Surgeons Outside of Cities: Longitudinal Trends in the Surgical Workforce of Rural Australia From 2013 to 2022

ABSTRACT

Objective

To examine differences and changes in workplace and demographic factors between metropolitan and rural surgeons in Australia over 10 years.

Methods

A retrospective study which analysed data from the Health Workforce Dataset Online Data Tool, based on annual registration data from the Australian Health Practitioner Regulation Agency (AHPRA) spanning 2013–2022. The dataset includes information on all surgeons who have completed their training and are registered as fellows with the Royal Australasian College of Surgeons, and who were working in Australia during the study period. The factors analysed included mean hours worked per week, gender, age, and origin of qualification. Regions of work were defined using the Modified Monash Model (MM) model.

Results

During the study period, the number of surgical fellows in Australia increased from 4568 to 5724, with a notable increase in the proportion working in metropolitan regions. On average, these surgeons worked 45 h per week across most regions. The percentage of female surgeons rose from 9.6% to 15.4% in metropolitan regions and from 6.9% to 12.4% in rural regions. Surgeons working in rural regions tended to be older. However, there has been an increase in the number of surgeons aged 35–44 working in these areas. Additionally, sub‐specialties other than general surgery were rarely found in rural areas.

Conclusion

While the number of surgeons in Australia has increased, there is a disproportionate shortfall of surgeons practising in rural areas.

Summary.

• What is already known on this subject

  • ○
    Australia faces a shortfall of fellowed surgeons in regional, rural, and remote areas.
  • ○
    Previous studies have suggested that demographic differences exist between surgeon workforces of metropolitan and regional, rural, and remote Australia.
• What this paper adds

  • ○
    This study reports longitudinal changes in workplace and demographic factors of surgeons working in metropolitan and rural regions of Australia.
  • ○
    Notably, rural areas faced a workforce shortfall in terms of the total number of surgeons, the proportion of female surgeons, and the availability of subspecialties other than general surgery.

1. Introduction

People residing in regional and rural areas of Australia experience poorer health outcomes, which is partly due to shortfalls in health workforce staffing in these areas [1]. Access to health care outside of metropolitan areas is particularly challenging for countries such as Australia which have large geographical areas and low population densities. Despite having a population of 26 million, Australia's average density is only 3.5 people per square kilometre1 (or 35 people per square mile) [2]. A second challenge is in how this population is distributed, with 29% of the population living in regional and rural areas [3] but only 22% of doctors practising in these areas [4]. General practitioners (also known as family doctors or primary care physicians) are the most common medical specialty in regional and rural Australia, with other medical specialties, such as surgery, far less common [4].

Surgical services in regional and rural Australia face the additional challenge of staff and resources being centralised in metropolitan areas [5, 6]. While centralisation is advocated to improve surgical outcomes of complex conditions [7], it imposes additional burdens on regional and rural patients, including fragmented care, delays in treatment and an increased financial burden [8]. This situation may be exacerbated by an increase in the number of people relocating to regional areas of Australia [2] and changing population demographics such as an ageing population [9].

Changes in workplace factors over time have been reported for Australian doctors overall [10], and the distribution of surgeons has previously been reported in a yearly census conducted by the Australian Royal College of Surgeons [11] and in online government dashboards [12]. To date, however, there has not yet been a comprehensive comparison between metropolitan and rural surgeons, nor an examination across surgery sub‐specialties. In addition, the numbers of hours worked per week are seldom reported despite their importance in understanding burnout [13].

In this study, we examined workforce and demographic trends among surgeons with fellowship registrations in both metropolitan and rural Australia from 2013 to 2022. As the data examined was based on compulsory annual registrations with the Australian Health Practitioner Regulatory Agency [14], the results presented include all surgeons registered to work in Australia during the study period.

2. Methods

2.1. Study Design

We conducted a cross‐sectional study to compare registration data across different years, sub‐specialties, and regions within Australia. The sub‐specialties included general, cardio‐thoracic, neurosurgery, orthopaedic, otolaryngology, oral and maxillofacial, paediatric, plastic, urology and vascular surgery. Regions of Australia were defined in accordance with the Modified Monash Model, which is used for health workforce planning in Australia (Table 1) [15]. For this study, Modified Monash (MM) model regions 2–7 were considered rural. The study outcomes included the number of registrations, percentage of registrations per sub‐specialty or region, and mean hours worked per week. This study was reported according to the STROBE statement checklist [16].

TABLE 1.

