About 15.1 million Americans live in a county with no general surgeon, according to a national study published Sept. 28 in the Journal of the American College of Surgeons. That is 1,180 counties, or 38% of all U.S. counties.
The gap is wider when all surgical fields are counted together. About 9.6 million people live in 951 counties with no surgeon in any of the 12 specialties studied. The researchers also found 475 hospitals and surgical facilities in counties without a full-time surgeon, including 434 critical access hospitals, the small rural hospitals that must keep emergency departments open around the clock.
For families in those counties, the numbers point to a practical concern. A sudden emergency such as appendicitis, a bowel blockage, or a serious injury may require care from a surgeon who does not live or practice nearby. The study did not measure how long that trip takes, which is one of its most important limits.
The Workforce Behind the 15 Million Figure
Researchers from the American College of Surgeons (ACS) and the University of North Carolina's Cecil G. Sheps Center for Health Services Research counted 201,394 surgeons across 12 specialties, according to the ACS release. They used federal provider records from April 2025 and Medicare facility data from 2025, the same data behind the ACS surgical workforce mapping tool.
Nationally, there are 59.2 surgeons per 100,000 people. The range is wide, from 20.8 per 100,000 in the Harlingen, Texas, referral region to 250.4 in the Rochester, Minnesota, region, home to a major academic medical center.
Every one of the country's 306 hospital referral regions, which are larger multi-county areas where patients typically get hospital care, has at least one general surgeon. Transplant surgery is far scarcer, with 0.3 surgeons per 100,000 people and none in 179 referral regions.
Fierce Healthcare's coverage of the study rounded the figures to just over 15 million people without a general surgeon and nearly 10 million without a specialty surgeon.
"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 Tsai, a surgeon, co-author of the study, and ACS medical director for health policy research.
Emergency Surgery Is Where Distance Matters Most
Many operations can be scheduled. Emergencies cannot. The National Institute of Diabetes and Digestive and Kidney Diseases calls appendicitis "a medical emergency that requires immediate care." Its classic sign is pain that starts near the belly button and moves lower and to the right, often with nausea, vomiting, fever, or loss of appetite.
In a county with no surgeon, the local emergency room can still evaluate and stabilize a patient, but may need to transfer them for the operation itself. That can add time, cost, and stress, especially for families without reliable transportation or with young children at home.
Critical access hospitals are rural facilities with 25 or fewer inpatient beds, typically more than 35 miles from another hospital, and they must provide emergency care 24 hours a day, according to the Rural Health Information Hub. When such a hospital sits in a county with no full-time surgeon, it may rely on visiting surgeons, temporary staff, or transfers. The study did not track those arrangements.
Texas shows how uneven the spread can be. The Harlingen region in the Rio Grande Valley has about one-third of the national surgeon density, while major metro areas draw far more surgeons per person.
Limits Readers Should Know About
The study shows where surgeons are listed, not how quickly patients reach care. It did not measure travel time, surgical volume, or capacity, and it may miss some ambulatory surgery settings and temporary locum surgeons.
That means a county with no resident surgeon could still have regular surgical coverage from a nearby town. It also means a county with a surgeon on paper could still have gaps if that surgeon works part-time or is near retirement.
"Mapping the surgical workforce is the first step to crafting a thoughtful growth strategy," said Patricia Turner, executive director and CEO of the American College of Surgeons. Lead author Erin Fraher directs the Carolina Health Workforce Research Center at UNC. Tsai also warned that the surgical workforce "may not be sufficient for the growing demand for surgical care for our aging population," Fierce reported.
Families in Surgeon-Short Counties Can Plan Ahead
Rural residents cannot change where surgeons practice, but they can reduce delays. Knowing which nearby hospital handles emergency surgery, and how to get there at night, is useful before a crisis. People with conditions that can lead to surgical emergencies, such as hernias or gallbladder disease, can ask their primary care clinician where they would be sent.
Anyone with sudden, severe abdominal pain, pain that moves to the lower right side, a hard or swollen belly, high fever, or vomiting that will not stop should seek emergency care right away. Calling 911 is appropriate when a person cannot travel safely. Parents should not wait to see whether a child's belly pain passes if it is severe or keeps getting worse.
Under the federal Emergency Medical Treatment and Labor Act, hospitals that take Medicare and offer emergency services must screen and stabilize patients regardless of ability to pay. Patients facing transfer can ask how transport will be billed and whether their insurance covers it.
The ACS said the findings are meant to guide investment in surgical training and support for surgeons in underserved areas. MedicalDaily will follow any state or federal response.
Key Questions Answered
How many Americans live in a county without a general surgeon?
About 15.1 million people in 1,180 counties, according to the ACS and UNC study.
Does that mean these people have no access to surgery?
Not necessarily. Every larger hospital referral region has at least one general surgeon, but the study did not measure travel time.
What is a critical access hospital?
A small rural hospital with 25 or fewer inpatient beds that must offer 24-hour emergency care. The study found 434 in counties without a full-time surgeon.
Which area had the fewest surgeons per person?
The Harlingen, Texas, referral region, with 20.8 surgeons per 100,000 people.
What are the warning signs of appendicitis?
Pain near the belly button that moves to the lower right abdomen, plus nausea, vomiting, fever, or loss of appetite. It needs emergency care.
What should rural families do now?
Learn which nearby hospital performs emergency surgery and how to reach it quickly, especially at night.
Published by Medicaldaily.com
