The Story of the American Healthcare Workforce, 1850-2017: A Time Series Analysis

Context: America experienced dramatic changes in the healthcare workforce over the past two centuries. Understanding how the workforce changed in density and skill mix over time yields lessons for predicting future workforce dynamics.

Objective: To quantify the changes in the American healthcare workforce from 1850 to 2017. The secondary objective is to quantify the changes in physicians and nurses from 1850 to 2017.

Design: Using data from the work of Kendix, the Census Bureau and the Bureau of Labor Statistics, we performed descriptive analysis on trends in the healthcare workforce from 1850 to 2017.

Setting: America from 1850 to 2017.

Participants: American healthcare workers from the Current Population Survey. Main outcome measures: The study will measure the number of healthcare workers, physicians and nurses. This number will be tracked in relation to the total American population and the total American workforce.

Results: The number of physicians per 100,000 Americans increased from 177 in 1850 to 331 in 2017; most of the gain occurred after 1950 following nearly a century of nearly flat trends. The number of nurses increased to 970 per 100,000 Americans. The healthcare workforce per 100,000 Americans as a whole increased from 198 to 392.

Conclusion: The American healthcare workforce has expanded dramatically over the past two centuries. After a period of flat supply (1850-1960), the healthcare workforce has grown faster than GDP, becoming one the largest sectors of U.S. labor. Understanding the trajectory of the health workforce may guide planning by countries undergoing similar economic transitions.


Eliezer Shinnar and Ariel Pablos-Mendez

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