Distribution of the Australian population by Australian Statistical Geography Standard (ASGS) Remoteness Structure and Modified Monash (MM) region. Data are from Versace et al. [3].

MM region	Description	Population number (%)
1	Metropolitan: Major cities	16 562 074 (71.3)
2	Regional centres within a 20 km drive of a town with over 50 000 residents	2 088 256 (9.0)
3	Large rural towns within a 15 km drive of a town between 15 000 and 50 000 residents	1 509 139 (6.5)
4	Medium rural towns: Areas within a 10 km drive of a town with between 5000 and 15 000 residents	922 965 (4.0)
5	Small rural towns: All remaining areas that are not remote or very remote	1 687 796 (7.3)
6	Remote communities: Remote mainland areas, remote islands less than 5 km offshore, and islands that have an MM5 classification with a population of less than 1000 without bridges to the mainland	270 545 (1.2)
7	Very remote communities: Very remote mainland areas and remote island areas more than 5 km offshore	179 638 (0.8)
Other	Residents living in an unclassified territory or regions	11 131 (0.1)
	Total: 23 220 413 (100.0)

2.2. Ethics Statement

This study was presented to the [anonymised] Human Research Ethics Committee. However, given the publicly available nature of the data and the characteristics of the research activities involved, an ethical review was not deemed necessary.

2.3. Participants and Study Size

The study participants included all medical practitioners registered with AHPRA and working within the surgical specialty from 2013 to 2022. A fellowship registration in a surgical specialty indicates the successful completion of a medical internship and specialised training, either through a specialist surgical college or assessment in the case of specialist international medical graduates (IMGs). As AHPRA registration is a mandatory requirement to work in medicine, the study population represents the total population of eligible surgeons in Australia during the study period.

2.4. Data Sources and Variables

Data was accessed from the Health Workforce Dataset Online Data Tool [17] on 24 November 2023. The field ‘Employed in Australia working in registered profession’ and the primary specialty field ‘Surgery’ were applied to all data. The summation value was the number of practitioners. Variables examined were total registrations, full‐time equivalent (FTE), specialty, age, gender, origin of qualification, and Modified Monash region of work. Datasets were created for the number of registrations and FTE per year, demographic factors per year, and location of work per sub‐specialty in 2022. The mean hours worked was calculated using a standard 1.0 FTE week, which is defined as 38 h to allow easier comparisons between groups.

2.5. Analysis and Statistics

Data analysis and visualisation were conducted using Deepnote, an interactive data science notebook platform Deepnote (Deepnote Inc., San Francisco, CA, USA, https://deepnote.com). Deepnote is a cloud‐based system that uses OpenAI and Codeium large language models to write code. Code was written in Python (Python Software Foundation, Wilmington, Delaware, United States, Version 3.8.10). Analysis took place between 8 April and 20 June 2024. The Deepnote notebook is publicly available here.

3. Results

3.1. Comparison of Registrations, FTE and Hours Worked 2013–2022

The number of registered specialist surgeons in Australia increased from 4568 in 2013–5742 in 2022 or 131 new registrations per year (slope of 131.0, 95% CI 126.2–135.8, p < 0.001) (Figure 1A). Full‐time equivalence (FTE, which takes into account hours worked per week) has continued to steadily rise from 5562 in 2013–6684 in 2022 at a rate of 111.9 FTE per year (slope of 111.9, 95% CI 83.6–140.2, p < 0.001). The average weekly working hours approximated 46 from 2013 to 2019 (slope of −0.13, 95% CI −0.29 to 0.026, p = 0.08) before dropping in 2020 and subsequently increasing.

FIGURE 1.

Changes in Australian surgeon workforce as measured by the (A) number of registrations and total FTE, and (B) mean hours worked per week. Data shown are for specialist surgeons working in Australia in their registered profession, from 2013 to 2022.

Between 2013 and 2022, the number of surgeons working in rural areas (MM2‐7) increased from 772 to 896 (Figure 2A). Overall, 83% percent of surgeons were registered in MM1 regions (slope of 0.05, 95% CI −0.01 to 0.12, p = 0.08) (Figure 2B). Less than 10% of surgeons practised in regional centres (MM2), with no significant change over time (slope of 0.03, 95% CI −0.00 to 0.07, p = 0.07). While 6.2% of surgeons worked in large rural towns (MM3), this declined (slope of −0.05, 95% CI −0.09 to 0.01, p = 0.03). Only 1.4% of all registered surgeons practising in small rural towns (MM5) and medium (MM4) rural towns in 2013, which was stable over time (slope of 0.01, 95% CI −0.03 to 0.01, p = 0.26). Similarly, the combination of remote (MM6) and very remote (MM7) regions had a gradual decrease in surgeons practising in the area from a peak of 0.39% in 2013 to a low of 0.12% in 2022 (slope of 0.006, 95% CI −0.042 to −0.013, p = 0.002).

