The evolving sex, race, and ethnic composition of the surgical workforce: North Carolina is a bellwether of national change

  • Erin P. Fraher
    Reprint requests: Erin Fraher, PhD, MPP, Cecil G. Sheps Center for Health Services Research, 725 MLK Jr Blvd, CB# 7590, Chapel Hill, NC 27599-7590.
    Departments of Family Medicine and Surgery, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, NC
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Published:March 20, 2021DOI:



      North Carolina, as a state with a significant Black population and fast-growing Hispanic population, serves as bellwether of demographic changes nationally and the challenges facing the nation to recruit and retain a general surgery workforce that mirrors the population.


      Annual licensure data from the North Carolina Medical Board were analyzed between 2004 and 2019. Physicians self-reporting a specialty of abdominal surgery, critical care surgery, colon and rectal surgery, general surgery, trauma surgery, proctology, and surgical oncology were categorized as general surgeons.


      Female surgeons made the most gains from 2004, at just 8% of the workforce in 2004 to 26% of the workforce in 2019. Over the same period, Black surgeons increased from just 5% to 6% of the workforce, with those gains largely represented by Black female surgeons. Almost half of North Carolina’s Black physicians are aged 46 and 55 and will be nearing retirement in the coming decade. Nearly two-thirds (64%) of Hispanic general surgeons were 45 or younger, and one-third of these young surgeons were international medical graduates.


      Although the general surgery workforce in North Carolina is slowly diversifying, growth in the Black surgeon workforce has stagnated in the last 15 years at levels much lower than their representation in the population. More research is needed on the individual and life course phenomena that drive this underrepresentation.

      Graphical abstract

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