From Birth to Practice: Characterizing the Geographic Migration of US Orthopaedic Surgeons
Bryce E Duffett1, Anoop S Chinthala, Samuel T Jines
1From the Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, IN.
The Journal of the American Academy of Orthopaedic Surgeons
|March 24, 2026
Summary
Orthopaedic surgeons often practice near where they trained, influencing workforce distribution. Aligning training programs with underserved areas could improve access to specialized care.
Area of Science:
- Orthopaedic Surgery Workforce Analysis
- Medical Education and Practice Location
- Healthcare Access and Disparities
Background:
- Significant disparities in healthcare access exist across the US, particularly for rural and underserved populations.
- Physician training proximity impacts workforce distribution, a trend not previously assessed in orthopaedic surgery.
- Understanding factors influencing orthopaedic surgeon practice location is crucial for addressing regional care gaps.
Purpose of the Study:
- To investigate the impact of birthplace and training location on practice location among US orthopaedic surgeons.
- To characterize the per-capita workforce distribution of orthopaedic surgeons.
- To identify potential strategies for mitigating regional disparities in orthopaedic care access.
Main Methods:
- Analysis of 8,676 orthopaedic surgeons who completed residency between 2004-2017 using the American Medical Association Physician Masterfile.
- Extraction of demographic and practice data, including birthplace, medical school, residency, and attending practice location.
- Stratification of locations by state and census division to analyze workforce distribution patterns.
Main Results:
- Surgeons returning to their state of birth, medical school, or residency were 21.7%, 31.8%, and 33.9%, respectively, with significant state-level variability.
- Wide disparities in per-capita resident training were observed, with Indiana training the fewest (1:1.15 million) and Ohio ranking fifth (1:191,000).
- Strong correlations were found between attending distribution per capita and state (R²=0.98) and census division (R²=0.99), indicating practice location is linked to training and origin.
Conclusions:
- Birthplace and training location are strongly associated with practice location for US orthopaedic surgeons.
- While trainee numbers vary by state, practicing surgeon distribution tends to normalize with state population, influenced by economic factors and local demand.
- Aligning orthopaedic training programs with underserved or high-need areas presents a viable strategy to reduce regional disparities and enhance access to care.
