That gap between technical coverage and real access is the heart of the story.
A person could live an hour or more from the nearest surgeon and still technically fall inside a region with plenty of surgical care. For rural families already stretched thin on time and gas money, that distance is not a paperwork detail. It is the difference between quick treatment and a dangerous delay during an emergency.
This Has Been Building for Decades
None of this is brand new. A 2019 study found that 1,196 of the nation’s 1,976 non-metropolitan counties, about 60 percent, had no active general surgeon that year. Rural counties have long carried a much thinner surgical workforce than cities, with about half the number of surgeons per 100,000 residents compared to urban areas. The new study confirms the trend has not reversed itself.
Critical access hospitals, the small rural hospitals meant to serve as a community’s front line, often lack a full-time surgeon on staff. Patients in these areas may arrive at a hospital only to learn the surgeon they need is not there, or only visits on certain days. That reality forces tough choices for families in a medical emergency, especially in winter weather or when time is short.
A Shortage Set to Grow Worse Nationwide
The access gap is not just a rural problem waiting to fix itself. A separate American College of Surgeons analysis using a federal workforce model projects the nation will face a shortage of nearly 28,000 surgeons by 2038. That is the first nationwide projection of its kind, and it suggests the counties without surgeons today may have company in the years ahead.
NEW: 15M+ Americans live in a county with no general surgeon. Nearly 10M live in one with no specialty surgeons.
38% of US counties have no general surgeon, as an aging population drives demand higher. The avg American may undergo up to 20 diagnostic or therapeutic procedures in… pic.twitter.com/9pL2e1yQ4k
— Healthcare AI Guy (@HealthcareAIGuy) September 28, 2026
Fewer new surgeons are choosing rural practice, and existing rural surgeons are aging out of the workforce faster than they are being replaced. Congress and state lawmakers have floated loan forgiveness and training pipeline programs aimed at rural placement, but none of that solves the problem overnight. For the 15 million Americans already living without a surgeon nearby, the fix cannot come soon enough.
Sources:
time.com, facs.org, fiercehealthcare.com, cdc.gov
