NATIONAL CENTER Seriesilr). 

For HEALTH STATISTICS I Number 1 

VITAL and HEALTH STATISTICS 

.. DATA ON NATIONAL HEALTH RESOURCES 

Health 

Manpower 

Statistics on persons employed in selected health occapations, 1965 and 1967; recent statistics on physicians, dental 

manpower, nursing manpuwer, and pharmacists in relation 

to location, type of practice, and,/or specialty; occupational 

statistics on persons employed in hospitals and in nursing 

homes, 1966; and discussion of sources of health manpower 

statistics. 

U.S. DEPARTMENT OF HEALTH, EDUCATION, AND W,ELFARE 

Public Health Service 

Health Services and Mental Health Administration 

Washington, D.C. Novemhet 196b 
Public Health Service Publication No. lOOO-Series 14.No. 1 

For sale by the Superintendent of Documents, U.S. Government Printing Office 

Washin&on, D.C., 20402 - Price 60 cents 
NATIONAL CENTER FOR HEALTH STATISTICS 

THEODORED. WOOLSEY,Director 

PHILIP S. LAWRENCE, Sc.D., Associate Director 

OSWALD K. SAGEN, PH.D.,, A ssistant Director for Health Statistics Development 

WALT R. SIMMONS, M.A., Assistant Director for Research and Scientific Development 

ALICE M. WATERHOUSE, M.D., Medical Consultant 

JAMES E. KELLY, D.D.S., Dental Advisor 

EDWARD E. MINTY, Executiue Officer 

MARGERY R. CUNNINGHAM, lnfoTmation Officer 

DIVISION OF HEALTH RESOURCES STATISTICS 

SIEGFRIED A. HOERMANN, Director 

PETER L. HURLEY, Chief, Health Facilities Statistics Branch 

JACQUELINE GLEASON, M.A., Chief, Health Manpower Statistics Branch 

EDYTHE A. GRAY, M.A., Chief, Hospital Discharge Suruey Branch 

Public Health Service Publication No. 1000.Series 14.No. 1 

Library of Congress Catalog Card Number 68-12646 
CONTENTS 

Page 

Measuring the Supply of Health Manpower-------------------------------- i 

Maryland Y. Pennell 

Sources of Health Manpower Statistics ___________________________________ ,7,8 ‘ Siegfried A. Hoermann 

physicians ________________________________________-------------------

Christ N. Theodore 

DentalManpower------------------------------------------------------

Stanley Lotzkar and Donald W. Johnson 

Nursing Manpower-----------------------------------------------------

Eugene Levine and Eleanor D. Marshall 

pharmacist Manpower-------------------------------------------------

Fred T. Mahaffey and Maryland Y. Pennell 

11 

26 

33 

40 

Manpower k Hospitals and Nursing Homes ________________________ - ______ 49 

Margaret D. West and James P. Cooney, Jr. 

References----------------------------------------------------------- 56 

iii 
IN THIS REPORT summary statistics aye presented on persons employed in 1965 and 1967 

in about 70 health occupations, OYcombinations thereof. The occupations aye grouped within 35 

health fields. 

Health manpower statistics are provided through such sources as educational programs, licenses to practice, certification, registration, association membership, places of employment, 

and other miscellaneous identifying factors. 

The 3.4 million pevson3? in health occupations in 1967 included move than 1 million physicians, 

dentists, and yegisteved nurses. The numbers of wovkeys in each of these three basic ca’Yee’Ys 

increased about 6 percent between 1965 and 1967. 

The allied health occupations comprised the balance of 2.3 million pevsons with specialized education OY on-the-job training that prepared them for finctioning in the health establishment. 

These occupations accounted fov 69 percent of the designated health wovkevs in 1967. 

Between 1965 and 1967 the allied health occupations gained almost one-half million wovkevs. 

The largest gains weye in nuvsing manpower-practical nurses, and aides, ovdevlies, and attendants-and in secvetavial and office pezsonnel. 

Physician statistics aye considered in tevms of physicians’ services as evidenced in present 

Yecovds, changes in classificationof activity and specialty, and development of special surveys. 

Estimates of dentist manpower and of dental auxiliaries aye provided, along with a discussion 

of the national data compilation system. 

Nuvsing manpower data aye available through decennial censuses, interagency estimates, and 

inventories of yegisteved nu’vses. Measurement of the nurse supply is considered in Yelation to 

size of the field, geopaphic distribution, employment diversity, and functional diffeevences. 

Pharmacist statistics based on State registrations aye shown according to residence, activity 

status, sex, education, age group, type of practice, and employment in community pharmacies 

and in hospital pharmacies. 

The occupations of the professional and technical workers employed in hospitals and in nursing 

homes in 1966 aye Yepovted from a special survey. Estimates of present shortages of hospital 

manpower weYe obtained at that time. 

SYMBOLS 

Data not available _______________________ ___ 

Category not applicable------------------- . . . 

Quantity zero ____________________________ _ 

Quantity more than 0 but less than 0.05---- 0.0 

Figure does not meet standards of 

reliability or precision------------------ * 

iv 
MEASURING THE SUPPLY OF HEALTH MANPOWER 

Maryland Y, Pennell, M. SC.~ 

The 95th annual meeting of the American 

Public Health Association (APHA) was the occasion for the delivery of a group of papers concerned with “Measuring the Supply of Health 

Manpower.” The speakers assembled on October 22, 1967, at Miami Beach, Florida, at a session sponsored by several sections of the Association-statistics, Dental Health, Medical Care, 

and Public Health Nursing-and the Conference 

on Community Health Planning. This publication 

has been prepared in response to suggestions that 

the papers be printed in one volume, in,order to 

reach a larger audience than the 150 persons who 

attended the session. 

Plans for the APHA meeting were developed 

in the Health Manpower Statistics Branch of the 

National Center for Health Statistics (NCHS). 

Within the Public Health Service, NCHS has the 

responsibility for conducting statistical studies 

using primary and secondary sources to determine the numbers, geographic location, age, and 

other characteristics of health manpower invarious fields. Hence this publication provides factual 

information on health manpower resources from 

other programs of the Service as well asnational 

professional agencies. Reference is also made to 

other government and nongovernment agencies. 

Each speaker was asked to provide information on the current number of persons active in 

the particular field and their location by State; 

a

Mrs. Pennell is Special Assistant to the Director, Division of Allied Health Manpower, Bureau of Health Manpower, 

Public Health Service. She was formerly with the National 

Center for Health Statistics. 

growth in employment in recent years; and distribution by type of practice, function, and/or specialty. These statistics form the background for 

the discussion of problems involved in measurement of supply. The papers were not intended to 

discuss projections of manpower to be available 

in the future, measures of health manpower needs, 

utilization of health services, or demand therefor. 

Following the APHA meeting, the speakers 

were given the opportunity to revise their papers 

for publication and to include later statistics. The 

article on physicians, for example, includes data 

as of December 31, 1967; that on dental manpower, as of mid-1967. Information fromthe 1966 

inventory of registered nurses and the 1966-67 

inventory of pharmacists was not available by 

March 1968, although both surveys of licensed 

personnel are nearing completion. 

Measuring the supply of manpower musttake 

into account several variables. For each health 

occupation there is the matter of definition; this 

affects who is counted, particularly when there 

are poorly defined categories or redefined titles 

that switch numbers from one category to another. 

In a particular occupation the supply depends on 

the number of persons who receive the appropriate 

education OY tvaining that qualifies them for functioning in that field. 

The supply may be influenced by subsidizing 

training, by changing admission requirements, 

or by other means, thus bringing it to the level 

of one’s expectations. The supply available for 

any field is also a function of the number of 

persons who can be drawn in from Yelated fields. 

IntwnationaZ migration is another factor in de-
termining the supply of manpower in several of 

the health occupations. These variables are 

considered in the discussions for each specific 

health field. 

Health manpower may be measured in two 

ways, by industry and by occupation. The U.S. 

Bureau of the Census reports that the “health 

services industry” at the time of the 1960 census 

employed 2.6 million persons in the civilian 

labor force, ranking third among some 70 industries.1 Between the 1950 and 1960 censuses, the 

number of workers in the health services industry 

increased by almost 1 million, for a growth rate 

of 54 percent. About two-thirds of the individuals 

employed in this industry have education and 

training unique to the health field. The other 

third-almost 1 million workers-are clerks, 

craftsmen, laborers, and others who themselves 

assist in the provision of health services but 

whose skills are not limited to the health establishment. 

The classification by “health occupations” 

focuses on those individuals possessing knowledge and skill unique to the health field. Included 

are health manpower in all industries, not just 

health services; for example, relatively few 

pharmacists and veterinarians are counted by 

the Bureau of the Census as being in the health 

services industry. The health occupations that 

are identified in table 1 suggest the range and 

diversity of health careers. Recognition of other 

supportive personnel-many in newly developing 

work areas-would greatly increase the number 

of occupations, to a labor force of approximately 

4 million workers. 

Physicians, dentists, and registered nurses 

comprise more than 1 million active health personnel. Between 1965 and 1967 each of these 

basic careers increased about 6 percent in numbers of workers, as shown below: 

Occupation 1965 1967 

Physician (M.D. and D.O.) . . . . . 288,700 305,500 

Dentist. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93,400 98,700 

Registered nurse . . . . . . . . . . . . . . . . . . 621,000 659,000 

1,837,700 2,312,100 

Allied health occupations...... to to 

I 1,858,OOO 2,347,400 

In addition to these three careers, there are 

more than 2.3 million persons with education and 

specialized or on-the-job training that had prepared them for employment in the health establishment in 1967. The allied occupations accounted 

for 65 percent of the designated health workers 

in 1965 and 69 percent of the total in 1967. 

Between 1965 and 1967the.alliedhealth occupations gained almost one-half million workersa tremendous increase of 26 percent. Thelargest 

gains were 300,000 nursing aides, orderlies, and 

attendants; 50,000 secretarial and office personnel; and 38,000 practical nurses. As many as 

5,000 or more additional workers wereestimated 

for such occupations .as clinical laboratory technologists, clinical laboratory technicians-assistants, food technologists, home health aides, 

pharmacists, and radiologic technologists-technicians-assistants. 

Allied health personnel function in comprehensive community health services, including 

hospital care, preventive medicine, and environmental protection. More than half of these health 

workers are accounted for in the professional 

and technical staffing of hospitals and nursing 

homes discussed in the last paper of this collection. Approximately one-fourth of the ‘total have 

education to at least the baccalaureate level. 

Many of these categories of allied health 

personnel have emerged since World War II, 

in order to provide a wide range in auxiliary 

services. At the same time there has been 

increasing specialization within many of the 

older disciplines in an effort to cope with the 

depth and thoroughness essential for optimum 

health care. The trend of diversification and 

specialization may be expected to characterize 

health manpower of the future. 2 

It is obvious that there are serious shortages 

in the supply of health manpower as well as 

inefficient use of some persons active in the 

health field. Maldistribution of facilities and 

services adds to the problem of rendering care 

to every member of our society. Attempts have 

been made toward measuring these shortcomings, 

but none of the many estimates can adequately 

measure the total need or demand. Even if one 

could envision the ideal staffing for health services for a community, for a State,, or for the 

Nation, the continuing development of new knowledge and techniques, new patterns of service, 

and new methods of payment are all constantly 

2 
changing the needs for both numbers and varie- ployment can be made more attractive in order 

ties of health workers. to retain persons currently in the labor force 

Nevertheless, opportunities for increasing and to return to practice inactive health perthe health manpower supply exist through adding sonnel. Action, study, and experimentation can 

to school capacities and attracting recruits to help produce an adequate supply of well-qualithe health field. In addition, through improve- fied health workers. 

ments in wages and working conditions, em- I 
Table 1. Estimated persons employed in selected occupations within each health field: 

1965 and 1967 

-

Workers 

Health field and occupation 

1965 1967 

Totall------------------------------------- 2,840,800 to 2,861,100 3,375,300 to 3,410,600 

I 

ADMINISTRATION OF HEALTH SERVICES------------ 31,500 to 37,000 39,000 to 44,000 

Administrator, program analyst, program representative-------------------------- 31,500 to 37,000 39,000 to 44,000 

ANTHROPOLOGYAND SOCIOLOGY------------------- 600 to 800 1,000 

Anthropologist - cultural and physical----------- Sociologist - medical---------------------------- 200 

400 

to 400 

600 

400 

AUTOMATIC DATA PROCESSINGINTHE HEALTH FIELD- 300 500 

Systems analyst----------------------------------

BASIC SCIENCES IN THE HEALTH FIELD-----------

Research scientist (other than physician, dentist, veterinarian)--------------------------

BIOixfEDICAL ENGINEERING-----------------------

Biomedical engineer------------------------------

Biomedical engineering technician----------------

CHIROPRACTIC AND NATUROPATHY-----------------

Chiropractor, naturopath-------------------------

CLINICAL LABORATORY SERVICES-----------------

Clinical laboratory scientist--------------------

Clinical (medical) laboratory technologist4------ Clinical laboratory technician and aide----------

DENTISTRY AND ALLIED SERVICES----------------

Dentlst------------------------------------------

Dental hygienist-------------------------_-___--- Dent-1 assistant---------------------------------

Dental laboratory technician---------------------

DIETETIC AND NUTRITIONAL SERVICES------------

Dietitian and nutritionist-----------------------

Dietary technician, food service supervisor------

See footnotes at end of table. 

