Burned Out: Is Your State Full of Overworked Doctors and Nurses?
Let’s face it—doctors and nurses have a tough job. Primary care doctors, specialists, and nurses take the most responsibility for our well-being, but despite high public esteem for those in the medical field, many physicians feel burned out. Could a reason for burnout be the fact that, in many areas in the United States, there are far more people than health care professionals?* And could living in states with fewer doctors and nurses affect the care you receive? These are the questions we wanted to find answers to, so we set out to learn more.
Our data-mining methods
We started by finding data from the US Census Bureau, FBI crime data, and the Kaiser Family Foundation. These sources provided the US and state population numbers and health care professional counts for each state. We then compared the doctor and nurse counts to the population data to get the number of professionals per 1,000 people. In short, if a state has a higher citizen-to-doctor ratio than other states, we consider those doctors to be more overworked, relatively speaking. Once we made all the calculations, we ranked each state by its degree of being overworked.
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How overworked are the nation’s health care professionals?
In the United States, there are a total of 923,308 primary care and specialist physicians.1 Compare that to the nation’s population (324,956,001 as of April 30, 2017),2 and you can see that for every 1,000 people, there are just 2.8 physicians.
The country has a lot more nurses, totaling 4,148,730 registered nurses (RNs) and licensed practical nurses (LPNs).3 That works out to 12.8 nurses per 1,000 people.
With so many people compared to the number of doctors and nurses, we can assume that these health care professionals have a lot of work to do. What’s more, the numbers vary drastically from state to state. In many areas, doctors and nurses are much more overworked than others.
For example, in Washington, DC, the physician-to-person ratio is more than 9.7 to 1,000, but in some states, the number of doctors drops to fewer than 2 for every 1,000. The state ratios for nurses differ widely, too, ranging from 1.9 per 1,000 at the lowest to 21.3 per 1,000 at the highest.
Top 10 states with overworked nurses
|Most Overworked Nurses||Nurses Per 1,000 People|
|5. District of Columbia||7.9|
|7. North Carolina||8.3|
|10. New Hampshire||9.2|
Despite being ranked as one of the best states for well-being, Hawaii’s 2,721 nurses are the most overworked in the nation. There are just 1.9 nurses for every 1,000 people in a state with 1,431,603 citizens. We wonder how Hawaiian nurses find time to eat with that much work to do. But there is a bright spot for nurses in the the Aloha state—these nurses live in one of the most beautiful states in the country!
With a ratio of 5.7 nurses to 1,000 people, this western state has the second-most overworked nursing professionals. There are 17,036 total nurses, which is a lot more than Hawaii, but Utah also has more than twice as many citizens with a population of 2,995,919. The disparity in nurses to people is partly thanks to a population double whammy: Utah has a super high birth rate and a long-living population, according to KSL.com. These factors are sure to keep nurses busy in the Beehive State for a while.
For every 1,000 people in Wisconsin, there are just 5.8 nurses, making the state the third highest for busy nurses in the United States. Like Utah, Wisconsin is facing a shortage of nursing professionals, according to a 2013 report. The report estimates that the state will be lacking almost 20,000 nurses by the year 2035, which means current professionals may have an even heavier burden in the future.
For Wyoming nurses, it may feel like the Wild West, where there are just 6 working nurses for every 1,000 citizens. Even with Wyoming’s smallest-in-the-nation population, there aren’t enough nurses to go around. Could it be that the wide-open spaces of the Cowboy State make for extremely long commutes for nurses? Or maybe the $62,980 average salary for Wyoming RNs, lower than the $72,180 national average, is a factor.4 Whatever the reason, Wyoming is another state looking at a shortfall in the number of nurses it needs.
With 7.9 nurses for every 1,000 people, the nation’s capital has too few nurses. This shortage exists despite the fact that DC RNs earn salaries just above the national average.5 One reason for the shortfall could be that a huge number of the area’s nurses have been retiring, according to a 2015 NBC story. DC needs to train, recruit, and hire new professionals to make up for the nurses leaving the workforce.
