An Association of American Medical Colleges (AAMC) report released in 2024 was so clear it was almost brutal: it predicted a shortage of 13,500 to 86,000 physicians by 2036. The worst news was that 10,000 to 19,900 individuals, or as much as 74% of the total shortfall, would be surgeons.1
This deficit could mean longer wait times, longer travel distances, and less timely care for patients in need of surgical procedures—situations exacerbated by the growing burden of chronic disease and rising median age among the US population. Without the physicians and surgeons needed to provide effective care, improving the health of US communities will be an overwhelming challenge.
How Shortages Might Arise
Physician shortfalls can be attributed to many factors, but three causes stand out: a medical school moratorium, the cap on federally funded surgical trainees, and an anticipated surge in retirement rates.
The moratorium had its origin in a report on the future of medical education issued in September 1980 by the Graduate Medical Education (GME) National Advisory Committee to the US Department of Health and Human Services. This report predicted an oversupply of 145,000 physicians by the year 2000.2
This posed a serious concern. An oversupply could impede physicians’ abilities to advocate for adequate work conditions, appropriate compensation, and even high-quality patient care.
As a result, a self-imposed moratorium among US medical schools followed. Starting in 1981, medical student enrollment was maintained at approximately 16,000 seats per year,2 and no new medical schools were established to avoid training more physicians than the country needed.
In response to the predicted surplus of physicians, Congress also acted to limit federal support for GME in the Medicare program. The Balanced Budget Act of 1997 capped the number of Medicare-supported residency positions at the levels that existed in 1996.
Since the federal government was and still is a primary source of funding for GME, this cap has further limited the number of physicians. In addition, GME slots are tied to their sponsoring institutions, and this freeze has locked in training in the geographic areas where programs were established—often far from areas experiencing the highest rate of population growth, such as Florida and the Southwestern US.3
The predicted oversupply did not materialize. By 2005, the moratorium had lasted for a quarter century. In that time, the US population had grown by 70 million people, medicine had specialized more extensively than ever before, and the logic of permitting zero growth among medical students had begun to seem misguided.
In addition, an aging population facing a growing burden of chronic diseases, such as cardiovascular disease, cancer, obesity, and diabetes—diseases that often require surgical treatment—has increased the demand for physicians, and especially surgeons.
Instead of an oversupply, the combined shift in physician training and population needs had created a shortage of surgeons.
Too Little, Too Late?
Medical schools responded by lifting the moratorium. Existing schools quickly added seats to incoming classes and additional campuses, and entirely new schools sprang up. By 2020, a new plateau of nearly 21,000 annual graduates of MD-granting institutions had been reached—approximately 30% above the previous level of 16,000.4
Accordingly, the number of resident physicians increased, too, from about 108,000 in 2008–2009 to approximately 158,000 in 2022–2023, according to the Accreditation Council for Graduate Medical Education (ACGME) data, an increase of approximately 46%.5 (These data include international and US medical graduates.)
Per the AAMC, the number of active physicians grew from 766,000 to more than 949,000 (24%) between 2005 and 2024.5 Because the US population increased approximately 16% in the same period, it appeared that physicians were growing at a pace at least somewhat well-matched to population needs, offsetting the relatively small numbers educated between 1980 and 2005.
But not all specialties have grown at the same pace. While the number of surgical residents grew by approximately 37% (from about 21,000 in 2007–2008 to 29,000 in 2022–2023),5 the population of practicing surgeons rose by less than 10%, from approximately 142,000 to 155,000 surgeons.6
In addition, the limitation on the number of Medicare-supported GME positions has remained in place, which limits the growth of the medical profession. The government has acted only recently—and insufficiently—to ease these limitations. In the Consolidated Appropriations Acts of 2021 and 2023, Congress approved a combined total of 1,200 new positions. As of last year, only half of these positions have been allocated to teaching institutions nationwide. Among healthcare professionals, concerns are growing that the slow pace of GME expansion will bottleneck the training of US and international medical graduates.
According to National Resident Matching Program (NRMP) data, in 2025, 99.8% of the available 1,778 surgical positions were filled on Match Day.7 However, the NRMP noted that approximately 20% of applicants, including more than 6% of US seniors in programs granting medical doctorates or doctorates of osteopathy, were unsuccessful in securing postgraduate positions across all specialties.7
The US needs those trainees. Using 7.5 general surgeons per 100,000 population as a benchmark, AAMC data now show that 21 states have fewer than the necessary number of general surgeons, a shortage that may be related to the cap on medical school enrollment in earlier years.8
At present, this has led to the view that rather than a surgeon shortage, a maldistribution of surgeons that overconcentrates resources in urban areas to the detriment of rural communities, may be a more pressing issue. A 2018 Health Resources and Services Administration (HRSA) report to the Senate Appropriations Committee found that rural areas nationwide had on average only 69% of the general surgeons needed to meet demand, while large metropolitan areas had more general surgeons than strictly required to meet the needs of urban populations.9 (Read the April 2024 Bulletin article, “Physician Workforce Data Suggest Epochal Change,” for more details.)
The problem will take time to fix. For disciplines such as general or orthopaedic surgery, full training includes approximately 9 years of medical school and residency. With many academic training programs requiring 2 years of research training and 1–2 years in a fellowship, a surgeon may train for 14 years. Policies to address surgeon shortages, whether at the current or predicted future levels, need to account for this.