300 500 

47,000 52,000 

247,000 52,000 

7,500 9,000 

2,500 3,000 

5,000 6,000 

16,000 to 18,000 16,000 to 18,000 

216,000 to 18,000 316,000 to 18,000 

85,000 to 95,000 100,000 

3,500 4,000 

35,.000 40,000 

46,500 to 50,000 56,000 

223,400 235,700 

593,400 98,700 

213,500 615,000

91,000 95,000 

25,500 27,000 

--g-+-p 

4 
Table 1. Estimated persons employed in selected occupations within each health field: 

1965 and 1967-Con. 

Workers 

Health field and occupation 

ECONOMIC RESEARCH IN THE HEALTH FIELD--------

Economist - health-------------------------------

ENVIRONMENTAL CONTROL------------------------

Environmental engineer--------------------------- Industrial hygienist-----------------------------

Other environmental program specialists---------- Sanitarian and sanitarian technician-------------

FOOD AND DRUG PROTECTIVE SERVICES------------

Food technologist--------------------------------

Food-and-drug analyst and inspector--------------

HEALTH AND VITAL STATISTICS------------------

Health statistician, vital-record registrar, demographer-------------------------------------

HEALTH EDUCATION-----------------------------

Public health educator---------------------------

School health educator, coordinator--------------

HEALTH INFORMATION AND COMMUNICATION---------

Health information specialist and science writer- Health ten&n&al writer--------------------------

Medical illustrator------------------------------

LIBRARY SERVICES IN THE HEALTH FIELD---------

Medical librarian--------------------------------

Medical library assistant------------------------

MEDICAL RECORDS------------------------------

Medic-1 record librarian-------------------------

Medic-1 r-cord technician-----------------------­

~,,,-CI~ /JiJD OSTEOPATHY----------------------

Physician (M.D.)---- --_-_--___--_--___----------- Physician (D.O.)---------------------------------

See footnotes at end of table. 

1965 1967

I 

35,000 35,000 

I 

9,000 “9,000

2,300 32,300

8,700 38,700

15,000 315,000 

16,500 21,500 

I 

15,000

1,500 

20,000

1,500 

1,400 to 2,400 1 2,400 

1,400 to 2,400 32,400 

16,700 19,800 

1,700

15,000 1,800

18,000 

3,500 to 4,500 4,500 

32 000 

32'000 

33.000 I 37,000 

12,000

25,000 

288,700 305,500 

294,100

11,400 

3500 
Table 1. Estimated persons employed in selected occupations within each health field: 

1965 and 1967-Con. 

l- Workers 

Health field and occupation 

1965 

MIDWIFERY------------------------------------ 5,700 

Lay midwife-------------------------------------- 25,700 

NURSING AND RELATED SERVICES----------------- 1,409,000 

Registered nurse--------------------------------- 621,000 Practical *urse---------------------------------- 282,000

orderly, attendant----------------- Nursing aide, 500,000 Home health aide--------------------------------- 6,000

OCCUPATIONAL THERAPY------------------------- 10,000 

Occupational therapist--------------------------- 6,000 Occupational therapy assistant, aide------------- 24,000 

ORTHOTIC AND PROSTHETIC TECHNOLOGY----------- 3,300 

3,300 

PHARMACY------------------------------------- 123,000 

Pharmac=st--------------------------------------- 2117,400 pharmacy aide------------------------------------ 2,7 5,600 

PHYSICAL THERAPY----------------------------- 17,000 

Physic-1 therapist-------------------------------

Physical therapy assistant, aide-----------------

PODIATRY-------------------------------------

7,600 

PSYCHOLOGY----------------------------------- 9,000 

Psychologist - clinical, counseling, and other health-------------------------------- 9,000 

RADIOLOGIC TECHNOLOGY------------------------ 70,000 

Radiologic (X-ray) technologist, technician------ 70,000 

SECRETARIAL AND OFFICE SERVICES IN THE HEALTH FIELD-------------------------------- 200,000 

Secretary, office assistant---------------------- 2200,000 

See footnotes at end of table. 

1967 

4,700 

4,700 

1,791,ooo 

659,000

320,000

800,000

12,000 

11,000 to 12,000 

6,500

4,500 to 5,500 

3,500 

3,500 

128,000 

1;;';;; , 

19,000 to 21,000 

13,000

6,000 to 8,000 

8,000 

8,000 

9,000 

39,000 

75,000 to 100,000 

is,000 to 100,000 

250,000 

250,000 

6 
25,000 6,000 

"17,000 19,000 

Table 1. Estimated persons employed in selected occupations within each health field: 

1965 and 1967-Con. 

Workers 

Health field and occupation 

1965 1967 

Manual 

SOCIAL WORK---------------------------------- 19,000 I 21,700 

Clinical social wbrker---------------------------

Clinical social work assistant-------------------

17,500

71,500 

20,200

71,500 

SPECIALIZED REHABILITATION SERVICES--'------- 5,300 to 5,900 8,600 to 8,800 

Corrective therapist----------------------------- Educational therapist---------------------------- 700 to 800 

500 

1,000 t;5;G200 

arts therapist---------------------------- 900 3900 Music therapist---------------------------------- 1,500 2,000 Recreation therapist----------------------------- 1,600 to 2,000 4,000

Homemaking rehabilitation consultant------------- 100 to 200 200 

SPEECH PATHOLOGY AND AUDIOLOGY---------------

Speech pathologist and audiologist---------------

TJEmRIj,Jmy MEDICINE--------------------------

Veterinarian-------------------------------------

VISION CARE----------------------------------

Optometrist--------------------------------------

Optician-----------------------------------------

Vision care technician---------------------------

Orthoptist---------------------------------------

VOCATIONAL REHABILITATION COUNSELING---------

Vocational rehabilitation counselor--------------

MISCELLANEOUS HEALTH SERVICES----------------

Inhalation therapy technician--------------------

Electrocardiograph technician--------------------

Electroencephalograph technician----------------- Surgical aide------------------------------------

14,000 I 16,000 

14,000 16,000 

22,500 24,200 

522,500 24,200 

40,400 40,400 

17,000

8,000 

317,000

38,000

15,000 315,000

400 3400 

6,200 7,800 

26,200 7,800 

28,.200 34,000 

I 

5,000 7,000 

1,200 2,000 

IEach occupation is counted only once. For example, all physicians are in medicine and osteopathy. 

2Estimate not previously published or revised from that shown in PHS Pub. No. 1509. 

'1965 estimate repeated in absence of sufficient information on which to base revision. 

4With bachelor's degree or ASCP certified. 

5Estimates revised to show active rather than total for dentist, physician, and veterinarian. 

'Preliminary estimate. 

'Limited to hospital employees in 1966. 

Source: U.S. Department of Health, Education, and Welfare; Public Health Service, National 

Center for Health Statistics: Health Resources Statistics: Health Manpower, 1965. 

Public Health Service Publication No. 1509. Washington, D.C., U.S. Government Printing Office, 1966. (1967 data based on 1968 edition of this publication, now in process.) 

7 
SOURCES OF HEALTH MANPOWER STATISTICS 

Siegfried A. Hoermann, B.A.b 

An evaluation of the sou.rces of health manpower statistics may be concerned with specific 

sources or references or with a more general 

approach. This paper is structured according 

to the latter, with examples of the former. Otherwise, a fairly large spectrum of specific sources 

has to be covered within a very limited space. 

In addition, I am concerned with issues of health 

manpower supply- current and future-rather 

than with issues of health manpower needs. The 

emphasis is on sources of national statistics, 

rather than on the myriad of sources and studies 

which pertain to specific State or local areas 

only. 

The identification and classification of 

sources are rendered difficult by a number of 

factors. Basic to the problem is the identification, 

as such, of health manpower occupations as distinct from occupations not related to health. Furthermore, the rapidly changing technology and 

systems for the delivery of health services have 

had an attendant and continuing proliferation of 

health occupations and functions within given 

occupations. One end of the broad range of health 

occupations is represented by persons who deliver 

health services directly to the population, such as 

physicians, dentists, and nurses. At the other 

end are those with an indirect, but nevertheless 

important, role in the total system for the delivery 

of health services, such as medical record librarians, sanitarians, and selected computer programmers. By 1965, the number ofhealth occupab Mr. Hoermann is Director of the Division of Health Resources Statistics, National Center for Health Statistics, 

Public Health Service. 

tions as measured by primary titles had reached 

at least 140 which are listed in Health Resources 

Statistics: Health Manpower, 19f5.3 

In addition to the differing skills required 

for persons in each of these occupations, there 

is also a wide range in the control which society 

exercises over these practitioners. Some are 

rigidly controlled and identified through State 

laws and regulations as in the case of physicians 

and pharmacists; others are unregulated except 

by laws which apply to everyone. Subsets of 

society, such as professional associations, also 

exercise varying degrees of control over their 

members. Clearly, the sources of manpower 

statistics can more easily be identified for the 

regulated than for the nonregulated occupations. 

Once the health occupations have been identified, there are several potential methods for 

obtaining information about them. One approach 

might be through household or establishment 

surveys or censuses. These censuses or surws, while undoubtedly excellent sources of 

data on economic activity, are not necessarily 

good sources of health manpower statistics. For 

one thing, many of these types of surveys are 

based on samples which, even if large, are 

often not large enough to provide needed data 

and geographic distribution for many of the 140 

health occupations, 

In household surveys, there is the additional 

problem of response errors becausetherespondent, often the housewife, is frequently unable to 

describe adequately the specific work activity of 

household members. This is particularly serious 

when differentiating among the highly specialized 

health occupations. In this way, for example, the 
orthopedic surgeon, the podiatrist, the optometrist, and the chiropractor may all be reported 

as “doctors.” 

More accurate or consistent occupational 

classifications may be achieved in surveys of 

establishments, providing the categories used 

are broad enough to fit the records available 

to the surveyed establishments. The resulting 

categories, however, may be so broad as to 

preclude the needed differentiation of health 

occupations. Furthermore, establishment surveys 

fail to cover the independent practitioners who 

fall outside the purview of establishment records. 

Both the household and establishment surveys 

are usually concerned with work activity rather 

than with usual occupation or training. Administrators engaged in health planning may need information on the trained reservoir as well as on 

active practitioners. 

For these reasons, we should also look 

elsewhere for sources of manpower statistics 

which will provide the necessary detail as regards 

fineness of occupational breakdown, geographic 

detail, and characteristics of both the active and 

the reserve health manpower. One of the initial 

steps in this pursuit is the identification by name, 

and location by address, of the members in the 

group to be studied. The development of such 

name-address lists, directories, or registries 

serves the double function of (1) being a source 

for developing simple counts of an occupation 

by geographic area and (2) providing the necessary mailing or field enumeration lists for more 

detailed surveys of given occupations. 

Let us first consider the sources for developing or obtaining such name-address lists. Some 

of these sources may, in addition, provide other 

useful data over and above merely name and 

address. If the occupation is licensed inallstates 

by law, as in the case of some 11 health occupations , names and addresses may be obtained 

from the official State licensing agencies. If the 

occupation is licensed in some but not all States, 

as is true for 14 additional occupations, other 

techniques would have to be used to obtain. names 

and addresses for nonlicensing States.4 

For some health occupations, specialty 

boards have been established to pass on qualifications and competency and to register or certify 

persons who meet established standards. Name 

and address lists may be obtained from these 

boards. Professional association membership 

lists may also be used as a source of names 

and addresses. For some occupations, however, 

the number of competing associations or their 

regional character may make further processing impracticable. For occupations which require 

specialized curricula or special schools, lists 

of graduates can be useful in identifying and 

locating those practitioners. 

Commercial addressing companies or list 

houses may obtain their data initially from State 

licensing agencies, specialty boards, professional 

associations, schools, or other basic sources. 

These companies thus become a good source 

of names and addresses for selectedoccupations. 

Other sources of name-address lists include 

city directories and the classified sections of 

telephone books. 

Use of the above-described sources raises 

the problem of ensuring complete coverage without duplication of practitioners in a given occupation for a specified period of time. For the 

occupations requiring a license to practice, the 

problem is primarily with practitioners who are 

licensed in two or more States. Such cases occur 

where a person is licensed bothinthestate where 

he graduated from professional school and in the 

State where he now practices. In addition, many 

persons practicing in the border areas of a State 

are also licensed in the neighboring State or 

States. The treatment by computer or clerk in 

including or excluding names which may have 

been variously recorded for the same person 

or are identical but for different persons may 

result in duplicate counts or omissions. 

For occupations less universally recorded, 

multiple sources of the types described above 

must .be used to obtain a comprehensive list. 

Thus the problem of coverage and duplication 

becomes more serious, since some members of 

an occupation may be registered, listed, or 

otherwise noted in several sources, while others 

are included in none. 

