Abstract
e13517Background: Surgical care remains central to solid cancer treatment in adults. A shortage of surgeons, including in rural regions, poses a challenge to cancer treatment. The American Board of Surgery's stated aims are to serve patients, society, and the specialty of surgery by setting standards in surgical education and practice. We evaluated the distribution of ABS-identified surgeons in USA by rurality of ZIP code to inform strategies to strengthen the surgical workforce and improve nationwide cancer care access. Methods: After ABS and institutional IRB approval, we linked data from ABS and US Census Bureau to identify rural-urban differences in surgeon supply, demographic profiles, and training backgrounds in the USA. US Census 2020 data was used to align variation in ABS-identified surgeon (regardless of current certification status) distribution across ZIP codes with USDA Economic Research Service rurality designations and aggregated as 50 state composites. ABS surgeon counts were converted to rates per 100,000 state population. Rurality was quantified as the percentage of state population living in US Census Bureau-defined rural areas. The association of state-level rurality and surgeon rates were compared using a gamma regression model. Results: ABS general surgery data accessed March 2025 listed 20,478 surgeons with designated addresses ("ABS-identified"), of whom 16,639 (81.3%) maintained active ABS certifications. In analyses of US Census and ABS data, there was no unadjusted association between percent rural population and the rate of ABS-identified surgeons per 100,000 state population (p = .693). A high degree of variation was observed in the urban and rural workforce overall; pronounced inter-state variation was noted, even between states with similar degrees of rurality. However, a strong correlation was noted between relative rurality of state and higher % of ABS-identified rural surgeons (Pearson r = 0.73). Conclusions: Surgery remains a crucial element of cancer care. Variation in surgeon and health care worker supply exist in the USA, along with variation in cancer screening, diagnosis, and outcomes. Our work demonstrates the complexity of combating previously described inferior cancer results in rural populations with simple numeric workforce calculations including surgeons per geographic unit. Further work should assess the contribution of factors including rural isolation, distance to provider and center, feasibility of patient travel for care, and potential outreach strategies. Understanding variability in the workforce available for cancer surgery will be necessary to improve access to guideline-directed cancer care across our entire population, including in rural regions, and will be essential to improving cancer outcomes in the USA. (The expertise of Carol L. Barry, PhD, of the American Board of Surgery, is gratefully acknowledged).