The global surgical workforce crisis: narrative review of the role of surgical educator development and technological innovations.

The surgical care infrastructure faces a critical dual crisis: acute access shortages in low- and middle-income countries and systemic instability in high-income countries. This dysfunction stems from a global surgical workforce crisis defined by dual failures: failure in workforce development in low- and middle-income countries and failure in workforce retention in high-income countries. At the individual level, these failures are driven by distinct "vicious triads" centered on surgeon burnout. In low- and middle-income countries, the triad of burnout, professional isolation, and rational exodus arises from systemic fragility. Conversely, in high-income countries, the convergence of burnout, diminishing aspiration for surgery, and aging of surgeons destabilizes retention. Beyond work-hour limits, durable retention requires improved working conditions and incentives aligned with clinical responsibility. Relying on migration to mitigate shortages is self-defeating; instead, essential countermeasures demand bilateral international partnerships and a fundamental cultural transformation, moving away from reliance on individual self-sacrifice toward a sustainable model. This requires developing surgical educators, empowering female surgeons, and enhancing working environments. Integrating these human-centric reforms with technological innovations to alleviate administrative burdens allows surgeons to focus primarily on specialized care-the art of surgery. Ultimately, protecting workforce well-being is vital for securing the future of the surgical care infrastructure.