As discussed earlier, most household and 

establishment surveys which are broad in scope 

are not particularly good sources of health manpower statistics, but they, together with selected 

administrative reporting systems, may also be 

useful as sources of name-address lists. Some 

9 
examples of these potential sources include the 

Internal Revenue Service returns which carry 

name, address, and occupation. The returns or 

address lists for the Censuses of Business and 

of Governments identify the places of work of 

many health practitioners. The National Science 

Foundation has developed biennial lists of scientists, many of whom are in health fields. The 

Bureau of Labor Statistics has questionnaire 

returns from its surveys of employment in State 

and local governments. The forms involved in the 

administrative functioning and in the surveys of 

the Social Security Administration might also be 

processed to provide lists. Records of the Naturalization and Immigration Service, including 

visas issued and annual alien registration would 

also be a potential source for obtaining name-address lists of selected foreign- born persons in the 

health occupations. This source could be particularly important for measuring total physician 

strength, including the large number of alien 

physicians in the country. 

Some private organizations ‘have conducted 

surveys of health personnel which involved name 

and address lists. For example, the American 

Medical Association conducts an annual survey 

to obtain current data on work status and specialization. 

One problem, of course, is that the surveys 

or reporting systems usually are administered 

under assurances of confidentiality and even 

name-address lists may not be released. Secondly, the health occupations or employment in 

the health services industry may lack the definitional precision required for adequate health 

manpower statistics. In addition, there is the 

problem of response errors. For these and other 

operational reasons, it may be difficult to develop 

a system for separating the desired names and 

addresses for health personnel from the nonhealth occupations and industries. In some cases, 

it may be necessary to include borderline groups 

to ensure complete coverage of the desired health 

field. 

Often no one list will cover a given occupation or occupational group completely. When 

this situation occurs, enough combinations of 

lists, either overlapping or mutually exclusive, 

must be used to achieve the minimally acceptable level of coverage, after removal of duplicates and nonapplicable cases. The level attained 

by this method may be determined by proper 

quality control procedures. 

These name-address lists, whether obtained 

from State licensing agencies, specialty boards, 

membership lists, graduation lists, list houses, 

city directories, generalized household surveys, 

or administrative records, may provide basic 

frequency and geographic distribution statistics 

and possibly other information. Probably equally 

important is their role as mailing lists to obtain 

detailed information about the practitioner and 

his practice. Once a list has been established 

and evaluated as relatively complete, it can then 

form the basis for a detailed census or a sample 

survey of a health occupation. If these surveys 

are to be recurring, the mailing lists may be 

either reestablished as required or kept current. 

The sources described above may provide 

statistics on the nature of the cuwmt supply 

of health occupations, including numbers and 

distribution from name-address lists and detailed 

characteristics from surveys based on these 

lists. There is also a source for providing statistics on estimated future supply. This is school 

records for those occupations with a fairly 

rigidly prescribed and specialized course of 

training or education, such as in the schools of 

dentistry, medicine, optometry, pharmacy, podiatry, and veterinary medicine. Attrition rates 

applied to student enrollment at various levels 

for these types of schools will yield short-range 

projections of increments to practitioners already 

in a given profession. Available age-specific death 

rates may be used to determine the corresponding 

losses. Longer range projections involve assumptions regarding the probable numbers of high 

school or university students who will enter 

given professional schools. Probably no long- or 

short-term projection techniques would be valid 

for occupations involving limited or on-the- job. 

training or for those involving rapidly changing 

functions. 

Because of the dynamic nature of health 

occupations and deficiencies in many of the 

above-described sources, great care must be 

exercised in the use and development of health 

manpower statistics. The Public Health Service, 

as part of its cooperative program with professional associations, is continuing its efforts 

to improve the quality and expand the coverage 

of statistics on health manpower. 

10 
PHYSICIANS 

Christ N. Theodore, M.AoC 

Because doctors of medicine and osteopathy 

play an important role in the production of health 

care services, there is considerable emphasis 

placed on physicians in the study of health manpower. The physician’s traditional role includes 

not only the performance of examinations and 

.diagnostic, surgical, and therapeutic procedures 

but also the coordination or management of health 

care services provided by others. When physicians coordinate other health care services, they 

may be regarded as “middlemen” charged with 

purchasing services on behalf of the consumers 

who lack the knowledge required to make such 

decisions. Herbert Klarman correctly has pointed 

out that “physicians are called members of the 

health team, but their preeminence as its leaders 

is unchallenged, whether the task is patient care, 

research, planning, or administration.” 5 

The double role which the physician has 

played in the health care industry must be considered in the study of physician supply, for 

physicians are not sought for themselves but for 

the services which they provide. Themainreason 

for measuring the supply of health manpower is 

to determine whether it meets certain demand 

criteria. In this context the examination of past 

and future demand for health care services is 

unavoidable, lest we treat this subject in the 

traditional manner of merely counting the number of physicians and comparing this number to 

the number of people that they may be servicing. 

Physician-population ratios may be useful in the 

‘Mr. Theodore is Director of the Department of Survey Research, American Medical Association. 

._ 

study of certain aspects of manpower. The use of 

such ratios alone, however, is not adequate since 

they do not reflect most of the factors which determine the demand for and supply of health care 

services. 

DETERMINANTS OF DEMAND 

AND SUPPLY 

During the past 20 years American consumers and government agencies have diverted 

increasing amounts of their annual budgets toward 

the purchase of health care services. Some of 

the factors which have contributed to the rise 

of demand are population growth and changes 

in its age and race distribution, increased education and sophistication regarding health, and 

the ability of the medical profession to provide 

more and better services. Of more importance, 

however, are factors which have enabled buyers 

to translate their wants into demand. Among 

these factors are rising disposable personal 

income, widespread health insurance coverage, 

and expanding government subsidies. When consumer income was low, at almost a subsistence 

level, health care was something of a luxury. 

Now with greater spending power, the consumer 

has accepted health care as a necessity. 

Faced with this growing demand, the health 

care industry responded with an expansion of 

output. The number of hospital beds was vastly 

increased, the output of the drug industry increased five-fold, and the number of physicians 

exceeded 300,000. The health care industry became the third largest employer in the economy. 

I 

11 
The transition has been difficult since supply had 

to increase during a time when the United States 

economy was at high employment. 

Given high employment, it was inconceivable 

that supply could increase without significant 

increases in cost. But cost increases could not 

have been translated into price increases unless 

enough consumers and government agencies were 

able to buy the additional output at constantly 

rising prices. Thus, pressures of demand against 

supply have been the critical factor in producing 

price increases. All evidence seems to support 

the thesis that the industry, or at least major 

segments of it, did not expand “fast enough.” 

Rapidly increasing prices were the result, especially for those components the supply of which 

tends to be rigid and which require highly trained 

medical and allied health personnel. To economists, the term “rapidly increasing prices” is 

synonymous with an imbalance between supply 

and demand. Today, there are very few who argue 

that the present supply of health personnel and 

particularly of physician services is adequate. 

Because this shortage of physicians has 

developed over a long period of time, we need 

not devise intricate methods to measure supply 

and demand in order to confirm the magnitude 

of the imbalance. There are enough indicators 

which substantiate its existence. Elton Rayack6 

arrives at an operational definition of this shortage on the basis of the rapid climb of physicians’ 

incomes, increases in physicians’ fees, and the 

search for less costly substitutes for their services, i.e., services of personnel with less training 

and experience. To these indicators we may add 

the long waiting lines of prospective students who 

wish to enter medical school. 

The problem that we are faced with today 

is how to increase the capacity of the healthcare 

industry and stabilize prices for health care 

services. Two approaches may be used to achieve 

this end: first, increase the number ofphysicians 

and, second, expand the productivity of existing 

manpower. It is necessary to do both if the supply 

of health services is to meet the growing demand. 

It should be noted, however, that the latter can 

be a long term approach involving the evaluation 

and, to some extent, the reorganization of the 

present system. 

MEASURING PHYSICIANS’ SERVICES 

Methods are needed to measure changes in 

(1) the supply of physicians and (2) their productivity. The first calls for a master file on physicians with demographic, biographical, and professional activity information. The second calls 

for special surveys of the physician population 

for the collection of utilization and financial data 

by type of practice organization for the study of 

productivity. 

The remainder of this chapter discusses 

methods which the American Medical Association has adopted to meet the above two requirements for measuring the supply of physicians’ 

services and describes the Association’s data 

gathering efforts. Although this discussion centers 

on doctors of medicine, it can be applied to doctors of osteopathy. Tables 2-6 at the end of this 

chapter present numbers, distribution, type of 

practice, and specialty of physicians-M.D. and 

D.O. 

Physicians’ Records Service 

A master file on M.D.‘s has been maintained 

by the Physicians’ Records Service of the American Medical Association for many years. It has 

included information on every physician in the 

United States and on those graduates of American 

schools who may be practicing overseas on a 

temporary basis. The file includes members and 

nonmembers of the Association. It also includes 

aliens residing in this country. Inclusion in the 

file starts during the medical school phase of a 

physician’s career or upon his entry into the 

country. The master file is divided into two sections: (1) the current records of professional activities and (2) the historical records. The current 

records are computerized with a closing date of 

December each year, and tabulations are prepared 

which are published in the Distvilmtion of Physicians, Hospitals, and Hospital Beds in the U.S. 

This series presents the number of Federal and 

non-Federal physicians by specialty, activity, and 

location. Comparable data are available starting 

with the year 1963. 

The historical records are currently being 

computerized. They will comprise an additional 

12 
source for manpower studies when they become 

available for analyses in 1969. Among the more 

important information included in the historical 

records are: place of birth; previous professional 

addresses and licenses; and year and location 

of postgraduate training, i.e., internships and 

residencies, including fields of specialization. 

Such data will facilitate studies of geographic 

mobility and specialization trends in medical 

practice. 

Reclassification of Physicians’ Records 

Since 1965 the AMA Department of Survey 

Research has been engaged in efforts to update, 

improve, and expand the existing information 

in the current records of professional activities. 

As part of this pursuit, consideration was given 

to the recommendations of the United States 

National Committee on Vital andHealth Statistics, 

published in PHS Publication No. 1125, United 

States Statistics on Medical Economics. It is 

generally agreed that, in order to provide a 

satisfactory description of the role of physicians 

in the production of health services, the following 

information should be available: 

1. geographic location, age, and sex 

2. specialty (primary, secondary, and tertiary) 

3. professional activity (full-time and parttime) including patient care 

4. type of practice organization (solo, partnership, associate, group, other) 

5. employer and mode of remuneration 

A review of available studies conducted by 

the Association and an examinationof the systems 

and methods used by the Physicians’ Records 

Service disclosed that the records meet quality 

standards with regard to age, sex, geographic 

location, and employment information. However, 

six important limitations of the present system 

were noted: 

1. the existence of categories which.are not 

mutually exclusive, resulting in a confusion between activity, specialty, and 

employer classes 

2,. lack of a criterion upon which to base 

classification 

3. the necessity for the respondents to 

choose unique categories for themselves, 

especially without a criterion for selection 

4. the questionnaire used for compiling the 

master records did not provide a functional or operational breakdown of activities-patient care, training, administration, medical teaching, and research 

5. the date of the most recent update of each 

individual record is not known 

6. the response rate for the annualverification is not known 

The elimination of the limiting factors in the 

present system will increase the validity and 

reliability of physicians’ records and facilitate 

the classification of manpower into more functional categories. This calls for the development of a new system for the reclassification 

of individual records. Such a system is currently 

being implemented by the Association. It was 

developed after extensive consultations with the 

National Center for Health Statistics, the Division of Demographic Surveys of the Bureau of the 

Census, and many organizations using physicians’ 

records. 

A new questionnaire has been adopted for the 

annual verification of physicians’ professional 

activities (exhibit A). The “Record of Physicians’ 

Professional Activities ,‘I as it is called, is divided 

into three discrete sections-professional activities, specialization, and present employer. Mutually exclusive categories have been developed 

within each of these sections, and definitions are 

provided wherever necessary to aid respondents. 

The number of hours spent during a typical 

week of practice is the criterion adopted for 

measuring activity status of physicians. This 

criterion was chosen as more suitable for more 

response, rather than other measures such as 

income or number of patients seen. Therespondent will enter the number of hours in all applicable categories, and the final classification will 

be done through computer editing instructions. 

This procedure will eliminate most arbitrary 

decisions by the physicians or the AMA staff. 

13 
Finally, followup procedures have been instituted to raise the response rate of the annual 

survey. The record of each physician will be 

dated to reflect the last update of his file or the 

last substantial change in either his activity, 

specialty, or employment status. 

Thus, additional information is being gathered 

for the accurate classification of each individual 

in more functional categories. Information will 

be available by December 31, 1968, on the number of hours which physicians spend in as many 

as 7 types of activities, 3 specialties, and 10 

employers. This is more information than has 

ever been available on professional activities. 

At present we know only what physicians wish to 

designate as their primary and secondary specialties, their primary activity, and only their 

primary employer. 