In Washington state, nurses are about as overworked as their DC counterparts. With 7.9 nurses for every 1,000 people, these health care professionals are kept working hard to care for their patients. Nurses in this northwestern state have been pressuring the Washington legislature to “address issues of nurse staffing levels, overtime, and rest breaks,” according to The Seattle Times.
7. North Carolina
North Carolina citizens have about 8.3 nurses per 1,000 people, making the health care professionals the seventh-most overworked in the nation. Even with more than 83,000 RNs and LPNs, nurses in the state are overworked thanks to North Carolina’s population that tops 10 million. The nurses per capita ratio may be most pronounced in the state’s rural areas where the shortage is the worst, according to North Carolina Health News.
Nurses in the Pacific coast state of Oregon are overworked at a rate of 8.4 professionals per 1,000 people. To care for their many patients, nurses often have to work several hours overtime, a problem that a 2015 Oregon state law sought to address, citing potential dangers for patient safety. According to the Oregon Center for Nursing, the recent law, which placed restrictions on overtime and increased state audits of hospital staffing, was designed to “ensure that every hospitalized Oregonian receives safe patient care in acute care hospitals.”
Nevada appeared in the bottom 10 of a comparison of health care quality by the US Agency for Healthcare Research and Quality (AHRQ), which points to a concern that 9.2 nurses per 1,000 people isn’t enough. AHRQ measures quality using several criteria, including “type of care (such as preventive or chronic), setting of care (such as nursing homes or hospitals), and clinical areas (such as care for patients with cancer or diabetes).” We wonder, could Nevada increase its standing in AHRQ’s comparison by hiring more nursing professionals?
10. New Hampshire
New Hampshire rounds out our top 10 most overworked states for nurses. This east coast state has a nurse per capita ratio of 9.2 for every 1,000 citizens, meaning there are only 12,288 nurses for the state’s 1,330,608 citizens. According to the US Bureau of Labor Statistics (BLS), the average salary for a registered nurse in New Hampshire was $68,630, which is more than $3,500 below the national average.6
Ranking the most overworked nurses by state
Top 10 states with overworked physicians
|Most Overworked Physicians||Physicians per 1,000 People|
|8. South Dakota||2.2|
Idaho didn’t show up on our list of most overworked nurses, but it took the number one spot for most overworked physicians. When we looked at the number of primary care and specialist doctors, there were only 1.7 physicians for every 1,000 people. This drastically low doctor-to-citizen ratio is a cause for concern in the state, as a Google search for “Idaho doctor shortage” shows plenty of news articles on the subject. One story in The Idaho Statesmen speaks to the doctor shortage: “There are too few primary care doctors to care for all of Idaho’s patients, many of whom are uninsured or covered by low-paying Medicaid.” Maybe these lower reimbursements for Medicaid patients are why aspiring doctors choose not to practice in Idaho and other states with large rural populations.
The second-most overworked physicians are in Wyoming. The state landed in the top four of both the overworked nurses and physicians lists and has just 1.9 doctors per 1,000 people. The dearth of doctors may be one reason the Wyoming government signed on to the Interstate Medical Licensure Compact, which allows doctors licensed in other states to practice medicine in Wyoming.
As mentioned previously, Nevada landed on AHRQ’s bottom 10 list for health care quality, and perhaps its low physician per capita ratio had something to do with it. There are just 2 physicians in Nevada for every 1,000 citizens. This strain is felt most by patients with Medicaid who may have to wait up to a month to access the care they need, according to The Nevada Independent.
For every 1,000 Utahns there are 2.1 physicians. It’s a wonder there aren’t more doctors in the state because the average salary for general practitioners in Utah, $210,680,7 is close to $10,000 higher than the national average. Like with the nurse shortage, the answer is due in part to the state’s soaring birth rate. Another answer, according to The Salt Lake Tribune, is that many doctors are baby boomers, who are retiring in droves.
This southern state takes number five for most overworked doctors. The physician-to-person ratio in Mississippi sits at 2.07 to 1,000, and the shortage maybe be one factor in the state’s ranking as one of the worst in the nation for overall health care. The state is working to curb the low doctor pool, though, and has been recently working to recruit new physicians to the field, according to Fox News.
