Capacity

Key dimensions of overall capacity include the number of health care resources, their distribution across geographic areas, and their projected future capacity. We provide basic facts about the number of physicians, registered nurses, and hospital beds in the United States.

Physicians. There were 921,900 physicians in the United States in 2006 (American Medical Association, 2008). Physician capacity varies widely between counties: 460 counties had 20 or more physicians per 10,000 population, whereas 672 counties had less than 5 physicians per 10,000 population.

Registered Nurses. Figure 1 shows the number and distribution of registered nurses (RNs) across the United States:

• There were 2.4 million RNs in the United States in 2007, an average of about 800 per 100,000 population.
• Of these, approximately 70 % were full time RNs, and 30 % were part time (Biviano et al., 2004).
• The current vacancy rate for hospital nursing positions is 8.5 % (Levi, Vinter, Segal, 2007).

Figure 1. Total Registered Nurses, 2008

SOURCES: Kaiser, 2008, based on Bureau of Labor Statistics, State Occupational Employment and Wage Estimates, May 2008. As of August 3, 2009: http://www.bls.gov/data/home.htm.
NOTES: The U.S. total includes the territories. Estimates for detailed occupations do not sum to the totals because of rounding. Estimates do not include self-employed workers. Registered nurses include advance practice nurses, such as nurse practitioners, clinical nurse specialists, certified nurse midwives, and certified registered nurse anesthetists. Click to Zoom

Primary and Specialty Care. Figure 2 shows trends in the number of physicians in primary care and in specialties:

• Between 1970 and 2000, the number of primary care and specialist physicians increased relative to the general population.
• The ratio of physicians to population is expected to flatten in 2005—2020 compared with that earlier period.
• The number of specialists is expected to decrease relative to the general population between 2015 and 2020.

Figure 2. Number of Physicians per 10,000 Population, 1970—2020

SOURCE: Analysis of data from the U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, Physician Supply and Demand: Projections to 2020, October 2006. As of August 15, 2008: http://bhpr.hrsa.gov/healthworkforce/reports/physiciansupplydemand/default.htm Click to Zoom

Trends in Number of Registered Nurses. Figure 3 charts the number of registered nurses over the period 1970 to 2020:

• The ratio of RNs to total population increased steadily between 1970 and 1995 before flattening out between 1995 and 2000.
• The number of RNs is projected to decrease relative to the general population between 2005 and 2020.

Figure 3. Registered Nurses per 10,000 Population, 1970—2020

SOURCE: Analysis of data from The U.S. Department of Health and Human Services, Health Resources and Services Administration, Bureau of Health Professions, National Center for Health Workforce Analysis, Projected Supply, Demand, and Shortages of Registered Nurses: 2000—2020, July 2002. As of August 15, 2008: http://www.ahcancal.org/research_data/staffing/Documents/ Click to Zoom

Distribution of Hospital Beds. Figure 4 shows the distribution of hospital beds across the country:

• In 2006, there were 947,412 total hospital beds in the United States, an average of 3.2 per 1,000 population (American Hospital Association, 2008).
• The supply of hospital beds per capita was below the national average in Western States.

Figure 4. Number of Hospital Beds per 1,000 Population, by State, 2007

SOURCE: Kaiser, not dated. Click to Zoom

A vital element of health system capacity is how well the system can meet a sudden surge in demand for services—for example, during a natural disaster such as a flood or hurricane, or a public health emergency such as an influenza epidemic or a bioterror attack.

The Trust for America's Health publishes state–by–state health preparedness scores based on key indicators, including hospital capacity during a pandemic flu. The most recent report finds that:

• Half of the states would not be able to generate enough bed capacity within two weeks of a moderate pandemic—that is, a pandemic with a severity midway between the severe 1918 outbreak and the mild outbreak in 1968.
• In a moderate pandemic, available beds would vary widely by state; some states would have significant available bed capacity; others would have high overload rates.
• In a severe pandemic (like in 1918), 47 states and the District of Columbia would run out of hospital beds within two weeks (Levi et al., 2006)

Another aspect of surge capacity is the availability of first responder health care workers. A 2005 study asked 6,428 metropolitan New York health care workers about their willingness and ability to come to work in the face of various emergencies. The study found that the willingness of the workers to report for work varied by the type of event:

• Employees were least willing to come to work during infectious events: 52 % of workers were not sure or not willing to appear during a SARS like outbreak.
• Workers were much more willing to appear during an explosion/mass casualty incident (MCI) or some kind of environmental incident.

A separate 2006 study of Maryland health care workers found that nearly half of workers were not likely to report to duty during a pandemic–influenza emergency (Balicer et al., 2006).