The new system will identify physicians 

engaged in direct care of patients. “Direct care” 

means seeing patients, but it also includes patient services by such M.D.‘s as pathologists and 

radiologists. The majority of the physician population (including interns, residents, those in 

office practice, and full-time hospital staff) fall 

into this category. “Full-time patient care equivalents” will also be developed from those physicians primarily engaged in other activities, such 

as teaching, research, or administration, but 

who also see patients. 

Pilot Study Results 

A study was conducted to test the above 

recommendations and the proposed questionnaire. 

Questionnaires were mailed to a simple random 

sample of 4,994 physicians. Of these 40 were 

undeliverable, leaving an effective sample of 

4,954. By the cutoff date, 4,494 (90.7 percent) 

usable responses had been received which were 

then machine edited. They resulted in 4,274 

(86.3 percent) acceptable records which form 

the basis for all tabulations. The results of this 

study bear out the need for acriterionfor classification if the records are expected to describe 

the fields of medicine in which physicians are 

actually practicing. The pilot study has demonstrated that it is possible to distinguish between 

activity and employer, or place of activity, and 

that the “number of hours spent during a typical 

week” is an appropriate criterion for classification. 

Changes in activity classification.-A onefor-one comparison between the activity carried 

in the master file and that reported in the questionnaire is not possible because (1) the questionnaire distinguishes between activity and type of 

employer and (2) the questionnaire includes activities which were not previously recorded. 

All possible activity comparisons between the two 

systems, projected to the total physician population as of December31,1966, are presented in 

table 5. 

Projections to the total physician population, 

on the basis of the pilot study results, show a 

marked decline (60.0 percent) in the number of 

physicians in “medical teaching.” Many of those 

who were previously classified as teachers, because they were employed by medical schools, 

will now be classified in other activities (e.g., 

research, administration, and patient care), on 

the basis of the number of hours they spend in 

each activity. “Medical research” and “administration” show increases of over 100 percent. 

Substantial increases are also noted in the number of interns and residents. 

An attempt was made to estimate the change 

in the number of physicians in patient care, 

although such a category has not been a part of 

physician records. This comparison is further 

complicated by the existence of the “full-time 

hospital staff” as an activity category in the 

records and a type of employer on the new questionnaire. Some of these physicians indicated, on 

the new questionnaire, patient care as a primary 

activity, while others indicated research, administration, or other activities. 

Changes in specialty classification.-Comparisons were made between specialty as recorded in AMA records at the time of sampling 

and specialty as listed on the new questionnaire. 

A one-for-one comparison was possible in this 

section, although the physicians were given the 

additional choice of a third specialty. Three 

basic comparisons were made: specialty in AMA 

records and that designated in questionnaire, 

specialty designated as primary in the questionnaire and that with the most hours, and primary 

specialty in AMA records and that with the most 

hours on the questionnaire. 

14 
Only the comparison between the master file 

and the specialty with the largest number of 

hours reported on the questionnaire is shown in 

table 6. A few categories showed decreases, 

notably unspecified, general practice, and otolaryngology. The net decrease in the.number of 

general practitioners may be due to the general 

tendency toward increased specialization. The 

decrease in the number of physicians whose 

specialty was unspecified is the result of more 

physicians responding to the specialty question 

rather than leaving it unanswered. 

Net increases of more than 1,000 physicians 

were noted in the number of obstetricians and 

gynecologists, ophthalmologists, and orthopedic 

surgeons. The increase in the number of physicians (3,754) who reported specialties not recognized by the Association further confirms the 

general tendency toward specialization. Such 

specialties will be reviewed for possible inclusion in future tables on the distribution of medical practice. 

The Periodic Survey of Physicians 

The Periodic Survey of Physicians (PSP) 

was initiated in 1966 by the Department of Survey Research for the conduct of special studies 

to gather information on (1) the number of patients 

that physicians see in the office, hospital, and 

other locations;(2) the reasons for which patients 

visit physicians; (3) special procedures performed; (4) the hospital affiliations of physicians; 

and (5) their years of practice, hours worked, 

annual income, operating expenses, and fees. The 

ultimate goal is to query physicians on methods 

used to treat approximately 10 conditions, representative of most conditions for which the public 

seeks care. Such information, gathered over 

several years, will aid in establishing an index 

‘to measure changes in patterns in medical care. 

The first PSP was conducted between February and May 1966, and results have been 

published. 7 The second PSP was conducted between September 1967 and January 1968, and the 

third PSP took place in the spring of 1968. Data 

from these surveys will be analyzed by type of 

medical practice organization. In this manner 

differences in the productivity of physicians will 

be measured. 

SUMMARY 

The present imbalance between the supply 

and demand for physicians’ services can be corrected by increasing the number of physicians 

and expanding the productivity of existing manpower. In order to estimate the amount of increase 

in numbers and to evaluate the relative merits 

of different systems of health care, it is necessary to measure the supply of physicians and 

their services. To do so we must have (1) data 

on the number of physicians by specialty, activity, 

and type of employer and (2) data on the utilization of physicians’ services and on changes in 

their productivity. The AMA has embarked on a 

program to obtain this information by expanding 

its master file and through the development of 

special surveys. When this information is available, those who set policy will have more facts 

on which to base objective decisions, and the 

profession will be able to reappraise the traditional role of the physician in the health care 

production process. 

15 
Table 2. Physicians in relation to population: selected years, 1963-67 

Population 

Number of physicians2 Physicians 

Year' per in 100,00q thousands w population 

All physicians Total' active and inactive 

203,704 322,045 308,630 13,415 158 

201,585 313,559 300,375 13,184 156 

19'3,278 305,115 292,088 13,027 153 

196,858 297,089 284,224 12,865 151 

194,169 289,188 276,475 12,713 149 

Non-Federal physicians, Civilians providing patient care4 

199,783 260,296 249,273 11,023 130 

197,662 254,396 243,333 11,063 129 

195;833 250,208 239,262 10,946 128 

193,612 244,542 233,772 10,770 126 

190,892 237,673 227,027 10,646 125 

Non-Federal physicians Civilians proving patient care 

in office-based practice 

199,783 100 

197,662 100 

195,833 100 

193.612 100 

190,892 99 

'All data as of December 31. 

2Includes non-Federal physicians in the 50 States, District of Columbia, Puerto Rico and other 

U.S. outlying areas (American Samoa, Canal Zone, Guam, Pacific Islands, and Virgin Islands);

those with addresses temporarily unknown to the American Medical Association; and Federal 

physicians in U.S. and abroad. Excludes physicians with temporarily foreign addresses. 

31ncludes civilians in 50 States, District of Columbia, Puerto Rico and other U.S. outlying 

areas; U.S. citizens in foreign countries; and the Armed Forces in U.S. and abroad. 

41ncludes those in solo, partnership, group, or other forms of office practice and those in 

hospital-based practice-interns, residents, fellows, and full-time hospital staff. 

Sources: A.M.A. Department of Survey Research: Di,stribution of Physicians, Hospitals, and 

Hospital Beds in the U.S.. 1967: Regional: State, Countv.Metronolitan Area. Chicago. American Medical Association. 1968. Also prior reports. 

A.O.A. Membership and Statistics Department: A Statistical Study of the Osteopathic Profession, December 31, 1967. Chicago. American Osteopathic Association. June 1968. 

Also prior editions. 

U.S. Bureau of the Census: Population estimates. Current Population Reports. Series 

P-25, Nos. 238, 272, 273, 283, 324, 327, 358, 383, 386, and 392. 

U.S. Department of State: Annual Report on U.S. Citizen Personnel and Their Dependents - as of March 31, 1967. Also prior reports. 

16 
------ 

- --- - -- 

- ------ 

-- 

Table 3. Location of non-Federal 

-

physicians in relation to population: December 31, 1967 

Non-Federal physicians, Non-Federal physicians 

Civilian 

active and inactive1 providing patient care2 

population Location in

thousands, F Number T Number 

July 1 ““lo’Kl :

1<.I). and M.D. D.O. 1.D. and M.D. D.O. civiiians

D.O. only only D.O. only only 

All locations-- 198,649 292,661 279,418 13,243 147 3260,296 249,273 ?1,023 131 

United States---- 195,669 290,420 277,177 13,243 148 258,279 247,256 11,023 132 

ALa,,ama------ 3,505 2,871 2,867 4 82 2,621 2,619 2 75 

*La&a------------ 238 177 173 4 74 164 162 2 69 

Arizona------------ 1,606 2,347 2,068 279 146 2,015 1,790 225 125 

*&ansas----------- 1,958 1,710 1,688 22 87 1,520 1,505 15 78 

California--------- 18,793 34,555 34,135 420 184 30,345 30,204 141 161 

Colorado----------- 1,927 3,685 3,425 260 191 3,235 3,013 222 168 

Connecticut-------- 2,,912 5,422 5,367 55 186 4,776 4,735 41 164 

Delawa,--- _ _ _ 515 727 686 41 141 671 635 36 130 

Dist. of Columbia-- 793 3,023 3,007 16 381 2,521 2,509 12 318 

Florida ____------__ 5,902 9,447 8,841 606 160 7,443 7,006 437 126 

Georgia----..------- .. 4,389 4,558 4,478 80 104 4,097 4,034 63 93 

Hawaii------------- 684 1,002 982 20 146 913 898 15 133 

Idaho----------- 695 676 639 37 97 622 598 24 89 

Illinois----------- 10,825 14,996 14,652 344 139 13,525 13,313 212 125 

Indiana------------ 4,989 5,158 4,960 198 103 4,682 4,516 166 94 

Iowa--------------- 2,752 3,298 2,889 409 120 2,892 2,566 326 105 

Kansas---------- 2,255 2,680 2,483 197 119 2,388 2,228 160 106 

~e~+-uc+------ 3,142 3,168 3,129 39 101 2,825 2,795 30 90 

Louisiana---------- 3,622 4,095 4,083 12 113 3,715 3,704 11 103 

Maine ------- 958 1,238 1,031 207 129 1,086 935 151 113 

Maryland --_-- - ---_- 3,606 6,374 6,351 23 177 5,481 5,466 15 152 

Massachusetts------ 5,387 11,195 10,913 282 208 9,762 9,584 178 181 

Michigan----------- 8,564 12,643 10,541 2,102 148 11,180 9,590 1,590 131 

Minnesota---------- 3,577 5,414 5,351 63 151 4,851 4,802 49 136 

Mississippi-------- 2,320 1,768 1,767 1 76 1,654 1,603 1 69 

Misso~i----------- 4,565 6,832 5,677 1,155 150 5,859 5,030 829 128 

Montana----------- 691 726 686 40 105 673 645 28 97 

Nebraska---------- 1,423 1,717 1,670 47 121 1,511 1,479 32 106 

Nevada-----m----w 437 477 449 28 109 437 415 22 LOO 

New Hampshire------ 681 964 938 26 142 813 797 16 119 

See footnotes at end of table. 

17 
- - - - 

Table 3. Location of non-Federal 

-

physicians in relation to population: December 31, 1967-Con. 

= - Non-Federal physicians, Non-Federal physicians

active and inactive1 r providing patient care2 

Civilian 

population in 

"y,'g,', I.D. and M.D. D.O. 

100,000

:ivilians I.D. and M.D. D.O. 100,000zivilians 

D.O. only only D.O. only only 

New Jersey--------- 6,947 10,041 9,398 643 145 9,202 8,688 514 132 

New Mexico--------- 985 1,050 928 122 107 895 788 107 91 

New York-- _________ 18,303 40,646 40,082 564 222 36,499 36,044 455 199 

North Carolina----- 4,913 5,168 5,136 32 105 4,505 4,484 21 92 

North Dakota------- 627 585 575 10 93 544 535 9 87 

Ohio--------------- 10,437 14,760 13,682 1,078 141 13,401 12,539 862 128 

Oklahoma-m- ________ 2,447 2,904 2,483 421 119 2,592 2,240 352 106 

Oregon------------- 1,994 2,935 2,766 169 147 2,555 2,422 133 128 

Pennsylvania------- 11,612 18,728 17,163 1,565 161 16,601 15,380 1,221 143 

Rhode Island------- 875 1,433 1,349 84 164 1,325 1,255 70 151 

South Carolina----- 2,526 2,111 2,105 6 84 1,910 1,906 4 76 

South Dakota------- 667 575 538 37 86 533 503 30 80 

Tennessee---------- 3,858 4,497 4,431 66 117 3,997 3,946 51 104 

Texas-------------- 10,657 12,571 11,760 811 118 11,333 10,644 689 106 

,,,-ah--------------- 1,020 1,365 1,346 19 134 1,205 1,188 17 118 

Vermont------------ 416 790 745 45 190 621 590 31 149 

Virginia----------- 4,349 5,183 5,147 36 119 4,566 4,538 28 105 

Washington--------- 3,029 4,725 4,515 210 156 4,133 3,973 160 136 

West Virginia------ 1,797 1,870 1,756 114 104 1,689 1,590 99 94 

Wisconsin---------- 4,185 5,218 5,037 181 125 4;693 4,539 154 112 

Wyoming -------- 311 322 309 13 104 297 288 9 95 

Puerto Rico------ 2,684 2,038 2,038 76 1,836 1,836 68 

U.S. outlying areas----------- 296 203 203 69 181 181 61 

Location 

thousands, I Number l-

:ate per 

t A 

Number 

late per 

'Excludes 27,724 Federal physicians (27,552 M.D.'s and 172 D.O. 's) and 1,660 with addresses temporarily unknown to the A.M.A. Includes 14,198 inactive physicians (12,898 M.D.'s and 1,300 D.O.'s). 

