The US Health Workforce: Composition, Shortages, and Distribution

The US health workforce is one of the largest employment sectors in the country, comprising more than 18 million workers across clinical, administrative, and public health roles — and it is under strain in ways that ripple directly into patient experience. Shortages are not evenly distributed, which means the question of where someone lives shapes what care looks like almost as much as their insurance status. This page maps the composition of that workforce, explains how shortages form and persist, and clarifies the distinctions that matter most when thinking about access.

Definition and scope

The health workforce includes every person whose labor contributes to the delivery or administration of health services. That spans physicians, nurses, dentists, pharmacists, behavioral health clinicians, physician assistants, medical assistants, community health workers, and the billing and coding staff who keep the financial machinery moving.

The Health Resources and Services Administration (HRSA) tracks this workforce at the federal level, with particular attention to shortages in designated areas. As of the most recent HRSA data, more than 100 million Americans live in a primary care Health Professional Shortage Area (HPSA), a federal designation that triggers loan forgiveness programs and other federal incentives for clinicians who practice there (HRSA HPSA designations).

Physicians alone number roughly 1 million active practitioners in the US, but that figure obscures significant variation. Primary care physicians — family medicine, internal medicine, pediatrics, and obstetrics/gynecology — account for approximately 30 to 35 percent of that total, with the remainder concentrated in specialty disciplines. The implications for healthcare access and equity are substantial: primary care is where most chronic illness is managed, where prevention happens, and where the health system first makes contact with patients.

How it works

Workforce distribution is shaped by four overlapping forces: training pipeline capacity, geographic incentive structures, specialty prestige and pay differentials, and the aging of the existing workforce itself.

The training pipeline runs through medical schools, nursing programs, residency slots, and advanced practice programs. Residency slots are particularly constraining for physicians — Congress set a cap on Medicare-funded graduate medical education positions in the Balanced Budget Act of 1997, and that cap has largely held for nearly three decades, limiting how many new physicians can complete clinical training annually.

Geographic incentives favor urban and suburban markets. Physicians finishing residency programs tend to settle near their training institution, and most major academic medical centers are in metropolitan areas. Rural communities and low-income urban neighborhoods compete for a smaller pool.

Specialty pay differentials are stark. A primary care physician in the US earns a median annual salary roughly 40 to 60 percent lower than a cardiologist or orthopedic surgeon, according to the Medscape Physician Compensation Report. Medical students graduating with $200,000 or more in debt — the median debt for indebted medical graduates, per the Association of American Medical Colleges — make rational financial decisions that push them toward higher-paying specialties.

Workforce aging compounds all of this. The American Medical Association estimates that more than 40 percent of currently active physicians are 55 or older, meaning a substantial retirement wave is approaching within the next decade.

Common scenarios

Three patterns appear repeatedly when workforce shortages become visible in daily life:

1. Rural primary care deserts — Counties with no practicing physician are not rare in states like Montana, Wyoming, and Kansas. Patients in these areas may drive 60 to 90 miles for a primary care appointment, or default to emergency care for conditions that primary care manages more efficiently and at lower cost.

2. Behavioral health gaps — Mental health and substance use disorder clinicians are in short supply almost everywhere, but particularly outside major cities. HRSA designates separate HPSAs for mental health, and the shortage is severe enough that telehealth and virtual care has become a structural solution rather than a convenience — particularly for therapy and psychiatric medication management.

3. Long-term care staffing crises — Nursing homes and home health agencies operate on thin margins with high turnover. Direct care workers in these settings earn wages near the federal poverty line for a family of three, creating persistent vacancies in long-term care that affect millions of older adults and people with disabilities.

Decision boundaries

Not all workforce shortages are equivalent, and the policy responses differ depending on type.

Geographic shortage vs. aggregate shortage: The US may produce enough physicians in aggregate — the AAMC's 2023 Physician Workforce Projections report projected a shortage of between 37,800 and 124,000 physicians by 2034 — but that figure reflects maldistribution as much as raw supply. Flooding the market with more physicians does not automatically place them in rural Mississippi or on the South Side of Chicago.

Scope-of-practice regulation vs. workforce expansion: One lever available to states is expanding what nurse practitioners, physician assistants, and certified nurse-midwives are legally permitted to do without physician supervision. 27 states and the District of Columbia grant nurse practitioners full practice authority (American Association of Nurse Practitioners, State Practice Environment), while others require physician oversight, effectively limiting the reach of mid-level providers in shortage areas.

Incentive programs vs. structural reform: Federal programs like the National Health Service Corps offer loan repayment in exchange for service in HPSAs. These are meaningful but temporary — a clinician serves two to four years and then may relocate. Structural fixes, like increasing residency funding or reforming community health center reimbursement, operate at a different timescale and require Congressional action.

The workforce question sits underneath nearly every conversation about healthcare disparities by population — it is rarely the only factor, but it is almost always one of them.