Rural-Urban Inequality in Healthcare Workforce: Geographic and Temporal Trends, 1999-2008

In the US, the escalating labor shortage in the health care sector has received greater exposure in recent years. However, strategies to strengthen and expand the health care workforce have yet to yield positive and sustained results nationwide. Moreover, the shortage of health care workers, namely physicians, nurses, technicians, and numerous others, is not uniform across the nation. Using annual time-series data from the Bureau of Labor Statistics and the United States Census Bureau for the years 1999-2008, spatial and temporal trends in the health care labor force were assessed for several health care occupation groups, including physicians with specialties, nurses, laboratory technicians, pharmacists, and others groups. Specific outcomes examined were the age-adjusted population-per-provider ratios, average wages, and average number of hours worked. All analyses were conducted on the state level. For all physicians, population-per-provider ratios were highest in areas of the South and Rocky Mountain states, even after accounting for age. Similar results were found for pharmacists and nurses. Average number of hours worked, however, was highest in the more urban states of the Northeast, Mid-Atlantic, and California. While the national population-per-provider ratios increased steadily throughout the period of study, the discrepancies between the state with the lowest value to the state with the highest value also increased from 37% in 1999 to 54% in 2008. The results of this analysis could be used to inform policies and strategies designed to encourage health care workers to work in underserved areas, including low-income and rural areas. This research adds to the body of knowledge on the growing health care labor shortage in the US by assessing not just the current disparities in the distribution of health care workers across the country, but also the spatiotemporal trends and related factors that are associated with such inequalities.