'Includes all non-Federal physicians in office practice as well,as those in training programs and on full-time hospital staffs who see patients. Excludes 30,145 non-Federa1M.D.'~ (11,166 on medical school 

faculties; 2,729 in administration; 3,352 in research; and 12,898 in inactive status) and 1,660 with 

addresses temporarily unknown to the A.M.A.; and 1,486 non-Federal D.O.'s (17 in administration; 127 on college faculties; 42 in miscellaneous activities; and 1,300 in inactive status); and 734 whose status was not reported to the A.O.A. 

'Total includes 775 D.O.'s in training programs and 181 in professional full-time hospital positions, for 

whom distribution by State is unavailable. 

Sources: A.M.A. Department of Survey Research: Distribution of Physicians, Hospitals, and Hospital Beds 

in the U.S., 1967: Regional, State, County, Metropolitan Areas, by J. N. Haug and G. A. Roback. 

Chicago. American Medical Association, 1968. 

A.O.A. Membership and Statistics Department: A Statistical Study of the Osteopathic Profession,

December 31, 1967. Chicago. American Osteopathic Association, June 1968. 

U.S. Bureau of the Census: Pspulation estimates. Current Population Reports. Series P-25, No. 

380, Nov. 1967 and No. 392, May 1968. 

18 
Table 4. Type of professional activity and -primary specialty 

Number 

of physicians: 

of M.D.'s 

December 31, 1966 

-

Number 

of F T Providing patient care TOther 

D.O.

in 

‘s 

Primary specialty profes- Coffice- Total In In In sional based

active office- hospital hospital- ac- pracbased training based tivityl Itice 

practice programs practice 

*ll specialties------------------------- 285,857 187,100 44,937 34,729 19,091 10,114 

General practice-------------------------- 70,223 64,063 672 4,876 612 28,764 

Medical specialties----------------------- 65,591 38,921 11,559 8,686 6,425 335 

Allergy--------------------------------------- 944 849 Cardiovascular disease------------------------ 2,047 1,091 3% Dermatology----------------------------------- 3,674 2,737 476 

Gastroenterology------------------------------ 701 394 127 Internal medicine----------------------------- 40,314 23,210 7,536 Pediatrics------------------------------------ 16,417 10,089 2,924 pediatric allergy----------------------------- 12 Pediatric cardiology-------------------------- 1% I? 57 Pulmonary disease----------------------------- 1,231 452 65 

Surgical specialties---------------------- 79,245 55,170 14,487 6,878 2,710 642 

General surgery------------------------------- 28,756 17,987 6,;;; 3,028 270 Neurological surgery-------------------------- 2,189 1,332 204 % 4 

Obstetrics and gynecology--------------------- yf;"; y; 2,629 1,321 604 

Ophthalmology--------------------------------- 247 1;; Orthopedic surgery---------------------------- 7:982 51564 ?E:: ::z 214 69 Otolaryngology-------------------------------- 5,429 4,192 )735 360 142 3-

Plastic surgery------------------------------- 1,207 903 196 75 33

Colon and rectal surgery---------------------- 647 618 42 

Urology--------------------------------------- 5,229 x;I 829 402 156 2: 

Other specialties------------------------- 70,798 28,946 18,219 14,289 9.344 

Aviation medicine-----------------------------

Anesthesiology--------------------------------

Child psychiatry------------------------------

812 

9,;;; 6,3::

417 

1,197; 252 

478 

1,108

170 

180 

461 

119 Diagnostic roentgenology---------------------- 13 Forensic pathology----------------------------

Neurology-------------------------------------

Occupational medicine-------------------------

Psychiatry------------------------------------

Pathology-------------------------------------

2;

2,295

1,727

18,875

8,914 

:5 

843 

1,440

8,895

2,458 

z 

':2 

x 

40; 

4,5%

2,945 

z 

469 

175 

1,819

1,343 

Thoracic surgery------------------------------ 1,627 2:: 2;; 14: 

Physical medicine and rehabilitation---------- 1,140 361 '219 396 164

General preventive medicine------------------- 1,005 422 180 365 Public health--------------------------------- 1,679 1,037 z: 176 432 Radiology------------------------------------- 10,069 5,862 1,752 1,924 531 124 Therapeutic radiology------------------------- 76 Not recognized-------------------------------- 3,917 61296 415; 3% 2,4:; Unspecified----------------------------------- 10,128 87 7,855 1,400 786 -

lIncludes medical school faculty, administration, and research. 

21ncludes 891 with practice limited to manipulative therapy. 

'Included in ophthalmology. 

Sources: A.M.A. Department of Survey Research: Distribution of Physicians. Hosvitals. and Hospital Beds in the U.S. Vol. I. Chicago. American Medical Association, 1967. 

A.O.A. Membership and Statistics Department: A Statistical Study of the Osteopathic Profession, December 31. 1966. Chicago. American Osteopathic Association, June 1967. 

19 
--- 

--- 

--- 

Table 5. Pilot study results on activity of physicians as of December 31, 1966 

-

AMA Question- Differ- Activity records nairel ence 

Total physicians---------------------------------------------- 300,371 300,399 + 228 

patlent care-------------------------------------------------------- 234,083 260,832 i-26,749 

Solo, partnership, group, or other practice----------------------- 189,537 -me -em 

Direct care------------------------------------------------------- -em 206,974 w-w 

Other direct care------------------------------------------------- 1,486 -mm 

Intern------------------------------------------------------------ 10,513 12,543 + 2,030 

Resident/fellow--------------------------------------------------- 34,033 39,829 + 5,796 

Administration------------------------------------------------------ 4,926 11,057 + 6,131 

10,934 4,457 - 6,477 

3,935 8,000 + 4,065 

Other-not dir-c. care---------------------------------------------- e-v 1,400 

Full-+--me hospital staff-------------------------------------------- 31,840 -mm 

14,653 14,653 

IActivity classification based on largest number of hours reported on 4,274 questionnaires,in­ flated to full coverage of all M.D.'s. 

2Error due to rounding. Extrapolations were made on each category; categories were then summed 

to obtain the total numbers of physicians. 

20 
--- 

----------------------------------------------------- 

--- 

Table 6. Pilot study results on specialty of physicians as of December 31, 1966 

AMA Question- Differ- Specialty records nairel ence 

Tot-1 physicians---------------------------------------------- 300,411 300,376 + 235 -

Unspecified--------------------------------------------------------- 24,871 13,877 -10,994 

Allergy------------------------------------------------------------- 781 1,172 + 391 

Anesthesiology------------------------------------------------------ 9,432 10,213 + 781 

Aviation medicine----------------------------------------------------- 361 1,172 + 811 

Cardiovascular------------------------------------------------------ 2,193 2,583 + 390 

Child psychiatry---------------------------------------------------- 781 931 + 150 

Diagnostic roentgenology-------------------------------------------- 541 -I- 541 

Dermatology--------------------------------------------------------- 2,884 3,274 + 390 

Forensic pathology-------------------------------------------------- 60 90 + 30 

Gastroenterology _________------------------------------------------- 781 1,081 + 300 

General practice _-_--_---------------------------------------------- 65,542 61,457 - 4,085 

General surgery _____-_---_-_---------------------------------------- 29,257 29,947 + 690 

Internal medicine--------------------------------------------------- 40,100 40,310 + 210 

Ne~-logical surgery------------------------------------------------ 2,253 2,403 + 150 

Neurology----------------------------------------------------------- 2,463 2,403 60 

Obstetrics and gynecology------------------------------------------- 18,804 20,516 + 1,712 

Occupational medicine----------------------------------------------- 1,622 1,172 - 450 

ophthalmology------------------------------------------------------- 8,290 9,522 -I- 1,232 

Orthopedic surgery-------------------------------------------------- 7,600 9,041 + 1,441 

Otolaryngology------------------------------------------------------ 5,857 5,377 - 480 

Pathology----------------------------------------------------------- 8,411 8,981 + 570 

Pediatrics---------------------------------------------------------- 18,383 19,254 + 871 

pediatric allergy--------------------------------------------------- 60 90 + 30 

pediatric cardiology------------------------------------------------ 361 300 61 

physical medicine and rehabilitation-------------------------------- 1,412 1,472 + 60 

Plastic surgery 1,262 1,562 + 300 

General preventive medicine _--_------------------------------------- 481 391 90 

Colon and rectal surgery-------------------------------------------- 631 691 + 60 

Psychiatry---------------------------------------------------------- 20,426 20,666 + 240 

public health------------------------------------------------------- 1,412 2,043 + 631 

pulmonary diseases-------------------------------------------------- 1,202 1,322 + 120 

Radiology----------------------------------------------------------- 10,723 10,603 - 120 

Therapeutic radiology----------------------------------------------- 150 + 150 

Thoracic surgery---------------------------------------------------- 1,772 1,652 - 120 

Urology------------------------------------------------------------- 5,437 5,857 + 420 

Not recognised---------------------------r-------------------------- 4,506 8,260 f 3,754 

ISpecialty classification based on largest number of hours reported on 4,274 questionnaires, inflated to full coverage of allM.D.'s. 

'Error due to rounding. Extrapolations were made on each category; categories were then summed 

to obtain the total numbers of physicians. 

21 
EXHIBIT A 

OFFICIAL RECORD - 1MMEDIATE RESPONSE REQUESTER IIRECORD OF 

PHYSICIANS’ PROFESSIONAL ACTMTIES 

DIRECTORY OF PHYSICIANS 

AMERICAN MEDICAL ASSOOIATION 

535 N. Dearborn Street 

Chicago, Illinois 60610 

Dear Doctor: 

It is important that you complete this questionnaire immediately to bring your official record up-to-date 

so that we will have the correct and current information for the printing of the 1969 AMA Directory. 

Information from this record will be utilized to describe the distribution of physicians and to analyze 

health manpower. 

Thank you. 

Instructions 

1. Please answer every question on the basis of your current professional activities. 

2. Upon completion, return the questionnaire at your earliest possible convenience, using the preaddressed envelope. 

Contents 

The questionnaire ,is divided into three sections: 

I Professional Activities, intended to classify each physician under the types of activities in which he 

spends most of his time during an average week. 

II Specialization, intended to find out the amount of time each physician spends in his major field of 

specialization. 

III Presenf Employer, intended to classify each physician under the type of practice organization or 

employer according to the number of hours spent per average week under various practice arrangements. 

22 
-- 

I. PROFESSIONAL ACTIVITIES 

HOURS Please describe your PRESENT professional activities by indicating the ayerage num- PERWEEK

be+ of hours spent during a typical week. Please answer EVERY question l-8. If you 7 do not spend any hours on any partxular activity below, so indicate by checking 

the%& designating “‘zero hours per typical week.” 

1. 

2. 

3. 

4. 

5. 

6. 

7. 

8. 

How many hours per week are you being trained? (Interns, residents, or fellows) 

Indicate whether you are a(n) 1 0 intern 2 0 resident 3 0 fellow 0 zero or- hrs. CI.=OP.~> 

How many hours per week do you spend in PRACTICE INVOLVING DIRECT 

CARE OF PATIENTS? Direct care means seeing patients; however, it also includes 

patient servicesby such physiciansas pathologistsand radiologists.&&de time spent in 

iraining, ieoching, or research. Include travel rime and time spent on record keeping and orher 

05% work connected with you-nts.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 zero ora....-- hrs. (4) 

How many hours per week do you spend on ADMINISTRATIVE ACTIVITIES, 

AS A STAFF MEMBER OR EXECUTIVE OF AN ORGANIZATION? Exclude 

time spent on record keeping and ofice work connected with management of your own proctice. Include activities connecred with fhe adminisrration or staff committees of (I hospital or 

orher health facility or agency. clinic or group. or any orher organizorion by which you may

bz salaried as on executive or staff member.. . . . . . . . . _. _. _. . . . _ _. . . _ . . . . . . . . . . . . . . . . . . . Cl zero or- hrs. fm 

How many hours per week do you spend on MEDICAL TEACHING? Zncfude 

hours spent in teaching os well os in preparation for subjects taught in medical schools. nursing 

schools, other hospital schools, hospitolr, colleges, universities. or any other educational institution. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . q zeroor--hrs. (SI 

OF THESE HOURS how many do you spend on direct care of patients? 

Exclude time devoted to patient core by house sfo5 under your supervision.. . . . . . . . . . . . . 0 zero or- hrs. (7) 

In view of possible overlap of hours spent in reaching and research, please do not 

double-count such hours. but reporf them instead in the most applicable category. 

How many hours per week do you spend on MEDICAL RESEARCH? ,411phase of 

investigafing medical problems regardless of source of funds for such research.. _, . . . . . . . . . 0 zero or- hrs. 18, 

OF THESE HOURS how many do you spend on direct care of patients? 

