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

Background: 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.

Objective: 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.

Methods: 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.

Results: 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%.

Discussion: 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.