FIGURE 2.

Changes in the Australian surgical specialist workforce across Modified Monash Model regions of Australia for (A) number of registrations, (B) percent of registrations, and (C) hours worked for 2013–2022. A small number of registrations which did not state a region of work were excluded from the graphs.

The average workload for surgeons was around 45 h per week in metropolitan regions, regional centres, and large rural towns. In small and medium rural towns, the average workload was around 40 h per week (Figure 2C). While the average hours worked remained stable for these regions, workload in remote and very remote regions varied greatly.

3.2. Comparisons of Gender 2013–2022

Between 2013 and 2022, over 84% of the Australian surgical workforce was male. There was an increase in the proportion of female surgeons, increasing from 9.6% to 15.4% in metropolitan regions (slope of 0.64, 95% CI 0.59–0.70, p < 0.001) and 6.9%–12.4% in rural regions (slope of 0.62, 95% CI 0.54–0.70, p < 0.001) (Figure 3). Although the increase in female surgeons was seen for both metropolitan and rural regions, the proportion of female surgeons was consistently higher in metropolitan regions.

FIGURE 3.

Trends in the percent of (A) male and (B) female Australian surgeons working in metropolitan (MM1) and rural (MM2‐7) regions as defined by the Modified Monash for 2013 and 2022. Data shown are specialist surgeons working in Australia in their registered profession.

3.3. Comparison of Age 2013–2022

Between 2013 and 2022, the age distribution of Australian surgeons changed, particularly between metropolitan (MM1) and rural (MM2‐7) regions (Figure 4). In metropolitan areas, 1.7% of surgeons were aged 20–34 years, with a small decline over time (slope of −0.06, 95% CI −0.11 to −0.02, p = 0.02). In comparison, only 1.2% of surgeons in rural areas were aged 20–34 years, and this was stable (slope of −0.03, 95% CI −0.11 to 0.05, p = 0.45). Variations emerged in the 35–44 year age group, with metropolitan regions experiencing a decline from 31% in 2013 to 28% in 2022 (slope of −0.40, 95% CI −0.47 to −0.33, p = 0.00), while rural areas saw an inverse increase from 20% in 2013 to 23% in 2022 (slope of 0.29, 95% CI 0.13–0.45, p = 0.01).

FIGURE 4.

Trends in the age distribution of Australian surgeons between metropolitan (MM1) and rural (MM2‐7) Modified Monash regions for 2013 and 2022. The data shown is for specialist surgeons working in Australia in their registered profession.

From 2013 to 2022, the percentage of surgeons aged 45–54 working in metropolitan areas increased from 28% to 35% (slope of 0.72, 95% CI 0.67–0.77, p = 0.00), while this decreased slightly from 33% to 32.6% (slope of −0.20, 95% CI −0.36 to −0.05, p = 0.03).

The proportion of surgeons aged 55–64 increased in both metropolitan regions (18% in 2013 to 20% in 2022) and rural regions (24% in 2013 to 28% in 2022). However, there was a gradual decline in the proportion of surgeons in the 65–74 age category in both metropolitan (slope of −0.56, 95% CI −0.66 to −0.46, p = 0.00) and rural regions (slope of −0.52, 95% CI −0.70 to −0.34, p = 0.00) with their proportions similar at approximately 10% in 2022. In contrast, surgeons in the 75–99 age category remained fairly consistent across the study period for both metropolitan (slope of −0.01, 95% CI −0.06 to 0.03, p = 0.54) and rural regions (slope of 0.04, 95% CI −0.09 to 0.18, p = 0.55), contributing to approximately 5% of all registered surgeons.

3.4. Comparison of Sub‐Specialties in 2022

The most common surgical sub‐specialty reported in 2022 in Australia was general surgery (32.2%) followed by orthopaedic surgery (25.7%; Table 2). In comparison, the least common sub‐specialty was paediatrics (1.6%), with a small number of fellows not reporting a specialty (0.3%). There was little change in the distribution of surgery sub‐specialties over time (Table 2). The mean hours worked for each surgical specialty declined slightly over time (Table 3), with the highest mean hours worked consistently seen in urology, plastic surgery, and cardiothoracic surgery. Only surgeons who did not register a sub‐specialty worked less than an average of 40 h per week.

