The spine surgeon shortage is often framed as a future problem. Some of the numbers, and surgeons’ experiences, suggest parts of it are already here.
Spine’s workforce is drawn from both orthopedic surgery and neurosurgery, making national workforce trends harder to capture in a single projection.
But recent workforce studies, federal projections and Becker’s reporting point in the same direction: demand is rising faster than the supply of specialists positioned to meet it.
Here are six warning signs:
1. Neurosurgeon supply is projected to barely grow as demand jumps. A workforce study published in the Journal of Neurosurgery projected the number of full-time-equivalent neurosurgeons would grow just 2.4% from 2022 to 2037, from 7,060 to 7,230.
Under the researchers’ status quo scenario, demand would rise 18% over that period to 8,310 neurosurgeons, leaving national workforce adequacy at 87%. If barriers to care were reduced for underserved populations, projected need would rise to 11,830 and workforce adequacy would fall to 61%.
The geographic distribution is also uneven, with metropolitan areas projected to remain better staffed than nonmetropolitan regions.
Vijay Yanamadala, MD, a spinal neurosurgeon with Hartford (Conn.) HealthCare, told Becker’s that some patients are already experiencing the consequences. “Patients already travel two to three hours for consultation in some regions,” he said.
2. Some communities are already losing spine surgeons faster than they replace them: Lali Sekhon, MD, PhD, a spine neurosurgeon at Reno (Nev.) Orthopedic Center, said the shortage is visible in his own market. “We have fewer spine surgeons now than when I first came to Reno in 2005,” Dr. Sekhon told Becker’s.
Retirements and departures have not been replaced quickly enough, he said. At the time of the January interview, a patient calling his office for an appointment would have been waiting until March. Dr. Sekhon said advanced practice providers are helping fill access gaps and expects AI to eventually absorb more routine tasks, but the underlying physician supply problem remains.
“Access is going to become one of the bigger issues,” he said.
3. The orthopedic pipeline is flashing its own warning signs: The U.S. had 16,260 orthopedic surgeons in 2021, according to Bureau of Labor Statistics data cited by Becker’s. By 2025, that figure had fallen to 14,100.
The Health Resources and Services Administration projects orthopedic surgery will reach an 88% workforce adequacy level by 2038, a 12% shortage. That matters directly to spine because orthopedic surgery is one of the two training pathways into the specialty. “The projected shortage in the number of practicing orthopedic surgeons is alarming,” Frank Aluisio, MD, of EmergeOrtho in Greensboro, N.C., told Becker’s. He warned that an aging population will simultaneously increase demand and put greater pressure on the surgeons who remain, potentially accelerating burnout and retirement.
4. One retiring surgeon may no longer be replaced by one new surgeon: The raw head count does not capture another shift: A retiring surgeon and an incoming surgeon may represent very different amounts of clinical capacity.
Leo Spector, MD, orthopedic spine surgeon and CEO of Charlotte, N.C.-based OrthoCarolina, said changing expectations around work-life balance are altering workforce math.
To replace one retiring senior surgeon, “we really need 1.5, sometimes two surgeons, as far as their work capacity,” he told Becker’s.
Scott Boden, MD, incoming dean at the Indianapolis-based Indiana University School of Medicine, has described a related dynamic. Senior surgeons retire with decades of speed, expertise and efficiency that cannot immediately be replicated by a physician just out of fellowship.
Replacing a 65-year-old surgeon with a 35-year-old surgeon, he said, is not necessarily a one-for-one exchange in productivity. That means practices can add a surgeon and still lose effective capacity.
5. Training programs are expanding, but creating a spine surgeon takes years: Demand for orthopedic training itself is not disappearing. Every orthopedic surgery residency position in the 2025 Match was filled, and the specialty had 4,437 active residents during the 2024-25 academic year, according to data previously reported by Becker’s.
Some of the largest programs are adding capacity. New York City-based NYU Langone Orthopedics increased its residency class from 14 to 16 residents per year in 2026, building on an earlier expansion from 12 to 14.
“There’s definitely an increased demand for orthopedic surgeons in the country,” residency program director Eric Strauss, MD, told Becker’s.
But adding residency slots cannot quickly correct a workforce imbalance. Becoming an independent spine surgeon requires medical school, residency and, for many physicians, fellowship training. Decisions about the pipeline today may not materially expand practicing supply for years.
That lag makes retention of existing surgeons nearly as important as producing new ones.
6. Keeping surgeons in practice may become the hardest part: Solving the shortage is not simply a matter of recruiting more residents. Spine and orthopedic leaders have pointed to administrative burden, call demands, practice economics, autonomy and career sustainability as factors that determine how long physicians remain clinically active.
Amit Jain, MD, spine surgeon and vice president of care transformation at Baltimore-based Johns Hopkins Medicine, has argued for earlier mentorship, modernized training and more flexible practice structures to reduce attrition. “We must treat recruitment and retention as a continuous investment in a surgeon’s professional longevity,” Dr. Jain told Becker’s.
The financial environment adds another layer. Declining reimbursement, administrative burden and rising practice costs can influence where surgeons practice and how long they remain in the workforce. Becker’s has also reported growing concern that these pressures could accelerate burnout and earlier retirement.
The shortage may not arrive everywhere at once. It is more likely to surface first as longer waits, retiring surgeons who cannot be fully replaced, practices struggling to recruit in smaller markets and patients traveling farther for specialized care. Some patients already travel two to three hours for spine consultations in certain regions, while practices such as Reno Orthopedic Center have reported fewer spine surgeons than they had two decades ago.
The workforce problem in spine, in other words, may become an access crisis long before it looks like an empty job count.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
