A national assessment of the pediatric surgery workforce and practice structure in the United States
Kenneth W Gow1, Abigail E Martin2, Sung-Gheel Jang3
1Division of Pediatric Surgery, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY 11794, USA.
Insights
The U.S. pediatric surgery workforce includes fellowship-associated (FA) and non-fellowship-associated (NFA) practices. NFA practices significantly improve geographic access, reducing travel for millions of children needing surgical care.
Area of Science:
- Pediatric Surgery Workforce Analysis
- Healthcare Access and Equity
- Surgical Practice Models
Background:
- Pediatric general surgeons are vital for child healthcare, but the U.S. workforce structure and geographic distribution are not fully understood.
- Characterizing pediatric surgery practices, including fellowship-associated (FA) and non-fellowship-associated (NFA) models, is crucial for assessing care delivery and access.
Purpose of the Study:
- To conduct a national assessment of the U.S. pediatric surgery workforce.
- To examine the composition, resources, and roles of FA and NFA practices.
- To understand the implications for geographic distribution and access to pediatric surgical care.
Main Methods:
- Identified 248 pediatric surgical practices nationwide using multiple data sources.
- Collected data on surgeon numbers, advanced practice provider (APP) utilization, and practice locations.
- Compared workforce distribution with U.S. Census data and modeled travel distances to assess access.
Main Results:
- The U.S. has 1191 pediatric surgeons across diverse practice sizes; APPs are common (79%), and locum tenens (LT) use is notable (24%).
- Fellowship-associated (FA) practices are larger and resource-rich, while non-fellowship-associated (NFA) practices are more numerous and geographically dispersed.
- Including NFA practices drastically reduces median travel distances by over 50% and decreases the population living >60 miles from care from 43% to 13%.
Conclusions:
- Pediatric surgery practices, both FA and NFA, have distinct strengths that are complementary.
- NFA practices are essential for expanding geographic reach and ensuring equitable access to pediatric surgical services.
- Data support informed workforce planning and policy to maintain timely surgical care for children.
Purpose:
Pediatric general surgeons provide essential specialized care for children, yet the structure, geographic distribution, and access implications of U.S. pediatric surgery practices remain incompletely characterized. This study presents a national assessment of the pediatric surgery workforce, examining practice composition, resources, and the complementary roles of fellowship-associated (FA) and non-fellowship-associated (NFA) practices in delivering care.
Methods:
Individual pediatric surgical practices were identified through multiple sources, including the American Pediatric Surgical Association membership directory. Practices were contacted to obtain data on surgeon composition, advanced practice provider (APP) utilization, locum tenens (LT) use, and the number of hospitals, clinics, consultation sites, and operating locations covered as of July 31, 2025. Practice locations were geocoded by zip code. Workforce distribution was compared with 2020 U.S. Census data on the pediatric population to calculate children-per-surgeon ratios by state. Travel distance modeling assessed access to care with FA practices alone and with NFA practices added. Data are presented as medians [interquartile range].
Results:
A total of 248 practices employing 1191 pediatric surgeons were identified across all states and the District of Columbia. Practice size varied widely (median 3.5 [2.0-6.0] surgeons). APPs were employed in 79% of practices, while 24% relied on LT coverage. State-level child-to-surgeon ratios showed substantial variability, with nearly half of the states having ratios that were either lower or higher than expected. Fifty-two practices (21%) were FA, and 196 (79%) were NFA. FA practices had significantly more surgeons, greater APP support, and broader institutional coverage across hospitals, clinics, and operating sites (all p < 0.0001). NFA practices, however, were more widely distributed geographically. Access modeling showed that including NFA practices reduced median travel distances for families by more than 50% and cut the share of children living more than 60 miles from surgical care from 43% to 13%, affecting approximately 32 million versus 5 million children.
Conclusion:
The U.S. pediatric surgery workforce comprises diverse practice models with distinct but complementary strengths. FA practices provide infrastructure-intensive care, while NFA practices substantially expand geographic access. Together, they form an interdependent national network critical to equitable pediatric surgical care. These findings provide essential data to inform workforce planning, policy initiatives, and strategies to preserve timely access to surgery for children.
