CHICAGO — The American College of Surgeons (ACS) has released the first national framework outlining measurable workplace standards for surgeons, aimed at improving surgeon well-being, patient safety, and workforce sustainability. The framework is published in the Journal of the American College of Surgeons (JACS).
Surgery remains one of the most demanding medical specialties, with long hours, unpredictable schedules, and significant administrative responsibilities contributing to burnout and workforce attrition. Until now, no formal parameters have defined sustainable clinical practice for surgeons.
The framework, "Developing Specialty-Specific Workplace Standards for Surgeons," provides measurable standards that can be customized by surgical specialty. It is designed to be incorporated into departmental policies, employment contracts, and professional society guidance.
"Our goal was to create guidance that would align surgeon well-being with patient safety and system efficiency, while promoting career longevity and workforce stability within the surgical profession," said lead author Douglas E. Wood, MD, FACS, FRCSEd, ACS Board of Regents Vice-Chair, and The Henry N. Harkins Professor and Chair in the Department of Surgery at the University of Washington. "Surgeons love their jobs. We are dedicated to patient care, and we want to help ensure that we create a workplace environment that allows us to continue providing excellent care, while also attracting a new generation of the best and brightest into the profession."
The recommendations address:
- Call schedule and compensation: Defining limits for frequency and intensity of call coverage using a data-driven approach.
- Access to the OR, clinic, and resources: Recommending appropriate OR and clinic time for full-time surgeons, tailored by specialty.
- Clinical support and team composition: Establishing appropriate staffing, infrastructure, and technology to support safe, efficient surgical care.
- Inpatient census limits: Defining safe patient coverage thresholds based on acuity and team structure.
- Fatigue mitigation and wellness support: Promoting policies that reduce fatigue and improve surgeon well-being, including flexibility after high-intensity call periods, which should be recognized as patient safety measures rather than discretionary wellness benefits.
- Compliance and administrative burden: Supporting fair compensation for required non-clinical training and administrative responsibilities.
Adaptable across surgical disciplines, the framework draws upon existing literature, benchmarks from other specialties, and input from practicing surgeons and health system leaders. The ACS has had formal conversations with more than a dozen other medical associations, all of which are preparing their own manuscripts using the ACS framework as the foundational document.
"The long-term sustainability of the surgical workforce requires a cultural and operational shift from informal expectations to transparent standards that support the critical work of surgeons across all specialties," said Patricia L. Turner, MD, MBA, FACS, Executive Director & CEO of the ACS, and co-author of the JACS article. "Clear workplace standards will support patient safety, improve retention, and create accountability around workload, resources, and compensation."
Additional co-authors include Philip R. Wolinsky, MD, FACS; Connie Bura; Christopher Dodgion, MD, MSPH, MBA, FACS; Rachael Essig, MD; Diana L. Farmer, MD, FACS, FRCS; Nancy L. Gantt, MD, FACS; Lena M. Napolitano, MD, FACS, FCCP, FCCM; Shelly D. Timmons, MD, PhD, FACS; David J. Welsh, MD, MBA, FACS; and Robert D. Winfield, MD, FACS.
Citation: Wood DE, Wolinsky PR, Dodgion CM, et al. Developing Specialty-Specific Workplace Standards for Surgeons: A Framework to Support Sustainable Surgical Careers. Journal of the American College of Surgeons, 2026. DOI: 10.1097/XCS.0000000000001880