Exclude time devoted to potienr core by house sfoff under your supervirion.. . . __. . . . . . . . 0 zero or __ hrs. (8~ 

How many hours per week do you spend on any OTHER medical activities (not 

listed above) INVOLVING DIRECT CARE of patients?. . . . . . . . . . . . . . . . . . . . . 0 aem or- hn. o0l 

How many hours per week do you spend on any OTHER medical activities (not 

listed above) NOT INVOLVING direct care of patients?. . . . . . . . . . . . . . . . . . . . 0 zero cr- bra. (II> 

About how many hours per week do you spend in ALL PROFESSIONAL 

ACTIVITIES? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . q zeroor-h=.(m) 

If you have checked “zero” on question 8, or if none of the above categories apply 

to you, please answer question 9. 

9. Are you: ’ q RETIRED 2 q SEMI-RETIRED 3 0 DISABLED cl=> 

10 TEMPORARILY not in practice 

E q Not active for other reasons(please describe) 

23 
-- 

-- 

II. SPEClALlZATlON 

1. Please indicate how you wish to be DESIGNATED 

numeral “1” next to your primary specialty, and the 

numeral “2” next to your ~econdmy specialty, mark 

number of hours spent per week. 

“Dun 

i-s,

Week 

Allergy

A 

t;esthesiology 

Fvation Medicine 

Cx&diovascular Disease 

f$d Psychiatry 

W&n and Rectal Surgery 

pilatology 

Ekgnostic Roentgenology 

pc,nsic Pathology 

yyroenterology 

$vsral Practice 

$leral surgery 

\“,fernal Medicine 

[~urological Surgery 

t$urology 

g%&etrics and Gynecology 

D&cupational Medicine 

i ~thalmology

P 

IN THE A.M.A. DIRECTORY by inserting: 

number of hours spent per week 

only one secondary spemlty If any. Give the 

-

~f..pedic Surgery 

D&lalyngology 

P&hology 

kdiatrics 

;;ptric Allergy 

kiatric Cardiology 

Physical Medicine and ;;habilitatmn 

Pztic Surgery 

Preventive Medicine 

~G&wal) 

pychiatry 

;;blic Health 

h~monaty Disease 

pdiology 

$erapeutic Radiology 

Thoracic Surgery TS 

kP’ow 

Primaly specialty not listed above: 

Secondary specialty not listed above: 

2. In addition to your primary and secondary specialties indicated above, do you have a THIRD SPECIALTY? II is not unusual for some physicians IO devote sipificont pmCons of their professional rime 10 specialties other than their primary and/or secondary 

specialfies OS lisred in the A.M.A. Direcfory.. . . . . . . . . . . . . . . . . . . . . 1 0 Yes 2 0 No 

If yes, specify which specialty: ,-- hrs. per week -

24 
Hi. PRESENT EMPLOYMENT STATUS 

Please indicate the current number of hours spent per we& for the follow~g types HOURS 

of empioyers. Please answer EVERY question I-10. If you do not spend any houIs for PER WEEK 

- any one of the following employers, so indicate by checking the box designating “zero 

hours per typica week.” 

1. Self: “solo” practice.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . q zero or- hi. (0 

2. Self: partnership practice.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . q =amor- hrs. w 

3. Arrangement with other physi&an(s): non-group . . . . . . . . . . . . . . . . . . . . . . . . . . q zero or hrs. (3) 

4. Group practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . lJzeroor~hrs.cr, 

ciiy stare Zip 

5. MEDICAL SCHOOL (or parent university) ............................. 

6. NON-GOVERNMENT AL hospital .................................... 

7. City or county government a. HOSPITAL ............................... 

b. OTHER than hospital. ....................... 

8. State government a. Ho%%& ............................... 

b. OTHER than hospital. ....................... 

9. Federal government a. HOSPITAL ............................... 

b. OTHER than hospital. ....................... 

1 

•1=e,o or- he. (5) 

•~~~or~t#s.~s, 

q zam or- hrs. O) 

0 zero or- hrs. ~1 

0 Zero or- hrs. (s) 

q zwo or- hrs. UO) 

0 zero orp hrs. (II) 

q zero or- hrs. LIZ) 

Indicate which agency: D Army 0 Public Health Service (C.C. & C.S.) 

0 *V,terans Administration (13) s 

10. OTHER ORGANIZATION -Not listed above (aa rypes of fn.ruran~e carriers, 

pharmzc~urical companies, corporations, voluntary organizafions, medical societies, arsocialions. cfc.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .._.........._..__.... q zemor- hrs. ((1) 

r 1 

If :he address appearingon the label is not the address at which you wish to receive medically 

relaled motrrial please show the correct address 

IdOW. L 

1 

number and street 

city state zip 

25 
DENTAL MANPOWER 

Stanley Lotzkar, D.D.S., M.P.H., and Donald W. Johnson, D.D.S., M.P.H.d 

Continuing reappraisal of the Nation’s dental 

resources is necessary for early identification 

of emerging resource problems and development 

of effective remedial-action programs. Essential 

to any such evaluation of resources, however, is 

a reliable source of data upon which manpower 

assessments, trends, and projections may be 

based. Only within the last two decades have 

reliable source data on numbers, distribution, 

and professional characteristics of dental manpower become available on a nationwide basis. 

SOURCES OF DENTIST DATA 

The first official count of the number of 

dentists in the United States was made during 

the 1850 census, and the U.S. Bureau of the Census remained the primary source of national 

dental manpower information until the American 

Dental Association (ADA) began publishing such 

data in the 1940’s. The 1850 census counted 

2,900 dentists in a total population of 23 millionor one dentist for every 8,000 persons. By 1900 

the persons-per-dentist ratio had improved to 

one dentist for every 2,550 persons, and by 1930, 

the census revealed the most favorable personsper-dentist ratio ever attained in this countryone dentist for every 1,728 persons. At about 

this time, advances in the standards for dental 

education resulted in the closing of many prod Dr. Lotzkar is Chief, and Dr. Johnson, Assistant Chief, 

of the Resources Analysis Branch, Division of Dental Health, 

Bureau of Health Manpower, Public Health Service. 

prietary schools. These advances, coupled with 

the growing economic problems of the depression years, reversed the trend in the supply of 

dentists. The 1940 census, the last before World 

War II, reflected the steady increase in the number of persons per dentist (to 1,870), a trend 

which continued into the midsixties. 

Although by 1940, it was possible to determine dentist-population ratios on a nationwide 

or State basis, data were not available for most 

States showing the distribution of dentists or the 

dentist-population ratios within various parts of 

the State. Recognizing the need for more definitive information on distribution, as well as on 

numbers of dentists, the American Dental Association compiled and published in 1942 its Distvibution of Dentists in the United States, containing 

a count of dentists (where obtainable) by city, 

county, and State. However, it was not until 1947 

that the ADA published its first American Dental 

Divectovy which, together with the Distribution 

of Dentists in the United States, has become an 

annual publication. The Directory, in addition to 

name and location of dentists, lists available 

information on age, dental school attended, year 

of graduation, and area of specialization. In1950, 

the ADA also began publishing every 3 years the 

Survey of Dental Practice, based on sample surveys of dentists to determine trends in such factors as number of patients seen per year, number of auxiliary personnel employed, and income 

of dentists. The publications of the ADA and, to 

a lesser extent, publications of the Bureau of the 

Census have provided much of the basic source 

material on dental manpower. 

26 
ESTIMATES OF 

DENTIST MANPOWER 

Current estimates and projections of the 

dentist supply are based upon information on the 

distribution and characteristics of dentists contained in the annual publications of the American 

Dental Association. In mid-1967, there were 

approximately 112,150 dentists in the United 

States, excluding 1967 graduates. Estimates prepared by the U.S. Public Health Service, Division of Dental Health, indicate that there were 

90,715 active non-Federal dentists located in the 

50 States and the District of Columbia; about 

7,955 Federal dentists in the Armed Forces, 

Public Health Service, and Veterans Administration; and a remaining 13,480 dentists who were 

retired or engaged in nondental activities. 

The Nation’s supply of dentists in relation 

to the civilian population declined between 1950 

and 1960. Even though the downward trend in the 

dentist-to-population ratio leveled off in the 

midsixties, the ratio still remains below the 1950 

level. In 1950, there were 50 active non-Federal 

dentists per 100,000 civilians, while by 1967 the 

ratio had dropped to 46 per 100,000 (table7). 

The dentist-population ratios and, therefore, 

the availability of dental services vary widely 

throughout the Nation because of the uneven 

geographical distribution of dentists (table 8). 

In 1967, the Northeast Region had the greatest 

number of dentists in relation to population-58 

active non-Federal dentists per 100,000 population-while the South had the least favorable 

dentist-to-population ratio of 34, the only region 

below the national average of 46. The two remaining regions, West and North Central, had 

ratios of 54 and 46 per 100,000population, respectively. 

Among the States, New York had the most 

favorable dentist-to-population ratio of 67. Only 

four other States-Hawaii, Massachusetts, 

Oregon, and Washington-had ratios as high as 

60. On the other hand, 12 States, mainly in the 

South, had fewer than 35 active non-Federal 

dentists per 100,000 population with the lowest 

ratio of 23 occurring in South Carolina. 

The distribution of dentists varies widely 

between metropolitan areas and nonmetropolitan 

counties. Furthermore, when nonmetropolitan 

counties are grouped according to the size of 

their central (largest) city, the number of dentists in relation to population declines with the 

size of the central city. Metropolitan areas consequently have dentist-to-population ratios twice 

as favorable as rural counties with central cities 

of less than 5,000 persons. 

The median age of non-Federal dentists is 

48 years and ranges over an age span of 5 years 

among the four census regions. The highest 

median age of 50 years occurs in the Northeast 

Region, followed by 49 years in the North Central Region. The two remaining regions, West 

and South, have dentists younger than thenational 

average with median ages of 47 and 46 years, 

respectively. 

Almost all active dentists provide care to 

patients, but some dentists are primarily engaged in nonclinical activities, such as teaching, 

research, or administration of dental programs. 

A number of dentists in private practice also 

devote a part of their professional time to teaching and research and to voluntary community 

services, such as examination of schoolchildren’s teeth. 

Although most dentists are general practitioners, the American Dental Association recognized 9,17’4 dental specialists in 1966. Over twofifths-some 4,000-of the specialists limited 

their practice exclusively to orthodontics. The 

next largest group-about 2,200-specialized in 

oral surgery, followed by approximately l-,000 in 

pedodontics. Only one-fifth of the specialists 

engaged in one of the other five recognized areasperiodontics, prosthodontics, endodontics, public 

health dentistry, and oral pathology. 

In 1967, 50 dental schools were in operation 

in the United States and Puerto Rico. Nine of these 

schools have been established since 1950, while 

several others have expanded their training facilities. As a result, the number of annual graduates has increased over 30 percent during this 

period. A total of 3,360 dentists were graduated 

in 1967, as compared with 2,565 in 1950. Undergraduate enrollment in dental schools reached a 

new high of 14,955 students in the academic year 

1967-68. 

27 
DENTAL AUXILIARIES 

In addition to dentists, the dental work force 

includes three auxiliary occupation groups-dental hygienists, dental assistants, and dental laboratory technicians. In 1967, the active dental 

auxiliary manpower supply had grown to approximately 137,000 from about 83,000 in 1950, according to estimates prepared by the Division of 

Dental Health. Although no directories or other 

basic up-to-date resource data exist for dental 

auxiliaries, information on the number and location of accredited training facilities, number of 

students enrolled, and number of graduates is 

available for auxiliaries, as well as for dental 

students, from the Dental Shdents’ Reg-ktev, an 

annual publication of the American Dental Association. 

It is estimated that 15,000 dental hygienists 

were in practice in 1967. Since 1950, the number 

of active hygienists has increased by 8,000, but 

there are still only 16 active hygienists per 100 

practicing dentists. Because part-time employment is common, the hygienist supply is actually 

less favorable than the ratio suggests. However, 

the number of schools offering the dental hygiene 

program has increased significantly in recent 

years, from 37 in 1960 to 67 in1967. As a result, 

the number of students in training increased by 

approximately 75 percent during this period, 

reaching an enrollment of 4,332 students in the 

academic year 1967-68 with 1,729 in the 1967 

graduating class. 

A similar but more dramatic expansion has 

taken place in the number of dental assistants 

and, to a lesser extent, the number of dental 

laboratory technicians. Approximately 95,000 

persons were employed as dental assistants in 

1967 as compared with only 55,200 in 1950. Traditionally, dental assistants have been trained on 

the job by their dentist employers. However, the 

marked increase from 26 to 101 institutions 

offering accredited training programs for assistants during the 6-year period 1961-67 suggests 

that the pattern is beginning to shift toward formal 

education. Fifty-one of these 101 training programs, or half of all the programs, were added 

during the last 3 academic years. The number of 

students in training increased from 1,181 in the 

1961-62 academic year to 3,819 in 1967-68, while 

the number of annual graduates jumped from 515 

in 1961 to 1,963 in 1967. 

