Across the country, millions of Americans live in communities where access to a surgeon is limited or nonexistent. For rural hospitals, this creates a significant challenge – recruiting and retaining surgeons, maintaining consistent coverage, and ensuring patients can receive the care they need close to home.
In this series, I’ll explore the challenges underserved rural communities face across healthcare service lines and highlight how organizations like Rural Physicians Group (RPG) can help address these gaps. In Part 1, we’re focusing on general & orthopedic surgery services and the growing need for sustainable surgical coverage in rural America.
A recent study from the American College of Surgeons and the University of North Carolina puts numbers behind a challenge rural hospital leaders have faced for years. In many parts of the country, there simply isn’t a surgeon close to home. Published in the Journal of the American College of Surgeons and presented at the ACS Clinical Congress 2026, the study analyzed surgeon availability by county as of April 2025. Fierce Healthcare covered the findings here.
The findings are striking:
- Approximately 15 million Americans live in counties without a general surgeon.
- Nearly 10 million Americans live in counties without a specialty surgeon.
- 38% of U.S. counties have no general surgeons.
- 30% of U.S. counties have no specialty surgeons.
- The study identified 434 critical access hospitals in rural counties without a recorded full-time surgeon.
These numbers highlight a significant access challenge for rural communities. When surgical services aren’t readily available locally, patients may have to travel farther for care, and hospitals face additional pressure to maintain services that are essential to their communities.
The study’s authors acknowledge that the data cannot fully capture surgical capacity or operative volume. They also call for further research into whether alternative staffing arrangements can help meet rural surgical needs beyond traditional recruitment and employment models. Study coauthor Dr. Thomas Tsai also points to longer-term solutions, including training surgeons in the communities where they are needed and ensuring reimbursement supports sustainable rural surgical practices.
These are important steps. However, developing the rural surgical workforce takes time, and hospitals facing immediate staffing gaps need solutions today.
What are we hearing from hospital leaders
In conversations with hospital leaders, I’ve heard firsthand how difficult it can be to recruit and retain surgeons. In many cases, the challenge extends beyond filling an open position. Hospitals are also working to maintain consistent coverage, manage provider burnout, and sustain productive surgical programs over time.
We typically see hospitals turn to RPG for general & orthopedic surgery support in a few common situations:
- Recruitment challenges: A hospital has struggled to recruit a surgeon and needs a dependable alternative to traditional hiring.
- Burnout or retirement: An existing surgeon is nearing retirement or experiencing burnout, and the hospital needs a sustainable plan to maintain coverage.
- Supplementing existing coverage: A hospital has surgeons in place but needs additional support to improve coverage and reduce the burden on its current team.
- Reestablishing surgical services: A hospital has lost its surgical program or gone without general or orthopedic surgery services and needs a path to bring those services back.
While each hospital’s circumstances are different, the underlying challenge is often the same: how do you maintain reliable surgical services in a rural community when recruiting and retaining individual surgeons is increasingly difficult?
How Does RPG Help Rural Hospitals with Surgical Services
At Rural Physicians Group, we built our general surgery & orthopedic surgery program to address these challenges. Rather than relying solely on recruiting an individual surgeon to fill a position, our model brings a core team of surgeons into a rural community to provide consistent, dependable coverage.
For hospitals, this approach can offer several advantages:
- More reliable coverage: A defined surgeon schedule helps hospitals plan around their surgical needs without placing the entire burden on a single provider.
- Reduced administrative burden: RPG manages physician scheduling and day to day provider related needs, allowing hospital leadership to focus on broader operational priorities.
- A more sustainable staffing model: A team-based approach can help reduce dependence on a single surgeon and provide a more structured path to maintaining services over time.
- Care closer to home: When clinically appropriate, patients can receive surgical care in their own communities. When a patient’s needs exceed the hospital’s capabilities, timely transfer to a higher level of care remains essential.
For rural hospitals, maintaining surgical services is about more than filling a staffing vacancy. It’s about supporting the hospital’s long-term ability to serve its community, helping patients access appropriate care locally, and giving hospital leaders a more sustainable approach to physician coverage.
Keeping Patients Local
The surgeon shortage highlighted in this study reinforces why rural hospitals need alternatives to traditional physician recruitment alone. While long-term workforce development remains critical, hospitals also need practical staffing models that help them maintain essential services today.
At RPG, our mission is to help rural hospitals deliver sustainable, high quality care close to home. Throughout this five-part series, we’ll highlight the healthcare challenges facing underserved rural communities and explore how RPG helps hospitals address them. In addition to our general and orthopedic models, we’ll take a closer look at our emergency medicine services, hospitalist services, and tele-specialist support.
If your hospital is struggling to recruit a surgeon, looking to reduce the burden on your existing surgical team, or planning for a future opening, I’d welcome a conversation. We can discuss your hospital’s needs, explore potential coverage options, and determine whether RPG’s model is the right fit.
Blog Author: Cody Patten
To learn more about RPG’s service lines, explore partnership opportunities, and discover how Rural Physicians Group® is helping strengthen rural healthcare, visit www.RuralPhysiciansGroup.com.
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