TABLE 2.

Distribution of Australian surgery sub‐specialties over time.

Sub‐speciality	N (%)
	2014	2016	2018	2020	2022
Cardio‐thoracic	167 (3.6)	169 (3.4)	170 (3.3)	173 (3.2)	183 (3.2)
General	1472 (31.5)	1584 (31.8)	1648 (31.8)	1754 (32)	1849 (32.2)
Neurosurgery	216 (4.6)	228 (4.6)	238 (4.6)	251 (4.6)	263 (4.6)
Orthopaedic	1206 (25.8)	1283 (25.8)	1336 (25.8)	1419 (25.9)	1478 (25.7)
Otolaryngology	427 (9.1)	459 (9.2)	458 (8.8)	481 (8.8)	498 (8.7)
Oral and maxillofacial	102 (2.2)	113 (2.3)	135 (2.6)	150 (2.7)	168 (2.9)
Paediatric	78 (1.7)	80 (1.6)	91 (1.8)	92 (1.7)	94 (1.6)
Plastic	402 (8.6)	425 (8.5)	436 (8.4)	452 (8.3)	487 (8.5)
Urology	384 (8.2)	401 (8.1)	432 (8.3)	458 (8.4)	473 (8.2)
Vascular surgery	187 (4)	204 (4.1)	207 (4)	220 (4)	232 (4)
Other/Not stated	39 (0.8)	32 (0.6)	26 (0.5)	25 (0.5)	17 (0.3)
Total	4680	4978	5177	5475	5742

TABLE 3.

Mean hours worked per week of Australian surgery sub‐specialties over time.

Sub‐speciality	N (%)
	2014	2016	2018	2020	2022
Cardio‐thoracic	47.6	49.2	49.5	46.0	45.2
General	45.3	45.2	45.8	42.4	44.0
Neurosurgery	50.0	49.3	49.5	46.4	45.7
Orthopaedic	46.2	45.7	45.3	42.2	43.7
Otolaryngology	42.6	43.5	42.8	40.3	41.7
Oral and maxillofacial	45.7	45.6	44.3	40.0	44.4
Paediatric	46.1	46.8	47.2	46.6	44.2
Plastic	46.1	46.3	46.6	43.0	46.2
Urology	46.2	47.3	47.0	44.1	47.2
Vascular surgery	48.4	46.6	47.5	42.7	43.5
Other/Not stated	24.9	25.9	34.9	29.5	26.8
Total	45.7	45.7	45.8	42.6	44.2

Surgical sub‐specialties were not common in rural regions, with just over 20% of general surgery registrations reported in these regions (Figure 5). Although orthopaedic surgery is the second largest sub‐specialty by percentage, the proportion of orthopaedic surgeons working in rural regions is 16%, a similar proportion to urology—a less popular sub‐specialty. Only general surgery, orthopaedic surgery, and urology sub‐specialties had registrations in small and medium rural towns, and only general surgery had registrations in remote and very remote regions, albeit at a very low level (< 0.5%).

FIGURE 5.

Percent of surgery sub‐specialties registrations in rural (MM2‐7) Modified Monash regions of Australian areas for 2013 and 2022. Data are shown as a percentage of each sub‐specialty. The category ‘Other’ includes all surgeons who did not state their specialty.

4. Discussion

This study presents an analysis of demographic trends of Australian surgeons over a nine‐year period, drawing comparisons between metropolitan, regional, and rural workplace trends. This work is novel as it reports data for all specialist surgeons registered and working in Australia during the study period and therefore measures the entire population of fellowed surgeons rather than a sample of it. Overall, the percentage of surgeons working in rural areas decreased slightly from 16.9% in 2013 to 15.5% in 2022. Similar shortfalls have been reported for the surgical workforce of Canada, where 18%–30% of the population live rurally, while only 8% of surgeons work rurally [18] and for the USA where there are twice as many doctors per capita in metropolitan areas than rural area [19]. Although the number of surgeons working in Australia increased from 2013 to 2022, the percentage of surgeons working in rural areas has decreased slightly. Within Australia, these shortfalls in rural practice reflect trends for doctors overall [10] and for nurses and allied health [4].

Surgeons tended to work considerably more hours than reported for Australian doctors overall [10]. There was a slight decline in the mean hours worked from over 46 h per week in 2013 to 45 h per week in 2019, although the mean hours worked per week never fell below 42 h for any year.