The number of dental laboratory technicians 

has increased from about 21,000 in 1950 to an 

estimated 27,000 in 1967. The vast majority of 

technicians are still being trained on the job, but 

the move to formalize their training programs 

has also gained momentum recently. One-third 

of the 15 accredited school-based programs in 

operation in 1967 were established during that 

year. Although these 15 programs had an enrollment of 729 students in the 1967-68 academic 

year, the rapid gains in enrollment have not yet 

been reflected in the annual number of graduatesonly 162 in the 1967 graduating class. 

NATIONAL DENTAL DATA 

COMPILATION SYSTEM 

The rapid increase in the population, coupled 

with a rising demand for dental care’ in recent 

years, has created tremendous problems with 

regard to ensuring an adequate supply of wellqualified dental personnel. The Division of Dental 

Health is developing a national data compilation 

system that will supplement existing information 

on the number, distribution, and characteristics 

of the manpower supply, as well as on private 

practice characteristics, including utilization of 

dental auxiliaries and patient service capacities. 

More comprehensive information of this type is 

needed to provide basic source material for estimating the Nation’s dental manpower training requirements, assessing the need for continuing 

education and refresher courses, and developing 

dental care programs. 

Under a contract with the Division, the 

American Association of Dental Examiners, 

working through its members-the 51 State 

boards of dental examiners, including the District 

of Columbia-has established a national system 

for collecting data from all licensed dentists 

and dental hygienists at the time of their annual. 

or biennial reregistration with the State examining 

boards. The system was established for dentists 

beginning with the 1965 reregistration period and 

was expanded in 1966 to include licensed dental 

hygienists. As a continuation of the system, a 

second survey of dentists was initiated in 1967. 

It is intended that dentist and dental hygienist 

28 
data be collected periodically so that trends may 

be established. 

The first dentist survey is in various stages 

of completion because reregistration dates vary 

over a 2-year period among the States. Most of 

the 49 participating dental examining boards 

mailed the survey questionnaires to the dentists 

with their license renewal applications. Each 

dentist returned the completed questionnaire to 

his State examining board which, in turn, forwarded all questionnaires to the American Association of Dental Examiners. The Association 

edits and codes the questionnaires and punches 

the survey data onto cards which are forwarded 

to the Division for machine tabulation. The Division then tabulates and analyzes the data and 

prepares a narrative report for each State. Data 

collection has been completed in all participating 

States, while reports containing analyses of survey results have been prepared for 20 States. 

Data from the first dentist survey present 

a rather detailed picture of the current dentist 

supply within each State. In addition to the age 

and distribution of dentists, this information 

includes their current status and professional 

activity, such as caring for patients or teaching, 

their professional background, and selected 

practice characteristics, including area of specialization and utilization of auxiliary personnel. 

The second dentist survey will collect data to 

update the count of dentists and to provide current information on their location and activity. 

New types of data will also be obtained, such as 

the patient load of dentists and their hygienists 

during a l-week period and the types of dental 

services provided to school-age children during 

the same period. 

Forty-nine States participated in the survey 

of dental hygienists. Since the data collection 

procedures in the hygienist survey were patterned 

after those used in the dentist survey, the types 

of data collected for active hygienists were 

similar to those collected for dentists. Future 

career plans of licensed hygienists who were not 

professionally active were also obtained. 

In both the dentist and dental hygienist surveys, the State dental examining boards experienced a very high response rate-about 90 percent 

for the dentist survey and almost 85 percent for 

the hygienist survey. Many of the examining 

boards are also furnishing available data on nonrespondents. As a result, these surveys are providing more accurate and comprehensive data 

than were previously available on dentists and 

dental hygienists. 

Each State dental examining board will receive a report containing the basic data tabulations from both the dentist and dental hygienist 

surveys. These reports highlight the distribution 

and other selected characteristics of the current 

supply of dentists and dental hygienists, such as 

sources of supply, age distribution, county distribution, professional activities, and practice 

characteristics. 

Survey findings will be useful for program 

planners and administrators in estimating future 

dental manpower requirements. Such estimates 

based on survey findings have already been 

utilized in several States for planning new and 

expanded dental schools and additional dental 

hygiene training facilities. In addition, data from 

the dentist and dental hygienist surveys have 

been used by State planning agencies, such as 

those involved in Regional Medical Programs and 

Comprehensive Health Planning. 

When the data are available from all States 

participating in these surveys, the information 

will be combined to provide the basis for new 

dentist and dental hygienist source books which 

will present up-to-date national and regional 

summaries and analyses of the dentist and dental 

hygienist manpower resources, as well as data 

on specific State and metropolitan areas. To 

establish a reference for future uses of survey 

data, each respondent has been asked to provide 

his Social Security number which will permit 

the identification and comparison of data supplied in subsequent surveys. Through the years, 

it will then be possible to develop dental manpower trend data and to make longitudinal studies 

of the dental profession. 

In view of the limited availability of basic 

resource data on the two remaining dentaloccupations-assistants and technicians-it is indeed 

unfortunate that they are not licensed and, therefore, cannot be included in the surveys conducted 

by the State examining boards. Because there is 

no central source, such as the State licensing 

boards, for contacting all dental assistants and 

laboratory technicians, survey procedures are 

29 
more difficult to develop for these occupations. 

As a first step, information about utilization of 

dental assistants and technicians is being sought 

from dentists on the survey questionnaires sent 

to them by the State examining board. Plans are 

underway for a few pilot studies in individual 

States to develop techniques for collecting resource data needed to provide a sound basis for 

planning additional training programs for these 

two dental auxiliaries. 

It should be pointed out that the data now 

being collected comprise a part of a comprehensive data bank which will eventually include 

other important areas of dental manpower. In 

addition to reliable data on dentists and dental 

auxiliaries, detailed information on specialized 

groups within the dental work force is also needed. 

For example, as a part of the overall system of 

dental manpower data collection, the Division of 

Dental Health is also involved in the compilation of 

an annual directory of dental school facultymembers. Under a separate contract with the American Association of Dental Schools, information 

is being developed which will be used in assessing current faculty practices, identifying trends, 

predicting future needs, and achieving optimum 

use of existing teaching resources. 

The national data collection system, in conjunction with data already available from the 

American Dental Association and other sources, 

holds promise of serving as the foundation of 

future dental manpower planning. When fully 

operational the system will provide continuously 

available information on a wide range of topics 

which are of interest to various professional 

organizations, educational institutions, and government agencies. Moreover, the system will 

permit the use of sophisticated sampling techniques and will make feasible studies in depth 

of subjects such as retirement patterns, trends 

in specialization, productivity, and migration, 

which are necessary to any real understanding 

of the Nation’s dental manpower needs. 

30 
Table 7. Dentists in relation to population: July 1, 1950, 1960, and 1967 -

Dentist and population 1950 1960 1967 

Total dentistsl------------------------------------------------------- 87,164 101,947 112,152 

Total population (thousands)2----------------------------------------- 152,271 180,684 199,118 

Dentists per 100,000 popuiation--------------------------------------- 57.2 56.4 56.3 

Active non-Federal dentists------------------------------------------- 75,313 82,630 90,716 

Resident civilian population (thousands)------------------------------ 150,790 178,153 195,669 

Active non-Federal dentists per 100,000 civilians--------------------- 49.9 46.4 46.4 

lExcludes graduates of years specified, but includes all other dentists, active or inactive. 

21ncludes all persons in the United States and in the Armed Forces overseas. 

Sources: Total dentist data-Bureau of Economic Research and Statistics: Distribution of Dentists in the United States bv State, Region. District and County. Chicago. American 

Dental Association. Annual issues and unpublished 1967 data. Adjustments to exclude 

graduatesofspecified years made by Division of Dental Health, Public Health Service. 

Active dentist data-estimates prepared by the Divisioti of Dental Health, Public 

Health Service. 

Population data-U.S. Bureau of the Census: Population estimates. Current 'Population Reports, Series P-25, No. 386, Feb. 1968. 
- Table 8. Number of non-Federal dentists and rate per 100,000 civilians: July , 1967 

= 

Number of non- rRate per 100,000 Civilian Federal dentists? civilians 

Location vopulation 

:bouk:nds' Total Active Total Active dentists dentists 

United States-------------------------------------- 195.669 104,195 

48,091 32,247

54,866 29,451

60,299 22,790

32,410 19,707 

3,505 1,117

238 84 

1,606 703 

1,95a 617 

18,793 11,699

1,927 1,174

2,912 1,918

515 222 

793 772 

5,902 2,951

4,389 1,346

684 466 

695 330 

10,825 6,286

4,989 2,242

2,752 1,547

2,255 997 

3,142 1,172

3,622 1,333

958 426 

3,606 1,590

5,387 3,838

8,564 4,426

3,577 2,482

2,320 649 

4,565 2,323

691 365 

1,423 920 

437 206 

681 306 

6,947 4,248

985 320 

18,303 14,298

4,913 1,547

627 290 

10,437 5,097

2,447 982 

1,994 1,489

11,612 6,539

a75 474 

2,526 634 

667 299 

3,858 1,574

10,657 3,918

1,020 621 

416 200 

4,349 1,732

3,029 2,101

1,797 634 

4,185 2,542

311 149 

!State figures do not add to total due to rounding. 

'Excludes graduates of the 1967 class. 

90,716 53 

27,746

25,207

20,376 

17,387 

1,015 

6% 

549 

10,245

1,036

1,705 59 

205 

670 it 

43 

?Z 28 

'422 

301 

5,323

1,952

1,292

a47 

1,036

1,194

350 

1,443

3,294

3,951

2,092

587 

1,922

318 

765 

194 

271 

3,736

291 

12,237

1,382

242 

4,424

863 

1,314

5,565 48 

415 47 

569 23 

247 

1,426

3,530

554 

173 

1,583

1,869

545 

2,150

132 

Sources : Total dentist data-Bureau of Economic Research and Statistics, American Dental Association. 

Chicago. 1967 data unpublished. Adjustment to exclude 1967 graduates made by Division of Dental 

Health, Public Health Service. 

Active dentist data-estimates prepared by Division of Dental Health, Public Health Service. 

Population data-U.S. Bureau of the Census: Population estimates. Current Population Reports, Series P-25, No. 380, Nov. 1967. 

32 
NURSING MANPOWER 

Eugene Levine, Ph.D., and Eleanor D. Marshall, B.Aoe 

SOURCES OF NURSE 

SUPPLY DATA 

Data on nurse supply are obtainedfromthree 

main sources: 

1. Decennial census of the U.S. Bureauof the 

Census 

2. Biennial estimate prepared by the National League for Nursing, American 

Nurses’ Association, American Hospital 

Association, and Public Health Service 

(Interagency Conference on Nursing Statistics) 

3. American Nurses’ Association inventories of registered nurses 

Decennial Census 

The decennial census provides rather comprehensive data on occupational fields. Census 

data pertaining to nursing for the years 1910 to 

1960 are contained in Health Manpower Souvcebook Section& NuvsiwPeYsonneZ (Public Health 

Service Publication No. 263, Section 2, revised 

January 1966) and also in the various editions 

of the American Nurses’ Association’s Facts 

About Nursing. 

eDr. Levine is Chief of the Manpower Analysis: and Resources Branch, Division of Nursing, Bureau of He 

i 

lth Manpower, Public Health Service. Mrs. Marshall is Assi tant Director of the Research and Statistics Department, $ merican 

Nurses’ Association. 

Because of reporting errors, adjustments 

have had to be made to improve the accuracy of 

census data. For example, the 1950 census count 

of 400,000 total active registered nurses had to 

be adjusted downward to 375,000 because of the 

inclusion of some student nurses in the count. The 

1960 census count was 582,000, which was considerably higher than the Interagency estimate 

of 504,000 for that year, and there was reason 

to believe that much of the higher census count 

was due to errors in sampling and reporting. In 

addition to these discrepancies, other limitations 

of census data as a source of nurse supply data 

include the fact that the data are not categorized 

by field of employment and they are not available 

frequently enough to provide current data or to 

be useful in trend analysis. 

Interagency Estimate 

Since 1952, representatives of the National 

League for Nursing, American Nurses’ Association (ANA), and Public Health Service have been 

meeting biennially to prepare an estimate of the 

number of registered nurses employed in the 

United States by field of practice. This group, 

known as the Interagency Conference on Nursing 

Statistics, has released nurse supply estimates 

for the even-numbered years 1954-66 and, beginning in 1967, on an annual basis (table 9). 

The Interagency estimate is prepared from 

data for selecting fields of nursing obtained from 

various sources (table 10). For some nursing 

33 
fields, supply counts areobtained from employers 

of nurses through ongoing surveys conducted by 

professional or governmental organizations: 

Field Sources of data 

Hospitals------------------------- Annual survey of hospitals, 

American Hospital Association 

(nursing data discontinued in 

1960 but gathered in special 

surveys conducted in 1962, 

1964, and 1966) 

Annual survey of osteopathic 

hospitals, American Ostoopathic Hospital Association 

Nursing homes --_ ----___________ Survey of manpower resources 

in nursing homes, Public 

Health Service (1966) 

Public health (including Biennial survey of public health 

school nursing and oc- agencies, Public Health Servcupational health) ice (since 1937) 

Nursing education-------------- Biennial survey of schools of 

nursing, National League for 

Nursing (since 1960) 

The advantage of the Interagency Conference 

on Nursing Statistics’ estimate is that itprovides 

a current estimate of nurse supply. Since an 

estimate has been made every other year, beginning in 1954, it also provides a time series for 

analyzing trends. 

