This analysis synthesizes 7 sources published the week ending Oct 7, 2026. Editorial analysis by the PhysEmp Editorial Team.
A gastroenterology task force reported in late September that the United States has 98% of the GI physicians it needs. In the same news cycle, a health system in California’s Central Valley announced a new GI fellowship specifically because it cannot find enough specialists. Both facts are true, and the distance between them is the central problem in the Healthcare Workforce & Labor Market right now: shortage is usually reported as a national number, but it is experienced, and priced, at the level of a county.
A national average that hides a 109% metro surplus
The American College of Gastroenterology task force put national supply at 98% of need, with metropolitan counties at 109% and nonmetropolitan counties in severe shortage. A 98% national figure with a 109% metro figure means the nonmetro deficit is being averaged away. The report’s description of what follows is concrete: rural gastroenterologists are consumed by procedure demand, leaving little room for outpatient clinic work, and advanced practice providers are filling that outpatient gap without adequate training or support.
Orthopedics shows the same split on a larger scale. Projections cited by Becker’s Spine have nonmetro areas at 52% workforce adequacy by 2036 against 95% in metro areas, and nine states already have fewer than three orthopedic surgeons per 100,000 residents, with Idaho at 1.55. The same roundup notes that BLS counts of employed orthopedic surgeons fell from 16,260 in 2021 to 14,100 in 2025, while a journal projection has supply down 2% and demand up 13% through 2036.
When a specialty’s national supply is near 100% of need, the shortage has not gone away. It has moved to the counties where no employer can offer enough volume, support staff or peer coverage to make the job workable.
Demand growth is not hitting every specialty equally
The national picture still matters, because the specialties differ sharply. A Case Western Reserve study, summarized by Hoodline, projects a deficit of nearly 28,000 surgeons by 2038, with supply falling 4% while demand rises 12%. Across ten surgical disciplines, the share of demand met ranges from 98.3% in colorectal surgery and 91.3% in general surgery down to 74.1% in plastic surgery, 73.1% in thoracic, 71.8% in ophthalmology and 65.8% in vascular surgery.
That spread matters for anyone treating “surgeon shortage” as a single labor market. Vascular surgery being a third short and colorectal surgery being nearly whole are different recruiting problems with different timelines. The study’s root cause is shared, the Medicare residency funding cap set in 1997, but its effects land unevenly because training capacity, procedure volume and patient age profiles differ by specialty.
Who is missing, and where the economics point
An analysis of Appalachia’s dermatologists adds the missing economic variable. Researchers found that 277 of 423 counties, 65.5%, have no dermatologist, and the top ten counties hold 47% of the region’s 870. Among counties classified as distressed, 90.9% lack a dermatologist; among the three counties classified as attainment, none do.
The pattern tracks county economics more than it tracks headcount. This is where mainstream coverage of workforce issues is incomplete. Stories on physician shortages overwhelmingly propose more medical school seats or residency slots, which add to national supply. The dermatology data suggests that new supply tends to settle where practice economics already support it, so adding specialists without changing what a rural or distressed-county practice can sustain risks widening the 98%-versus-109% gap rather than closing it.
Nevada illustrates a second version. Fox5 reports that the state has the lowest radiologist density in the country, 9 per 100,000 people, and that University Medical Center started a four-year diagnostic radiology program that admits four residents a year, for 16 at full capacity. A local radiologist told the station AI tools cannot replace a radiologist, because every result still needs human review. Here the constraint is a training pipeline measured in single digits, set against rising imaging volume.
Training sites are becoming the recruiting strategy
Employers in undersupplied regions appear to have reached the same conclusion about where specialists come from. Adventist Health opened applications on October 1 for an ACGME-accredited three-year GI fellowship based at Adventist Health Tulare, its first specialty fellowship, selecting two physicians. Its ambulatory medical officer said physicians are more likely to practice where they complete training. Kern County shows the baseline that motivates this: 47 primary care physicians per 100,000 residents against 60 to 80 statewide, and Kern Medical describes 2026 as a record year, with more than 250 residents, fellows and medical students across 13 programs, because many trainees stay.
The scale is worth stating plainly. Two fellows over three years will not close a regional gap. But the move shifts the recruiting model from competing for finished specialists in a national pool, where metro systems with 109% supply have the advantage, to growing a local supply that has existing ties to the community.
A fellowship class of two is trivial against a national deficit and meaningful against a single county’s. Pipeline programs pay off in local markets first, which is why they are a rural employer’s tool more than a national policy fix.
What the geography changes for physicians and employers
For a specialist weighing a move, the data points to a distinction that national salary surveys do not capture. In a nonmetro county where the specialty sits well below need, the hospital has few alternatives to the physician in front of it, which should shape what a candidate asks for in call coverage, support staff and procedural volume. The GI report’s finding that rural gastroenterologists have little clinic capacity left after procedures is a workload question a candidate can probe before signing.
For executives and recruiters, the same data argues for tying a posting to a training relationship rather than a job board. If distribution follows county economics, employers in distressed or nonmetro areas are competing against a structural pull toward larger markets, and a fellowship or residency track is one of the few tools in the sources that directly addresses it.
What to watch
The gap between 52% nonmetro adequacy and 95% metro adequacy in orthopedics is the number that will show whether any of this works. If new residency slots and local fellowships are effective, that ratio should narrow in the next round of projections. If it holds, the national supply figure will keep improving while the counties furthest from a metro area see little change, and vascular surgery’s 65.8% will become a harder number to recruit against than any headline suggests.
Sources
The U.S. has 98% of the GI physicians it needs. So where’s the shortage? – Becker’s ASC Review
The orthopedic surgeon shortage in 9 numbers – Becker’s Spine
US Could Lose 28,000 Surgeons by 2038, With Vascular Care Hit Hardest – Hoodline
Two-Thirds of Appalachian Counties Have No Dermatologist, Registry Analysis Finds – Bioengineer.org
How Las Vegas radiologists are using AI as valley sees doctor shortages – Fox5 Vegas
Kern County has 47 primary care doctors per 100,000 residents, Kern Medical says – Bakersfield Now