Chapter 5:Workforce

Workforce

Chartbook 2003

Physician Workforce

After dropping slightly in 1999, the number of active physicians per thousand population rose slightly in 2000, while the number of medical and dental residents in training held constant. The number of physicians per thousand varied by region and was particularly high in the Northeast and Mid-Atlantic and relatively low in parts of the South and West (Charts 5.1 – 5.3).

Hospital Workforce

The number of full time equivalent employees (FTEs) working in hospitals continued to increase, although FTEs per adjusted admission has been declining since 1992. The number of registered nurse (RN) FTEs has been increasing slowly; however the number of RN FTEs per adjusted admission continues to decrease. RN FTEs as a percentage of total hospital FTEs has remained steady between 24 and 25 percent from 1986 through 2000 (Charts 5.4 – 5.7).

Current and Long-term Workforce Shortage

It is well documented that the U.S. population is aging. As people age, they tend to have greater health care needs. Unfortunately, the current health care workforce is also aging and many fear that the current nursing shortage will worsen over the next 20 years just as the population is requiring more health care services. However, efforts to build the RN workforce may be making progress. 2002 data indicated an 8 percent increase in individuals enrolling in entry level baccalaureate nursing programs. It will, of course, be a few years before these new graduates enter the workforce and, when they do, hospitals will face fierce competition in hiring them (Charts 5.8 – 5.13).

Focus has recently returned to the debate over the adequacy of the size, specialty mix, and geographic distribution of the current and future physician workforce. Though the number of primary care and specialty physicians is growing, there are currently geographic pockets of physician shortage now. As with the aging nursing population, there is also concern that the aging physician population will be inadequate to serve the health care needs of the aging population.

Chapter 5:Workforce

52

Workforce

Chartbook 2003

1.92.1

2.22.4

2.5 2.6 2.5 2.6

0

0.5

1

1.5

2

2.5

3

80 85 90 95 97 98 99 00

Chart 5.1:Total Number of Active Physicians

per 1,000 Persons1980 – 2000

Chart 5.2:Total Number of Active Physicians(1)

per 1,000 Persons by State2000

Source: Health United States, 1982, 1996-97, 1999, 2000, 2001, 2002

(1) 1980 does not include doctors of osteopathy

Source: Health United States, 2002

(1) Includes active non-federal doctors of medicine and active doctors of osteopathy

< 2

2 – 2.993 – 3.99

> 4

RI 3.33DE 2.44DC 6.91

(1)

53

Workforce

Chartbook 2003

0

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01

0

10,000

20,000

30,000

40,000

50,000

60,000

70,000

80,000

90,000

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01

Chart 5.3:Medical and Dental Residents in Training

in Community Hospitals1980 - 2001

Source: The Lewin Group analysis of American Hospital Association Annual Survey data, 1980 – 2001, for community hospitals

Chart 5.4:Total Full Time Equivalent Employees

Working in Hospitals1980 - 2001

Source: The Lewin Group analysis of American Hospital Association Annual Survey data, 1980 – 2001, for community hospitals

Thousa

nd

s

54

Workforce

Chartbook 2003

0

200

400

600

800

1000

1200

86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 010.010

0.012

0.014

0.016

0.018

0.020

0.022

0.024

0

0.01

0.02

0.03

0.04

0.05

0.06

0.07

0.08

0.09

80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01

Chart 5.5:Full Time Equivalent Employees

per Adjusted Admission1980 - 2001

Source: The Lewin Group analysis of American Hospital Association Annual Survey data, 1980 – 2001, for community hospitals

Chart 5.6:Number of RN Full Time Equivalent

Employees and RN FTEs per Adjusted Admission

1986 - 2001

Source: The Lewin Group analysis of American Hospital Association Annual Survey data, 1986 – 2001, for community hospitals

Thousa

nd

s of

RN

FTEs

RN

FTEs

per

Ad

just

ed

A

dm

issi

on

RN FTEs RN FTEs per Adjusted Admission

55

Workforce

Chartbook 2003

20%

21%

22%

23%

24%

25%

86 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01

Chart 5.7:RN Full Time Equivalents

as a Percentage of Total Hospital Full Time Equivalents1986 - 2001

Source: The Lewin Group analysis of American Hospital Association Annual Survey data, 1986 – 2001, for community hospitals

Chart 5.8:Number of Physicians by Age

1980, 1990, and 2001

Source: American Medical Association, Physician Characteristics and Distribution in the US, 2003-2004 Edition

56

350300250200150100500

50100150200250300350400450500

1980 1990 2001

Under 35

35-44

45-54

55-64

65 & Over

Ag

e 4

5 a

nd

over

Ag

e u

nd

er

44

Num

ber

of

Physi

cians

(in t

housa

nd

s)

Age Group

Workforce

Chartbook 2003 57

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

1980 1984 1988 1992 1996 2000

Chart 5.9:RN Employment by Type of Provider

1980 - 2000

Source: Findings from the National Sample Survey of Registered Nurses, 1980-2000, Bureau of Health Professions, Division of Nursing

Hospitals

Nursing Homes / Extended Care Facilities

Public / Community Health

All Other

Chart 5.10:Distribution of RN Workforce by Age Group

1980 - 2020 (Projected)

Source: Buerhaus, P.I. et al. Implications of an Aging Registered Nurse Workforce. JAMA: 2000: 283: 2948-2954

1,000

500

0

500

1,000

1,500

1980 1990 2000 (proj.) 2010 (proj.) 2020 (proj.)

Num

ber

of

RN

s (i

n t

housa

nd

s)

Ag

e u

nder

40

Ag

e 4

0 a

nd

over

AgeGroup

20s

30s

40s

50s

60s

Workforce

Chartbook 2003 58

Chart 5.11:Annual Percentage Change in Entry Level

Baccalaureate Nursing Enrollment1990 - 2002

12.4%

10.2%

2.6%

-2.6%

-6.2%-6.5%-4.8%-4.4%

-2.0%

3.7%

8.0%

14.3%

-10.0%

-5.0%

0.0%

5.0%

10.0%

15.0%

20.0%

90 92 93 94 95 96 97 98 99 00 01 02

Source: Berlin LE et al. Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing. Washington, DC: American Association of Colleges of Nursing, 1990-1991 – 1996-1997.

1,500

1,700

1,900

2,100

2,300

2,500

2,700

2,900

2000 2005 2010 2015 2020

Chart 5.12:National Supply and Demand Projections for

FTE RNs2000 - 2020

Source: National Center For Health Workforce Analysis, Bureau of Health Professions, Health Resources and Services Administration, 2002

FTEs

(in t

housa

nd

s)

RN FTE Demand

RN FTE Supply

Shortage of over 800,000 nurses in 2020