Similarly to other Australian medical specialties, surgery saw the number of hours worked per week decrease in 2020 due to Covid‐19, with a subsequent increase in 2021 onwards that is yet to match pre‐Covid levels [10]. This workload was similar for metropolitan areas, regional areas, and large rural towns but consistently lower in medium and small rural towns, which were closer to a 38‐h‐per‐week workload. The hours worked by surgeons in remote and very remote Australia varied greatly, although the reasons for this remain unclear. These findings contrast with previous reports of surgeons having higher workloads in rural areas [20]. Interestingly, mean hours worked per week did not appear to be greatly influenced by the COVID‐19 pandemic in 2020 in any region, despite the movement of individuals to inner and outer regional areas during this time [2].

Surgeons practising in rural settings face a range of additional challenges beyond extended work hours. Previous studies of rural general surgeons frequently cite on‐call obligations as a deterrent to rural practice [21]. Additionally, rural general surgeons have faced challenges including professional isolation and difficulty in establishing of mentors, limited professional development opportunities due to geographic isolation, and limited access to infrastructure in comparison to metropolitan centres [22]. The reduced availability of multidisciplinary team members, such as pathology, radiology, and intensive care units, along with other specialities, can compound these challenges [22]. In 2022, less than 16% of Australian surgeons were women, dropping to 12.4% in rural areas. This is considerably lower than the 45% of Australian doctors overall or the 53% of Australian medical school students [23]. Similar proportions of female surgeons by sub‐specialty have been reported for the USA [24]. In contrast, 38.9% of newly qualified surgeons in Canada are female [25]. The proportion of female surgeons was even lower in rural areas, similar to a study of general surgeons in the USA, which reported that a greater proportion of female surgeons worked in metropolitan centres [26]. Regardless of region of work, the low proportion overall suggests there are clear barriers to being a female surgeon in Australia, which may be even greater for some sub‐specialties. The proportion of female surgeons in Australia varies across sub‐specialties, with 20.5% in general surgery, but ranging from 5.5% in orthopaedic surgery to 31.0% in paediatric surgery [27]. Some of the barriers to women working in surgery include gender‐based discrimination and harassment, long and inflexible hours, and a lack of mentoring [27, 28]. Other barriers identified to rural training of include impacts on family life such as childcare and educational needs, and partner career development [29]. Despite some advantages to working in rural areas, such as lifestyle, work proximity, and the nature of rural work, a small study of surgeons indicates that these factors appeal to female surgeons [30].

Overall, however, the lower proportion of female surgeons in rural regions suggests additional barriers exist for regional and rural areas and warrant further investigations.

The Australian population is ageing, and the proportion of individuals aged over 65 is expected to rise to 21%–23% by 2066 [9]. Simultaneously, the Australian workforce is also ageing, with 15% of working Australians aged over 65, a significant rise from the 6.1% reported in 2001 [9]. However, this ageing trend is not as apparent in the surgical workforce. The number of surgeons aged 65–74 in both metropolitan and regional/remote areas has declined since 2013. The decrease in the number of surgeons aged 65–74 may be attributed to both the physical and mental demands of surgical work. A 2016 census report by the Australian Royal College of Surgeons highlighted that surgeons over 65 often continue working due to job satisfaction, as the retirement age for surgeons is competency‐dependent and lacks specific regulation [31]. The declining numbers in this age bracket could also reflect changing attitudes in medicine towards retirement and part‐time work [32]. Interestingly, the number of surgeons aged over 75 has remained stable across all regions, although this only represents a very small proportion of the surgical workforce. Differences in age were seen between regions. Metropolitan areas had a higher proportion of surgeons aged 35–54 years compared to rural areas, and a lower proportion of surgeons aged 55–64 years, suggesting a younger workforce in metropolitan areas. There was, however, an increase in surgeons aged 35–44 years in rural areas. This is perhaps surprising, as newly qualified surgeons entering regional and rural areas are perceived to lack preparedness for rural practice and self‐efficacy [33]. It may also be that this increase in younger surgeons working rurally is a response to evolving opportunities for consultant‐level surgical positions outside metropolitan centres, which newly qualified surgeons are pursuing.

