Every workers’ compensation claim involving a serious injury eventually runs into a question of access: Is there a surgeon available to operate, and how soon? Surgeon supply drives surgical wait times, which drive temporary disability duration, return-to-work timelines, and ultimately claim cost.
A new study “National Analysis of Trends and Factors Associated with Surgeon Attrition in the US” published in the Journal of the American College of Surgeons (2026, published ahead of print) is the largest national look to date at how surgeons are leaving active practice — and it gives a data-backed sense of where the supply pressure is, and is not, building.
The team of researchers tracked 224,629 surgeons across 19 surgical specialties using Medicare billing data from 2013 through 2023, following them for a median of 8 years. They defined “attrition” as a surgeon who stopped showing meaningful clinical activity (fewer than 50 evaluation-and-management services per year) for three straight years. They then used statistical modeling to identify which factors predicted leaving practice.
Nearly one in ten U.S. surgeons left active practice over eight years, but the loss is concentrated — heaviest among mid-career surgeons and a handful of specialties, lightest in the orthopedic and podiatric fields that drive most workers’ comp surgical care. The supply picture is best understood specialty by specialty, not as a single national number.
– – Roughly 1 in 10 surgeons (9.7%) left active clinical practice over the 8-year window. That works out to about 15,753 surgeons.
– – Annual attrition held steady at 1.5–1.7% per year from 2013 to 2018, then spiked to 2.5% in 2019 before dropping to 1.3% in 2020. The authors attribute the spike largely to the early COVID-19 period.
– – If that rate holds, the authors project a loss of roughly 2,000 surgeons per year — about 25,000 to 30,000 over the next decade.
– – The workforce is aging: median years in practice nearly doubled from 7 (2013) to 16 (2023).
– – The share of women surgeons rose from 21% to 29%.
– – Rural surgical presence shrank — from about 10.5% of surgeons in rural/non-metro areas in 2013 to 8.5% in 2023.
The detail that matters most: it varies enormously by specialty. Attrition is not uniform — and for workers’ compensation purposes, the differences cut in a reassuring direction for the specialties that are critical..
High-attrition specialties 5-Year Cumulative Attrition
– – Oral & Maxillofacial Surgery – 25.1%
– – Obstetrics & Gynecology – 23.2%
– – Plastic & Reconstructive Surgery – 19.3%
Low-attrition specialties 5-Year Cumulative Attrition
– – Otolaryngology (ENT) – 1.8%
– – Podiatry / Foot & Ankle – 1.8%
– – Orthopedic Surgery – 2.4%
– – Vascular Surgery – 3.1%
The specialties that handle the bulk of occupational injuries — orthopedic surgery, podiatry/foot-and-ankle, and to a lesser extent vascular and neurosurgery — show among the lowest attrition rates and the shallowest decline curves. Orthopedics in particular, the workhorse of musculoskeletal injury care, is a relatively stable specialty in this data. That’s encouraging for surgical access on most lost-time claims.
The authors suggest the high-attrition specialties are pressured by heavy call burdens, malpractice exposure, market competition, and the availability of non-clinical career exits — while the more stable specialties tend to offer more predictable schedules and clearer paths to dialing back late-career rather than leaving outright.
One of the more surprising results: attrition does not rise steadily with age. Instead, surgeons 10–14 years into practice were more than twice as likely to leave as those 5–9 years in (hazard ratio 2.58). Both newer surgeons (under 5 years) and those 15–19 years in were less likely to leave. The authors link this “mid-career spike” to peak burnout, administrative burden, and competing leadership and family demands.
Other notable findings
– – Sex made no difference. Female and male surgeons left at essentially identical rates (HR 0.99) — contrary to some prior studies in academic medicine.
– – Geography mattered modestly. Compared to the Northeast, surgeons in the South had somewhat lower attrition; the West was slightly higher. Rural versus urban differences were small in the adjusted model.
– – Surgical access for orthopedic and podiatric claims looks comparatively secure based on this data — useful context when evaluating treatment-delay arguments or utilization-review timelines.
– – Rural claims face a compounding squeeze. Fewer surgeons in non-metro areas means longer travel and potential delay for injured rural workers — a recurring access issue worth flagging in case management.
– – Provider relationships are fragile mid-career. Networks and treating-physician arrangements built around a single surgeon carry succession risk.
A key caveat the authors flag: because the data is administrative billing data, they cannot always tell the difference between a true retirement, a move to a non-clinical or part-time role, or a shift in how someone bills. So “attrition” here means departure from active clinical surgical practice as Medicare sees it — not necessarily retirement.