The Surgeon Shortage Nobody Is Talking About – And What You Can Do About It

Attrition Shock: Surgical Workforce Frameworks

[00:00:00] Imagine you’ve built your surgery center schedule around five key surgeons. Your OR efficiency is tight. Your cases are profitable. Your patient satisfaction scores are climbing. Then over the next three years, one of those surgeons is gone. Just gone. That’s not a hypothetical. According to brand-new research published in the Journal of the American College of Surgeons, that scenario is playing out in almost one in ten surgical practices across the country.

And for certain specialties, the numbers are dramatically worse. I’m Erik Sunset, your host of the DocBuddy Journal, and today we’re going into the data, the real numbers on surgical workforce attrition, what the American College of Surgeons just did about it, and most importantly, what it means for you as a surgery center administrator.

Let’s go

So let’s start with the research, because this is one of the most comprehensive looks at surgical workforce attrition that has ever [00:01:00] been published. Researchers at The Ohio State University linked two massive federal datasets. These are Medicare’s Physician Public Use Files and the National Plan and Provider Enumeration System to build a core ho-cohort of two hundred and twenty-four thousand unique surgeons across nineteen specialties, tracking them from twenty thirteen to twenty twenty-three.

This is ten years of data, a quarter of a million surgeons. This is really not a small survey. Here’s the headline finding: The cumulative attrition rate over eight years was nine point seven percent. Call it what it is. Nearly one in ten surgeons exited clinical practice within an eight-year window. Now, let’s put that in operational context for a minute.

If your center works with, say, twenty active surgeons, that number says you should statistically expect to lose two of them within the next eight years. If you have fifty surgeons, you’re looking at losing nearly five. That is a material staffing risk, and it needs to be in [00:02:00] your strategic planning conversations.

But here’s where it gets really interesting and operationally important when you break it down by specialty The five-year cumulative attrition rates by specialty are striking. Oral and maxillofac– ew . Oral and maxillofacial surgery comes in at twenty-five point one percent. So that’s one in four surgeons leaving within five years.

If you’re in a dental or oral surgery specialty center, that number should stop you cold. For OBGYN, that’s obstetrics and gynecology, the number is twenty-three point two percent, so nearly one in four OBGYNs. For, for ambulatory surgery centers doing gynecologic procedures, this is a pipeline issue hiding in plain sight.

Plastic and reconstructive surgery is at nineteen point three percent, so that’s just about one in five. Uh, for cosmetic and reconstructive ASCs, this represents real succession risk. But on the other end of the spectrum, the lowest [00:03:00] annual attrition rates were in otolaryngology at point five percent, podiatry and foot and ankle surgery at point four percent, vascular surgery at point eight percent, and orthopedic surgery at point seven percent.

If those are your primary service lines, the immediate pressure is lower, but you are absolutely not immune to what’s coming. Now, when are surgeons most likely to leave? Well, the research found that the highest risk group is mid-career surgeons with five to nine years of practice. These aren’t the ones burning out after three brutal years of residency recovery.

It’s not the veterans approaching retirement. These are the ones in the sweet spot of their career, the ones your organization may have just invested years of credentialing, scheduling, and relationship building into. This is a significant finding. There was also a notable demographic shift in the workforce over the study period.

The share of female surgeons rose from twenty-one point two percent in twenty thirteen to twenty-eight point six percent in twenty twenty-three. [00:04:00] That’s a meaningful increase that signals a changing workforce with potentially different support needs and priorities. Meanwhile, the share of surgeons practicing in rural and non-metropolitan areas fell from ten and a half percent to eight and a half percent.

That’s a geographic consolidation of the surgical workforce that has serious access to care implications. And if you operate in a rural or suburban market, it’s a recruitment and retention flag you should be paying attention to One more important data point before we move on. Attrition rates were relatively stable from twenty thirteen to twenty eighteen and then spiked sharply in twenty twenty.

The researchers attributed this largely to accelerated retirements during COVID-19. But here’s the uncomfortable truth. The pandemic may have pulled forward retirements that were already coming. The underlying structural pressures, which are long hours, administrative burden, burnout, unpredictable schedules, all the things that we talk about here on the DocBuddy Journal, uh, those didn’t just [00:05:00] go away when the pandemic ended.

In many settings, they got worse. And depending on who you ask, we’re still feeling, uh, sort of the long effects of this COVID-19 pandemic.

So what is organized surgery doing about this? Because two months before this attrition study dropped, the American College of Surgeons released something genuinely historic. In March 2026, the ACS published the first-ever national workplace standards framework for surgeons. First ever. And this is in the one hundred and thirteen-year history of the American College of Surgeons.

There had never been a formal, measurable set of workplace standards for surgical practice. So let that sink in for just a moment. This is the very first. And this framework, which was published in the Journal of American College of Surgeons, is called, quote, Developing Specialty-Specific Workplace Standards for Surgeons, end quote.

And it was designed to be actionable, not aspirational. These are measurable standards that can be built [00:06:00] directly into departmental policies, employment contracts, and specialty society guidance. The ACS Board of Regents Vice Chair, Dr. Douglas Wood from the University of Washington, led the effort, and he framed it in this way.

The goal is to align surgeon well-being with patient safety and system efficiency, while also making the profession attractive enough to recruit the next generation of surgeons. So what does the framework actually cover? It’s in six domains. One, call schedule and compensation. The framework calls for data-driven limits on the frequency and intensity of call coverage, not vague guidelines, but defined limits.