Most surgery sub‐specialties were limited in rural areas. The exception was general surgery, with over 20% of general surgeons working in rural areas. In Canada, which has a similar proportion of the population in rural areas, only 8% of general surgeons work in rural settings [18]. General surgery stands as the sole reported surgical specialty present in remote and very remote Australia, a distribution likely influenced by the nature of the specialty itself [31]. General surgery has historically offered rural surgery fellowships and incorporated training streams aimed at preparing generalists with an extended rural scope, equipped with skills in additional specialties like trauma and vascular surgery, particularly in the rural context [34, 35]. Positive results of rural general surgery centres have been demonstrated in South Australia, which had outcomes equivalent to metropolitan centres [36]. In comparison, the centralisation of surgical services in metropolitan centres directly influences the availability of sub‐specialist services in rural and regional areas. Some sub‐specialties may need to operate from metropolitan centres due to staffing and facility requirements. For example, paediatric surgery requires a diverse multi‐disciplinary team, including specialist intensive care units, anaesthesiologists, and nurses. Additionally, high case volume in complex procedures may allow maintenance of surgical skills in complex areas, which may decrease patient morbidity and mortality [7]. Elective procedures, such as elective plastic or orthopaedic surgery, may be offered in urban centres. It also needs to be considered that some surgical subspecialists may be registered in urban areas but conduct outreach visits to rural and remote areas, either conducting elective surgery there or conducting outpatient clinics and conducting the surgery in urban centres. These locum surgical offerings would not be captured in the dataset analysed. However, general surgeons are required for acute presentations where timely transfer to a larger centre is not feasible.

This study has a number of limitations. The analysis is based on self‐report surveys from AHPRA annual registration data. Due to the nature of AHPRA data, the assignment of the Modified Monash model (MM) region does not measure contributions made by staff rotations or doctors working as locums or fly‐in, fly‐out doctors [37, 38] and may therefore be an underestimation of the workforce in rural areas. In addition, AHPRA data does not capture trainee status, and this work therefore does not include the significant contributions made by doctors working in surgery traineeships. Data provided by the Health Workforce dashboard includes means, but does not include standard deviations, limiting a full understanding of possible population spread. Finally, non‐binary gender titles were not included in the data, limiting the data's ability to capture a wider range of genders. As additional inclusive language is incorporated into registration information, these demographics should be reported in future works.

In conclusion, surgery in regional and rural Australia areas faces several challenges, including a disproportionate shortfall of surgeons, a lower proportion of female surgeons, an older workforce, and a low proportion of subspecialties other than general surgery. Providing an adequate surgical workforce in rural and regional Australia is likely to remain a significant challenge in the future. Recognising the complexity of balancing centralised and regionally available services, the Australian Royal College of Surgeons (RACS) has taken initiatives to promote regional and rural career development in multiple subspecialties that include financial incentives, enhanced rural training exposure, and preferential selection for trainees with rural backgrounds as key measures to improve recruitment and retention in these areas [35]. For instance, RACS is currently implementing rural selection points for surgical trainee positions. This includes promoting rural training for all specialties, such as rural‐focused urban specialist programmes for specialties such as cardiothoracic surgery and neurosurgery, and establishing a faculty of Global, Remote/Rural/Regional Deployable (GRiD) Surgery program [35]. However, the low percentage of surgeons in rural areas persists, and future initiatives should focus on supporting the career of young surgeons, particularly women, who choose to work outside of metropolitan areas.

Author Contributions

Tracey Edwards: conceptualization, methodology, analysis and interpretation, writing – original draft. David Garne, Lyndal Parker‐Newlyn, Rowena G. Ivers, Judy Mullan, Kylie J. Mansfield and Andrew Bonney: analysis and interpretation, writing – review and editing. Colin H. Cortie: conceptualization, methodology, visualisation, data curation, analysis and interpretation, writing – review and editing, supervision.

Ethics Statement

This study was presented to the University of Wollongong's Social Science Human Research Ethics Committee. However, given the publicly available nature of the data and the characteristics of the research activities involved, an ethical review was not deemed necessary.

Conflicts of Interest

The authors declare no conflicts of interest.

Edwards T., Garne D., Parker‐Newlyn L., et al., “Surgeons Outside of Cities: Longitudinal Trends in the Surgical Workforce of Rural Australia From 2013 to 2022,” Australian Journal of Rural Health 33, no. 5 (2025): e70097, 10.1111/ajr.70097.

Data Availability Statement

The data that support the findings of this study are available in Australian Health Workforce Dataset Online Data Tool at https://hwd.health.gov.au/datatool/. These data were derived from the following resources available in the public domain: Dashboard, https://hwd.health.gov.au/datatool/.