A National Assessment of the Pediatric Surgery Workforce and Practice Structure in the United States.
Publication/Presentation Date
7-16-2026
Abstract
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 1,191 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.
First Page
163289
Last Page
163289
ISSN
1531-5037
Published In/Presented At
Gow, K. W., Martin, A. E., Jang, S. G., Greene, A. C., Vu, M. T., Hamilton, N. A., Ladd, M. R., Lotakis, D. M., Robie, D. K., Romain, C., Edwards, M. J., Kennedy, A. P., Jr, Zagory, J. A., Sutyak, K. M., Fallat, M. E., Zeug, A., Chandler, N. M., Badru, F. O., Wadie, G., Iocono, J., … DeRoss, A. L. (2026). A National Assessment of the Pediatric Surgery Workforce and Practice Structure in the United States. Journal of pediatric surgery, 163289. Advance online publication. https://doi.org/10.1016/j.jpedsurg.2026.163289
Disciplines
Medicine and Health Sciences | Pediatrics
PubMedID
42462998
Department(s)
Department of Pediatrics, Department of Surgery
Document Type
Article