Abstract
Surgical workforce shortages represent a consequential but underrecognized threat to healthcare access, hospital viability, and health system stability in rural communities across the US. Although rural health policy has historically focused on primary care shortages and hospital closures, the role of surgical care as a foundational component of rural health systems has received comparatively limited attention. Drawing on insights from the 2025 Access in Rural Surgery Symposium hosted by Creighton University and CHI Health, this policy analysis applies the Health Policy Triangle framework to examine the contextual factors, stakeholders, policy landscape, and advocacy processes shaping the rural surgical workforce. Across three domains (training pathways, health system stability, and workforce retention) the analysis identifies persistent deficiencies in rural surgical education, highlights the central role of surgeons in sustaining rural hospitals and regional healthcare capacity, and examines policy opportunities to strengthen recruitment, retention, and coordinated advocacy. Addressing the rural surgical workforce crisis will require policies that extend beyond expanding surgeon supply to improve workforce distribution, support rural training and practice, and recognize surgery as an essential pillar of rural health system sustainability.