J Am Coll Surg
One in 10 surgeons leave practice within eight years
Clinical Takeaway: Surgeon attrition is concentrated in specific subspecialties and career stages, not evenly distributed. Retention efforts focused on ob-gyn, oral and maxillofacial, and plastic surgery, as well as surgeons 10 to 14 years into practice, may have an outsized impact.
The U.S. faces a projected surgeon shortage estimated at 10,000 to 20,000 over the coming decade, set against an aging workforce and constrained training pipeline. Whether the loss is evenly spread or concentrated in specific specialties and career stages has been poorly defined. This national analysis tracked who is leaving active surgical practice, when, and from which fields.
Nearly one in 10 surgeons (9.7%) exited active clinical practice over a median eight-year follow-up. Five-year cumulative attrition reached 25.1% in oral and maxillofacial surgery, 23.2% in ob-gyn, and 19.3% in plastic and reconstructive surgery. Orthopedics, ENT, podiatry, and vascular surgery held steady, with five-year cumulative attrition under 4% each.
The most striking pattern was by surgeon career stage. Those 10 to 14 years into practice had more than double the attrition hazard of those five to nine years in. Late-career surgeons with 15 to 19 years in practice were the least likely to leave. The authors describe this as a "mid-career spike" and link it to the period of highest burnout, heaviest administrative burden, and competing leadership and family demands. Interestingly, gender was not associated with attrition.
The study linked Medicare billing files to the national provider database from 2013 to 2023, identifying 224,629 surgeons across 19 subspecialties. Attrition was defined as the first year a previously active surgeon was followed by three consecutive years with fewer than 50 evaluation and management services billed.
The workforce composition also shifted over the decade. The proportion of women rose to 29% from 21%, while the proportion practicing in rural or non-metropolitan areas dropped to 8.5% from 10.5%. The rural decline is particularly concerning given longstanding access gaps in those communities.
The findings argue against one-size-fits-all retention strategies. High-attrition subspecialties face distinct drivers, including malpractice exposure in ob-gyn, heavy emergency call volume in oral and maxillofacial surgery, and market competition in plastic surgery. Mid-career retention may require different interventions than late-career, focused on work control, administrative friction, and aligning clinical and leadership responsibilities.
“Surgeons deliver a disproportionate amount of high severity, sensitive health care, which is especially critical right now in a country with an aging population,” said Timothy Pawlik, MD, MPH, PhD, FACS, a surgical oncologist at The Ohio State University Wexner Medical Center, and co-author on the study. “These findings show that surgical attrition is a real problem, and that we need to address it in a nuanced and tailored way.”
Source: Elemosho A. J Am Coll Surg. 2026 May 20. A national analysis of trends and factors associated with surgeon attrition in the United States