Trends in the U.S. Health Care Workforce: A Decade of Staffing and Compensation Practices Across Care Settings

Nurses are integral to patient care in US hospitals, yet high burnout rates exacerbated by staffing shortages and the COVID-19 pandemic pose challenges in retaining nursing staff. Understanding staffing dynamics and trends in the care team composition is vital to improve care and address the well-being of the health care workforce.

To examine trends in employment and compensation among registered nurses (RNs), physicians, nurse practitioners (NPs), physician assistants (PAs), medical assistants (MAs), licensed practical and vocational nurses (LPN/LVNs), and administrative staff from 2012 to 2022.

Data from the Occupational Employment and Wage Statistics (OEWS) was utilized to analyze employment and wage trends in hospitals and physician offices. The annual RN-to-physician, NP-to-physician, and PA-to-physician ratios and change in employment and compensation over time were calculated.

Although hospital RN employment increased by 12%, this was outpaced by physician (40%), NP (105%), PA (38%), and MA (44%) employment growth. The hospital RN-to-physician ratio declined by 21%, whereas the NP-to-physician and PA-to-physician ratios increased by 46% and 28%, respectively. In offices, the NP-to-physician ratio increased by 107%, whereas the RN-to-physician ratio remained stable. Wage growth for all clinical hospital staff increased around 30%, while physicians saw wage growth of 43%.

The declining RN-to-physician ratio in hospitals signals a shift in the care team composition. While APP employment has drastically risen, RN growth has lagged significantly behind. Urgent action is needed to optimize staffing strategies to safeguard patient care.