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.
Introduction:
Healthcare access varies dramatically across the United States, with rural and underserved populations facing notable barriers to timely, specialized care. The proximity of physician training affects the overall workforce distribution; however, this trend has not been assessed within orthopaedic surgery. This study investigates the impact birthplace and training location have on future practice location among US orthopaedic surgeons and characterizes the per-capita workforce distribution.
Methods:
Eight thousand, six hundred seventy-six orthopaedic surgeons who completed residency training between 2004 and 2017 were identified from the American Medical Association Physician Masterfile. Demographic and practice data were extracted, including birthplace, medical school, residency and attending practice as of January 1, 2023. Locations were stratified by state and census division.
Results:
The cohort represented 94.84% of orthopaedic surgeons trained nationally during the study period. Attendings returning to their state of birth, medical school, or residency to practice were 21.7%, 31.8%, and 33.9%, respectively, with pronounced state-level variability (birthplace: 2.50% to 47.95%; medical school: 3.94% to 61.8%; residency: 11.71% to 63.95%). Indiana (pop:6,880,131) trained the fewest residents per capita (1:1.15 million), whereas neighboring Ohio (pop:11,824,034) ranked fifth nationally (1:191,000). Univariate logistic regression revealed notable associations ( P < 0.01) between practice location by census division at all career stages. Attending distribution per capita showed strong correlations by state (R 2 = 0.98) and census division (R 2 = 0.99), whereas birthplace (R 2 = 0.71), medical school (R 2 = 0.53), and residency (R 2 = 0.63) showed moderate association.
Discussion:
This study demonstrates that birthplace and training location are strongly associated with practice location for US orthopaedic surgeons. Despite variation in trainee numbers by state, the distribution of practicing surgeons normalizes relative to state population, likely driven by economic incentives, local workforce demands, and market conditions. Given the strong statistical association for surgeons to practice near their training location, aligning local programs with underserved or high-need areas may offer a potential solution to reduce regional disparities and improve access to orthopaedic care.
