In a survey of all 88 hospitals in Ontario communities with fewer than 100 total acute care beds, the 80 (91%) respondents reported a total of 25 008 major general surgery cases per year at 63 hospitals, for an average of 397 per hospital yearly. General surgeons were the dominant specialists, but there were only 56 local active staff FRCS general surgeons. Twenty-four hospitals (30%) reported a shortage of general surgeons in their community now, while 49 hospital Chiefs of Staff (61.3%) predicted a shortage in 5 years.