Montana’s vast landscape is home to just 2,225 primary care and specialist doctors who are responsible for the state’s 1,032,949 people. Many counties in the state lack an adequate number of physicians, and a government proposal has been in the works to secure funding to train more doctors for the underserved areas, according to a story by Independent Record. In particular, experts have worried about a lack of mental health providers in Montana, which in 2016 had the highest suicide rate in the nation, according to the paper.
Texas’s doctors are overworked, and it’s leading some to even restrict the number of patients they’ll see. In fact, close to 80% of physicians in Texas reported being at full capacity, according to a survey quoted by the Texas Medical Association. With only 2.2 physicians per 1,000 people, it’s clear why many health care professionals in the Lone Star State feel they are taking on extra burdens.
8. South Dakota
Every 1,000 South Dakotans are matched with 2.2 physicians. Featuring lots of rural land separated by long distances, South Dakota is another state in need of doctors to care for its citizens. One obstacle could be the Trump administration’s recent crackdown on American visas for foreign-born workers, says a CNN Money report. Changes in rules for visa requirement workers could make it difficult for physicians to continue working in the United States.
In Arkansas, there are 2.2 physicians per 1,000 people. The doctor shortage is due in part to a lack of medical schools in the southern state, according to a PBS Newshour story. But a new med school may stem the tide of doctor vacancies and help Arkansas residents get access to more medical professionals, the story states.
Last on the list at number 10 most overworked, Oklahoma has 8,854 physicians and 3,911,338 people, leading to a ratio of 2.3 to 1,000. Legislators in the state have proposed a bill that will give doctors working in rural Oklahoma regions a $25,000 tax break, according to a story by KWTV News9.
Ranking the most overworked physicians by state
Less overworked nurses and doctors could mean better health care
Why should you care if the physicians and nursing professionals are overworked in your state? There is some evidence that having access to fewer physicians could affect the quality of care you can expect to receive. According to a study published in the journal Health Affairs, the more primary care doctors and specialists in a state, the better quality of care that state has:
“Having more physicians, both specialists and [family practice/general practitioners], is associated with better quality.”
In addition, more nurses could also lead to better care in hospitals, according to a 2002 study of hospital surgical nurses in California that found that high patient-to-nurse ratios correlated with higher hospital mortality rates. In the study, each patient’s risk of death within 30 days of admission was increased by 7% for every extra patient a nurse took on.
Overworked nurses become burned out, which leads to job dissatisfaction and errors, according to the same study:
“Nurses nationwide consistently report that hospital nurse staffing levels are inadequate to provide safe and effective care. Physicians agree, citing inadequate nurse staffing as a major impediment to the provision of high-quality hospital care.”
If you’re in one of the states with too-busy nurses or doctors, or you’re worried about health care professional burnout, there are few things you can do to ensure you get quality care.
- First, think carefully when choosing a primary care doctor or specialist. Assess what your health and other needs are (such as language requirements), and then do some research to ensure your doctor will meet those needs.
- Second, get referrals. We don’t just mean from other doctors, but from family, friends, and neighbors, too. If someone you trust has a good experience with a health care professional, chances are you will too.
- Finally, take accountability for your own care. From the type of health care coverage you choose to the treatments you decide to undergo, you are responsible for making your own health care decisions. Doctors, specialists, and nurses are definitely the experts when it comes to vast amounts of medical knowledge and treatment, but your experiences and your knowledge of your own body matter, too. And if you feel uneasy about the care provided by a doctor or nurse, speak up.
We hope that even if your state landed on the list of overworked doctors or nurses, you understand that with a little work, you can get access to the quality care you need.
* This data is based on the total number of citizens in each state and don’t reflect the exact number of patients that any individual doctor or nurse may be responsible for.
1 Kaiser Family Foundation, “Total Professionally Active Physicians”
2 US Census Bureau, “US and World Population Clock”
3 Kaiser Family Foundation, “Total Number of Professionally Active Nurses”
4 US Bureau of Labor Statistics, “Registered Nurses”
5 US Bureau of Labor Statistics, “Registered Nurses”
6 US Bureau of Labor Statistics, “Registered Nurses”
7 US Bureau of Labor Statistics, “Family and General Practitioners”