Locum tenens coverage and access to pediatric surgical care in the United States

Workforce shortages and geography may limit access to pediatric surgical care. Locum tenens (LT) surgeons help fill staffing gaps, yet their role in pediatric surgery remains poorly defined. This study evaluates the prevalence, practice settings, and clinical coverage of LT pediatric surgeons to inform workforce planning and access strategies.

The American Pediatric Surgical Association (APSA) membership list was used to identify United States pediatric surgery practices. Each practice was contacted to obtain data on surgeon composition, use of LT, advanced practice providers (APPs) composition, and the number of hospitals, clinics, consultation sites, and operating rooms covered as of July 31, 2025. Service locations were geocoded by zip code. Values are expressed as median and interquartile range [IQR]. Comparisons between practices using and not using LT were done by Mann-Whitney U tests, with p < 0.05 considered significant.

Of 248 practices, 59 (23.8%) reported using LT. LT practices are in 29 of 50 states and the District of Columbia (56.9%), most commonly in Florida (n = 6), Texas (n = 5), New Jersey, and Pennsylvania (n = 4 each). LT surgeons cover a median of 1 [1-1] hospital. Compared with non-LT (NLT) practices, groups using LT were significantly smaller (median 2 [2-3] vs. 4 [3-6.5] surgeons, p < 0.001) and less likely to host a fellowship (8.5% vs. 24.9%, p = 0.006). They covered fewer hospitals, clinics, consultation sites, and operating sites (all p < 0.01). APP employment and practices that cross state lines were similar between groups. Maintaining LT-supported practices substantially improves access, reducing median travel distances by almost half (from 48.6 to 29.2 miles across state lines and from 51.5 to 31.3 miles within state lines). The proportion of children living >60 miles from surgical care dropped from 19.9% to 6.7%, reducing the number affected from ∼14.5 million to about 5 million.

LT surgeons play a critical role in pediatric surgery, expanding access and reducing travel distances for children, particularly in smaller, non-fellowship practices. While LT reliance helps fill gaps, it also highlights potential workforce vulnerabilities. Understanding LT utilization is essential for planning a resilient pediatric surgical workforce and ensuring equitable care nationwide.