General surgery residency expansion does not systematically scale with population growth across U.S. regions: a national analysis, 2013–2024

Abstract Purpose General surgery residency positions are disproportionally concentrated in urban centers, potentially limiting resident case exposure and operative preparedness. As the national per capita supply of general surgeons declines, rural regions have a disproportionately older workforce with insufficient replacement. Residency programs with rural training exposure improves rural retention yet recent trends in regional allocation of the general surgery resident workforce relative to population growth remains poorly defined. Here, we perform a retrospective review to investigate whether regional differences in general surgery resident workforce allocation align with population changes across U.S. regions. Methods We performed a retrospective review of publicly available data from the National Resident Matching Program and the United States Census Bureau spanning 2013–2024. General surgery resident workforce is approximated by entering residency positions per capita. Regions are defined according to U.S. Census Bureau divisions. The strength and direction of a linear relationship between percentage change in entering general surgery residency positions per capita and percentage change in population from 2013 to 2024 was assessed by Pearson Correlation Coefficient. Differences in these percentage changes were assessed by paired t-tests. Results The national mean percentage change in entering residency positions per capita and population from 2013 to 2024 was 1.35% and 0.48%, respectively. There was no significant difference between workforce and population changes across regions ( p > 0.05). Regionally, New England demonstrated a significant decline in residency positions per capita, whereas several regions, including the Mid-Atlantic and South Atlantic, showed significant growth over time ( p < 0.001). Workforce allocation relative to population varied by region, with the strongest positive correlation observed in the East North Central region ( r = 0.63) and the most negative in the East South Central region ( r = − 0.57). Conclusions U.S. general surgery resident workforce allocation from 2013 to 2024 varies by Census Bureau regions and does not systematically scale with population growth. Heterogeneity in allocation highlights regional disparities in training environments and access to surgical care.