US Sees Continued Growth in Health Care Workers per Population, but Significant Shortages Challenge Industry

The Association of American Medical Colleges (AAMC) projects that the U.S. will face a shortage of up to 86,000 physicians by 2036, even as the country has seen a 12.8% increase in health care workers per 1,000 Americans in the past decade. This shows the significance of health care shortages in the industry.

Numerous issues contribute to the health care shortages that trouble many areas of the country, from burnout to COVID-19 challenges. Our study examines which states have seen the biggest changes in health care workers per population and where shortage areas are more common.

Key findings

Rate of health care practitioners per 1,000 Americans grows

Nationally, the rate of health care practitioners per 1,000 Americans increased by 12.8% between 2013 and 2023. The U.S. had 24.84 health care workers per 1,000 residents in 2013, steadily growing to 26.73 in 2018 and 28.01 in 2023.

Despite the increase in the rate of practitioners, it’s important to understand these changes don’t paint a rosy picture of the industry. Health care shortages remain significant in many areas of the country, which we’ll explore in depth below.

Rate of health care practitioners per 1,000 Americans

Changes in practitioner-to-population ratio by state

Of course, the changes in the health care practitioner-to-population ratio differ by state. The three states with the largest increases in the rate of health care workers per 1,000 residents in the past 10 years are:

There are various reasons why the three Western states saw such increases in health care workers over the past decade. California, for example, passed a law that gives nurse practitioners (NPs) authority to work in rural areas without physician agreements — potentially attracting more NPs to underserved areas and expanding health care access to those in need. Meanwhile, Nevada was one of the states that received federal funding for incentives and programs to rebuild public health systems in the wake of the COVID-19 pandemic.

Not all states experienced increases in the rate of health care workers over the 10 years. Two states — Maine (1.1%) and Montana (0.9%) — saw the rate dip between 2013 and 2023.

In Montana, a retiring workforce may be a large part of the problem. According to the Montana Hospital Association, the state struggles to keep qualified health care workers due to one of the fastest aging health care workforces in the U.S. Maine, a state also facing a retiring health care workforce, also has no medical degree-granting medical school. As a result, the state must rely on other programs in the region to provide training for the majority of its primary care physicians.

Change in health care practitioners per 1,000 Americans (by state)

Data: Changes by occupation

Although we can’t provide changes for every occupation within the wider health care category, we wanted to include a few notable breakdowns from the past decade.

Change in registered nurses per 1,000 Americans (by state)

Change in dentists per 1,000 Americans (by state)

Change in physician assistants (PAs) per 1,000 Americans (by state)

Western states have lowest practitioner-to-population ratios

Three Western states — New Mexico (23.34), Hawaii (23.69) and Nevada (24.11) — have the lowest practitioner-to-population ratios in the country. Overall, Western states occupy the top eight spots in terms of the fewest health care workers per 1,000 residents as of 2023.

Lowest/highest rate of health care practitioners per 1,000 Americans (by state, 2023)

Therefore, it makes sense that New Mexico — a state where 60% of the population resides in rural communities — has health care worker shortages in 30 out of 33 counties, according to the University of New Mexico Health Sciences Center. Doctors are also leaving the state in response to changes to New Mexico medical malpractice laws that increased the cap on claims and the associated hikes in malpractice insurance rates, according to an Albuquerque Journal editorial.

In Hawaii, physician shortages are in large part due to the high cost of practicing medicine in the Aloha State. Providers report losing money on caring for patients on Medicare, Medicaid and Tricare, according to Island News. Meanwhile, the high cost of living also drives new physicians away as an aging health care workforce retires.

Conversely, health care shortages seem less severe in Midwest and North states. South Dakota (39.12), Massachusetts (35.30) and North Dakota (35.12) have the highest practitioner-to-population ratios in the U.S.

Where primary care, mental health, dental health shortage areas are more common

As a reminder, good practitioner-to-population ratios don’t necessarily mean areas don't have a shortage of health care providers. The Health Resources and Services Administration (HRSA) defines a health professional shortage area (HPSA) as a geographic area, population or facility with a shortage of primary, dental or mental health care providers.

As of March 31, 2024, the HRSA reports a need for 12,651 primary care practitioners, 9,407 dentists and 5,990 mental health providers to eliminate shortage areas nationwide.

ValuePenguin looked at the data for these health professions. Below are the details by state.

Primary care shortage areas

When a geographic area qualifies as an HPSA, it’s eligible to apply for assistance from the National Health Service Corps (NHSC). To qualify as an HPSA for primary care services, an area needs to satisfy certain practitioner-to-population ratios:

Despite the growth in practitioners per population, close to 73 million people (22.1% of the country) live in primary care shortage areas. Almost half of New Mexico residents (48.7%) reside in one. And a large portion of Mississippi (46.6%) and West Virginia (41.7%) residents share the same problem. But there are two states — Vermont (0.2%) and New Jersey (0.3%) — with almost no residents living in primary care shortage areas.

If you live in a primary care shortage area, Sangameshwar suggests asking your health care provider if they offer a waiting list. "Many doctors' offices get last-minute cancellations," she says. "The trick is to book the appointment offered but ask to be added to a waiting list, especially if you can be flexible with dates or times. More often than not, when a cancellation happens, you’ll be contacted to fill in the slot."

However, she also notes that such options may not be feasible for hourly wage earners, the uninsured, the very sick or the physically challenged.

Primary care shortage areas (by state)

Mental health shortage areas

The requirements to qualify as an HPSA for mental health care services depend on the guidelines and how the designation is sought.

Many Americans — 36.4%, to be exact — reside in mental health shortage areas. Almost all Wyoming residents live in shortage areas (98.1%). Indiana (74.5%) and Mississippi (74.4%) residents also have a significant number in underserved areas. Conversely, the states with the lowest rates of residents living in underserved areas are New Jersey, Massachusetts and Pennsylvania.

Mental health shortage areas (by state)

Dental health shortage areas

To qualify as an HPSA for dental health care services, a geographic area needs to meet the following practitioner-to-population ratios:

Nationally, nearly 55 million Americans (16.6% of the population) live in dental health shortage areas. More than half of Alaskans (56.1%) live in underserved areas. Mississippi (47.4%) and West Virginia (41.7%) aren’t far behind. But only about 1.0% of the population live in dental health shortages in New Jersey, Vermont and Massachusetts.

Dental health shortage areas (by state)

"A shortage in health care workers — especially critical care providers like physicians, dentists and psychiatrists — will have a significant financial impact in the form of higher labor and staffing costs for hospitals and health care systems," Sangameshwar says. "This will, in turn, be passed on to the consumer in the form of higher insurance premiums and poorer quality and access to care, hurting every American’s physical and mental health in the long term."