This is enormous for ASCs because of how your call structure works directly, uh, affects whether surgeons want to be affiliated with your center. Two, access to the OR, clinic, and resources. Recommended operating room and clinic time for full-time surgeons customized by specialty. This is a direct conversation about block time allocation, something every ASC [00:07:00] administrator knows is one of the most politically charged negotiations in the building.

Number three, clinic and, uh, excuse me, clinical support and team composition. Appropriate staffing, infrastructure, and technology to support safe, efficient surgical care. Translation, are you adequately supporting your surgeons with the right scrub techs, instrument sets, and turnover teams? Or are you asking them to work in resource-constrained environments that are slowly grinding them down?

Number four, inpatient census limits. Safe patient coverage thresholds based on acuity and team structure. While this is more hospital-facing, it matters to the ASC administrators because surgeons who are overloaded in their hospital practice bring that exhaustion into your ORs. Five, fatigue mitigation and wellness supports.

And here’s the line that I want every administrator to hear directly. The framework says that flexibility after high-intensity call periods should be recognized as a patient safety [00:08:00] measure, not a discretionary wellness benefit. So listen to that one more time. The framework says that flexibility after high-intensity call periods should be recognized as a patient safety measure, not a discretionary wellness benefit.

This is the ACS putting into formal language what many of us have known intuitively. A fatigued surgeon is a patient safety risk. Protecting recovery time isn’t coddling, it’s good medicine and good operations. And finally, number six, compliance and administrative burden. Fair compensation for required non-clinical training and administrative responsibilities.

For ASC administrators, this is a signal to look at how much paperwork, compliance documentation, and credentialing overhead you’re generating for your surgeons, and whether any of it can be reduced or absorbed by your administrative team. Here’s the scale of what the ACS is attempting. They have already had formal conversations with more than a dozen other medical associations, all of which are preparing their own manuscripts using [00:09:00] this framework as the foundation.

This is intended to become the national standard across surgical specialties. The ACS CEO, Dr. Patricia Turner, said it plainly, “The long-term sustainability of the surgical workforce requires, quote, ‘a cultural and operational shift from informal expectations to transparent standards,’ end quote. That shift is coming.

The question is whether your surgery center gets ahead of it or gets caught off guard by it

So let’s bring this full circle and share what this means for you right now. You’re an ASC administrator. You run a tight ship. You care about your surgeons, your staff, and your patients. What do you actually do with all this information? First things first, you gotta audit your specialty mix for attrition risk.

Go look at your active surgeon roster and tag every surgeon by specialty. If you’ve got OB-GYNs, plastic surgeons, or oral or maxillofacial surgeons affiliated with your center, you’re in the highest [00:10:00] attrition subspecialties. What is your succession plan if one of them leaves in the next three years? Do you have a pipeline?

Are you engaged in your relationships with residency programs? This should be a board-level conversation. Next, number two, pay attention to your mid-career surgeons. The five- to nine-year mark is the danger zone according to this research. Excuse me. These are surgeons who have made it through the grind of early practice, they’ve built a patient base, and are now asking whether this is really su-sustainable long term.

Are you checking in with them? Do you know their frustrations? Are there operational changes you can make at your center that would remove friction from their day? A fifteen-minute conversation with a surgeon who is quietly burning out could prevent a multi-year recruitment and credentialing nightmare.

Number three, read this ACS framework and use it as a conversation starter. Of course, we’re gonna have the link to this in the show notes, but you gotta understand, you don’t [00:11:00] have to wait for your specialty societies to adopt this. You’re gonna download this article, read the six domains, and bring it to your medical advisory committee or your surgery department head and ask, “Are we meeting these standards at our center?

Where are the gaps?” This is a chance to be proactive, to position your ASC as a place that takes surgeon sustainability seriously. This is a competitive recruitment advantage

Fourth, treat fatigue mit-mitigation as an operational variable, not a soft benefit. The ACS framework was explicit on this. If your scheduling model relies on surgeons doing back-to-back heavy case days without recovery time, you are running a patient safety risk and a retention risk simultaneously.

Look at your block scheduling, your turnaround expectations, and your after-hours demands. There’s likely room to make changes that benefit your surgeons, your patients, and your center’s outcomes all at once. And finally, number five here, watch the rural access trend. [00:12:00] The share of surgeons in rural and non-metro areas dropped from ten and a half to eight and a half percent over the study period.

If you operate in a rural or suburban market, this is a structural headwind. Plan for it. Partner with health systems, residency programs, telehealth networks, and specialty groups to build a diversified referral and recruitment pipeline before the gap becomes a crisis.

Let’s wrap it up here, folks. This has been great. Um, but the big-picture takeaway from today’s show is that the surgical workforce is shrinking relative to demand. Attrition is real and measurable, and now for the first time, there is a national framework to address it. As surgery center administrators, you sit at a unique intersection of clinical ops, physician relationships, and business strategy.

You have more influence over surgeon experience than almost any other stakeholder in the health system. The decisions you make about block scheduling, support staffing, administrative [00:13:00] burden, and culture at your center are direct inputs into whether a surgeon stays in practice or walks away. The data is in, the framework is out, and the question now is what you build with it.

So I’ll leave you with that. Thank you for listening. Once again, I’m your host, Erik Sunset, here at The DocBuddy Journal. Be sure that you’re subscribed on Apple Podcasts, Spotify, and YouTube, uh, so you always get all the newest episodes of the show. You can also get new episodes of the show on docbuddy.com.

Links to all of these documents and studies referenced in the show will be available in the show notes. And if this episode was useful, please do share it with colleagues. Until next time, thank you for listening. I’m your host, Erik. Take care.