Thousands of extra surgeons are going to be needed over the next few years to meet demand, a report warns.
Some 6m patients are operated on each year
The Royal College of Surgeons (RCS) said there would be a 2,760 shortfall by 2010 because of early retirement and new working practices.
The figure amounts to 50% of the current number of surgeons and takes into account surgeons who will graduate from training in the coming years.
The study said action was needed now as it takes 10 years to train a surgeon.
The RCS said the government has been relying on short-term measures such as international recruitment.
But it said there was a need for more long-term plan, adding: "The bedrock of UK surgery remains the high standards and lifelong commitment of UK-trained consultants."
The report raised concerns that as many as 4,000 surgeons could take early retirement by 2007 as they had reached their maximum achievable pension entitlement.
More surgeons will also be needed as the effect of the 56-hour working week demanded by the European working time directive kicks in.
RCS president Hugh Phillips said the government needed to act straight away if the demand for 6m operations a year was to be met in the years to come.
"In 2001 we said we did not have sufficient numbers of consultants.
"Since then there has been expansion but now even more are required because of new technologies, new treatment opportunities and the increased demands of training and education."
And he added the extra training places must be funded as patient safety was paramount.
Dr Alan Russell, deputy chairman of the British Medical Association consultants committee, said if the government did not act it could harm a key election promise.
"The shortage of surgeons in England and Wales is critical.
"It is extremely difficult to see how the government can meet its proposed 'patient journey' waiting list target of no more than 18 weeks if the NHS does not have enough surgeons to carry out operations.
"The BMA totally supports the call for increased government funding for more surgical posts."
The government said it had increased the numbers of consultants, which includes surgeons and all types of other specialists, by nearly 5,000 from 2000 to 2003.
However, the government missed its target of increasing consultants by 7,500 by 2004.
A Department of Health spokeswoman said the government was looking to increase the number of surgeons.
"It is something we are working towards. We know we have more work to do here.
"But the vacancy rate has done down and the number of medical student places has increased."