Steven couldn’t remember when he first noticed the spot on his toe, only that it began as a blister a few weeks earlier. He finally saw his doctor, but only when the entire toe had turned black. His doctor referred him to me, but he missed the appointment because the drive was 90 minutes, and he couldn’t take the day off work.
Two weeks later, half of his foot was dead, and the resulting infection placed him in the intensive care unit (ICU). The only option left was to amputate his leg. Unfortunately, Steven’s story isn’t unique. In fact, 400 amputations happen each day in the U.S. due to vascular disease, a condition that is preventable and treatable, if diagnosed early.
The danger of vascular disease, combined with limited awareness and too few specialists, leaves millions without timely care. As the population ages, the shortage will worsen, putting more people at risk for peripheral arterial disease (PAD), stroke, and aneurysms. Rural and low-income communities face the steepest challenges.
A small specialty facing outsized demand
Vascular surgery is a small specialty with only 5,800 practicing surgeons in the United States. We treat blood vessels outside of the head and heart, often managing serious and common conditions like PAD. Our work frequently involves collaboration with other surgeons and interventionalists, enabling their specialties to function at a high level. While some procedures are preventative, such as removing plaque from a carotid artery to prevent a stroke, many are urgent and emergency cases. As fewer patients can access vascular surgeons, more face an increasing risk of disability and death from otherwise correctable problems.
This shortage isn’t hypothetical; it is happening now. The average job opening for a vascular surgeon takes over 200 days to fill. The predicted current need is almost 8,000 vascular surgeons, compared to the current workforce of 5,800. Over the next decade, we expect the number of available surgeons to remain fairly constant, while demand is expected to grow to 9,000, driven by the aging population and the correlation between age and risk of vascular disease.
Metropolitan areas often have academic and community hospitals with vascular surgeons, but 83 percent of U.S. counties have none. That leaves roughly one-third of Americans without local access to a vascular surgeon. This is largely a structural issue. There is a pipeline desert effect; states that lack training programs tend to have the lowest number of practicing vascular surgeons per capita. Rural hospitals tend to operate with fewer resources, and ongoing closures of rural and critical access hospitals exacerbate these issues.
This burden carries a human cost, with our most vulnerable populations bearing a disproportionate share of the impact. A patient’s zip code should not determine the quality of care they receive. However, it unfortunately does, and as the shortage worsens, this will become more pronounced.
A workforce in flux
After medical school, vascular surgeons train through two pathways. The traditional pathway involves five years of general surgery training followed by an additional two years of vascular surgery-specific training. However, nearly 20 years ago, an integrated training model emerged, allowing medical students to match directly into five-year vascular surgery programs. While the number of fellowship spots remains relatively stable at 120 annually, integrated training spots have increased.
Although more trainees enter the field, retirements offset the gains. The median age of practicing vascular surgeons is 50, and many will exit the workforce in the coming years. In addition to training new surgeons, we need to keep them in the workforce. Burnout poses a significant concern, stemming from administrative burden, challenging medicolegal issues, decreasing reimbursement, impact on personal health, and an onerous call schedule with frequent emergencies.
Building solutions from policy to practice
Without policy and health system solutions, the current problems will become a crisis. Passage of the Resident Physician Shortage Reduction Act, introduced in 2025, offers hope. In addition to introducing funding for an additional 14,000 spots over seven years, a certain percentage of the spots must go to hospitals in rural areas and those in health professional shortage areas.
Investing in infrastructure at rural and critical access hospitals could make vascular surgery service lines more feasible in locations where they aren’t today. Programs, such as loan repayment and salary supplements, may encourage surgeons to practice at these locations and fill the gaps. In other situations, it may not be practical to bring in a vascular surgeon. In these instances, regionalized health care with coordinated telehealth triage, formal transfer networks, and transportation support can bridge the gap.
The vascular surgeon shortage is real, and patients suffer today. But solutions exist. We must commit to expanding graduate medical education funding, investing in the care of underserved populations, reforming payment policy, and restructuring our health care system. Every delayed diagnosis and preventable amputation, like Steven’s, represents a failure we already have the tools to address. The time to act is now, while solutions can still make a difference.
Daniel Torrent is a vascular surgeon.