The limitations of the Interagency estimate 

are: 

1. It combines data from different sources 

which have varying degrees of accuracy. 

2. It depends on sources of data over which 

the Interagency Conference on Nursing 

Statistics has little control. In 1960, for 

example, the American Hospital Association discontinued the collection of data 

on nursing personnel as part of the 

annual survey of hospitals. In 1962, atthe 

urging of the Conference, a special survey of hospital nurse supply was undertaken by the American Hospital Association. This survey was repeated on a 

sampling basis in 1964. In 1966, nursing 

data were gathered as part of a comprehensive survey of manpower resources 

in hospitals. 

3. It provides nurse supply estimates only 

for the United States as a whole. 

Inventories of Registered Nurses 

As indicated, the census conducted by the 

Federal Government is one source of data on 

nurse manpower. If the decennial census could 

provide sufficiently detailed, reasonably accurate, 

and up-to-date data on registered nurses, there 

would be no need for the AmericanNurses’ Association to r.onduct another census for that purpose. It was precisely the limitations in census 

data which, in 1950, led to the exploration of 

other ways in which to measure the Nation’s 

supply of registered nurses. 

The primary problem with the census data 

is that it suffers from the tendency of some 

people to define their occupations rather loosely 

or to upgrade themselves. When one considers 

that practical nurses, aides, orderlies, and attendants, as well as registered nurses, all function in nursing service, it is conceivable that 

errors in classification can occur. However, the 

inclusion of people in the registered nurse 

category who do not belong there not only distorts the data on detailed characteristics, but 

also precludes comparison of information about 

nurses with those of other occupational groups. 

One criterion which the ANA sought in the 

approach to conducting an inventory would be 

to rule out the inclusion of other nursing groups 

in the registered nurse category. Working through 

the State licensing mechanism provided amechanism for doing this. 

Every State, and the District of Columbia, 

issues licenses to practice nursing. These State 

governmental agencies do maintain statistics on 

the licenses they issue. In the aggregate, there 

are many more licenses than there are nurses 

since a substantial number of nurses maintain 

licenses in more than one State. Also, nurses 

are not always licensed in the State in which they 

are located. The State licensure counts, then, 

are not synonymous with nurse counts nor do 

they represent the State’s nurse supply. The 

licenses which a State issues belong to nurses 

34 
both within and without its borders. A State’s It seemed obvious that a way had to be found 

own licensure total may fail to include those to retain the best elements of the methodology of 

nurses living or working within its borders who the three studies. In 1962, the ANA contracted 

are not licensed there, people who are actually with the Public Health Service to conduct a 1962 

part ‘of its labor force or potential labor force. Inventory. In addition to having gained knowledge 

These limitations are pointed out because so and experience through the establishment of prooften groups conducting State surveys of nurse cedures for the three prior Inventories, ANA’s 

manpower needs and resources consider only the role as coordinator of the efforts of 51 separate 

licenses issued by their State licensing boards, governmental units is enhanced by its special 

not realizing the distorted picture of actualnurse ’ relationship with the boards through its Council 

supply which often results. 

Although licensure statistics are not useful 

for the purpose of assessing manpower, the 

mechanism for renewing licenses is most useful. 

It provides an additional advantageover conducting 

a census restricted to employed persons or persons seeking work; it enables securing information on part of the potential labor force-that is, 

nurses who are inactive but legally qualified to 

practice by virtue of holding a current license. 

In the first three NurseInventory Studies-in 

1949, 1951, and 1957-the ANA experimentedwith 

slightly different procedures. The first Inventory 

utilized a post card questionnaire. In the second 

Inventory, a separate questionnaire was mailed 

out with the license renewal application. In each 

case, the State board of nursing handledthemailing to its registrants. Since in each Inventory 

the questionnaires were returned to the ANA 

rather than the State agency, problems were encountered with the percentage of returns. The 

third Inventory sought to reduce this factor by 

incorporating the Inventory questions into the 

renewal notice itself. The procedure for handling 

data for the 1957 study was decentralized; that 

is, each State arranged to have its data processed 

locally according to a manual of instructions prepared by project directors in the ANA Research 

and Statistics Department. The decentralization 

resulted in some differences in interpretation and 

application of the instructions. Uniformity is of 

utmost importance since the data cards from each 

of the States are merged into one deck. Also, the 

collection of data often spanned entire renewal 

periods. Although about half of thestatesrenewed 

licenses every year, the balance renewed over 

a 2-year period. This proved too lengthy a time in 

which to conduct such a census. Cost was an 

overriding factor throughout. 

on State Boards of Nursing. The financial support 

received from the Public Health Service for data 

processing and certain costs other than staff, 

equipment, and overhead at ANA enabled the 

centralization of processing operations. 

As a result of the previous work in conducting inventories, most of the licensing application forms already contained the basic set of 

Inventory questions. Where this was not so, the 

ANA submitted redesigns of State forms to 

accommodate the needs of the Inventory as well 

as those of the licensing agency. In those States 

where it was not possible to use the application 

form, a separate questionnaire was sent to the 

nurses. Rather than use an entire licensing 

period, a cutoff date was selected for each State 

to ensure as full coverage as possible. The completed application forms were sent to the ANA by 

the States. In the few places where the forms 

could not leave the States, arrangements were 

made to obtain the data by other means. Usually 

this involved visiting the State to hire and train 

personnel for editing and coding the raw data 

and to arrange with local firms for machine data 

processing. 

Almost a million licenses were processed 

in that 1962 Inventory. Elimination of the duplicate licenses was achieved through alphabetizing 

of names and addresses, a particularly unwieldy 

process. In the 1966 Inventory, which the ANA 

is presently completing under contract with the 

Public Health Service, the Social Security number is being used for that purpose. After allowing 

for duplication of those licensed in more thanone 

State, the resulting master deck of cards is 

sorted according to the State in which the nurse 

is employed or, if not employed, according to 

State of residence. 

35 
------------ 

Detailed tables on such characteristics as 

age, sex, marital status, field of employment, 

type of position, area of clinical practice, and 

educational preparation are prepared for each 

State and for the United States. A complete analysis and presentation of tabular material appear 

in a separate report, and selected data are 

published in Facts About Nursing, astatistical 

reference book published annually by the ANA 

(table 11). Thus, the Inventory of Registered 

Nurses, conducted by the American Nurses’ 

Association, represents bench mark data on 

supply and potential supply and is a reasonably 

complete universe count. The availability of a 

complete card file on registered nurses at the 

conclusion of each Inventory represents a ready 

universe to be utilized for more detailed studies 

of segments of the nurse population. 

CHARACTERISTICS OF THE 

NURSE MANPOWER SUPPLY 

Nursing is, perhaps, the most complex of 

all health manpower fields. An outstanding characteristic of nurse manpower is this complexity, 

which stems from the following characteristics, 

making measurement of the nurse supply a challenging task. 

1. Size of the manpower field.--The most 

numerous of all health manpower categories is 

the field of nursing. As of January 1, 1967, about 

half of the Nation’s health manpower were employed in nursing: 640,000 as registered nurses; 

300,000 as practical nurses; 700,000 as aides, 

orderlies, and attendants; and 10,000 in a newly 

emerging group called home health aides. In 

addition, there are over a half-million persons 

in the United States today who have received 

training in the nursing field but who are not 

actively employed in nursing: 500,000 registered 

nurses and more than 100,000 practical nurses, 

aides, and orderlies. Furthermore, almost 

200,000 students are currently being trained in 

schools of nursing: 130,000 in schools of nursing 

(R.N.) at the undergraduate level, 13,000 at the 

graduate level, and 33,000 in schools of practical 

nursing. 

Because of its large size, nursing manpower 

is beset with numerous problems. One problem 

is the need to maintain huge educational resources 

to meet the demands for new manpower. These 

demands arise from steadily increasing nursing 

needs and the constant attrition and mobility 

among the existing manpower ,supply. Take registered nursing alone: Over 20,000 new nurses 

have to be graduated each year just to keep up 

with attrition. This is 50 percent greater than 

the total number of graduates from medical, dental, and pharmacy schools combined. 

2. Varied geographic distribution. -If the 

distribution of nurse manpower is analyzed, great 

variation is found geographically. No two States 

in the Nation have the same ratio of nurses to 

population. In 1962, Arkansas, at the lowest end, 

had 119 registered nurses per 100,000 population. New Hampshire, at the top, had 474 nurses 

per 100,000 population. Practical nurses ranged 

from 52 per 100,000 population in Alaska up to 

220 per 100,000 population in Massachusetts. 

Moreover, the urban-rural distribution is 

also extremely variable. Compared with urban 

areas, rural areas have relatively fewer registered nurses per 100,000 population: 

NwseArea population 

ratio 

Greater metropolitan------------------------------~. 328 

Lesser metropolitan---------- _-.-____-_ 240 

.&djacent to metropolitan -----. -.------- _.--- ____._ 254 

Semi-isolated rural_______________.__________________ 243 

Isolated rural ___________________________________ ___.__ 126

When States are grouped regionally, significant differences are found from one section of 

the country to another. In the Northeast, there 

were 413 registered nurses per 100,000 population in 1962; the southern States had a ratio of 

only 215 per 100,000 population. 

Finally, as individual institutions are examined, great variation is found in nurse manpower 

employment patterns from one institution to 

another. Some hospitals, for example, maintain 

staffing ratios of nearly two nursing personnel 

for each patient while others have as few as two 

nursing personnel for every eight patients. 

This great variation in distribution of nurse 

manpower underscores the difficulties in trying 

to meet health manpower needs of people in 

different parts of the Nation. Although some of 

the variation is attributable to differences in 

36 
----------------- 

------- 

------------ 

demand-the Northeast Region has a higher proportion of older persons than does the Southern 

Region- some of it signifies the inability of certain areas of the country to provide needed manpower resources. 

3. Employment diversity. -Nursing personnel are found in a great variety of employment 

settings. Although the vast majority are employed 

by hospitals, as many as 70,000 registered 

nurses are in private duty, over 40,000 are 

employed in the offices of physicians, and 40,000 

are working for publicheahhagencies and boards 

of education. 

As employers of nurses, hospitals and related institutions vary greatly in their characteristics. Hospitals range in size from under 10 

beds to as many as 10,000 beds, and this variation presents many differences in job requirements, responsibilities, and work assignments. 

Hospitals also vary by type of patients cared for. 

Although the majority are classified as general 

hospitals, there are largenumbers ofpsychiatric, 

tuberculosis, and chronic and convalescent hospitals. Moreover, differences in the ownership 

of hospitals provide variety in employment settings-governmental hospitals have different 

characteristics from nonprofit community hospitals which in turn differ from proprietary hospitals . 

Although no accurate count of the number of 

different employers of nursing personnel is 

available, it is estimated that over 80,000 are 

in existence today. 

&spit& _--__________--__--_------------------------------ 9,000 

Clinics and other outpatient facilities------------- 1,000 

Nursikg homes, homes for the aged, etc:---------- 25,000 

Public health agencies, including VNA----------- 3,000 

Elementary and secondary schools 5,000 

Schools of nursing _______________--_____________ 1,100 

Industrial offices and plan& _____-------- 4,000 

Physicians’ and dentists’ offices------------------- 40,000 

4. Functional c@%vences.-There are three 

major categories of nurse manpower: the registered nurse, the licensed practical nurse, and 

the auxiliary nurse who may be called a nursing 

aide, nursing assistant, orderly, or attendant. 

The latter also includes a new category-the 

home health aide-which has been created to 

assist in home nursing care programs. The main 

categories of nurse manpower are differentiated 

not only functionally, with highest level duties 

assigned to the R.N. and least skilled to auxiliary 

personnel, but also in terms of educational attainment. The registered nurse is a graduate of an 

approved school of nursing which can be a2-year 

junior college program, a 3-year hospital-based 

program, or a 4-year baccalaureate program. The 

licensed practical nurse, unless licensed by 

waiver on the basis of experience, is a graduate 

of an.approved school of practical nursing, usually 

a l-year educational program. Aides, orderlies, 

and attendants generally have no formal training 

but are prepared on the job. 

In addition to diversity in educational preparation, other differences are found when the 

particular functions that nursing personnel perform are examined. This is particularly true for 

registered nurses. Functions differ according 

to the field within which a nurse practices. A 

hospital nurse performs different duties than, 

say, a nurse in the health unit of an industrial 

plant. Moreover, within most fields, a variety 

of job titles can be found. This is especially 

true for hospitals. Many hospitals have more 

than a half-dozen different job categories for 

registered nurses, including the staff nurse, 

head nurse, supervisor, inservice educational 

director, and director of nurses. 

The great variation in the geographic clistribution of nurse manpower, the many kinds of 

employment settings in which they work, their 

differing educational preparation, and the variety 

of functions they perform greatly complicate the 

analysis of this most numerous health manpower 

field and make measurement of the manpower 

supply quite difficult, indeed. Moreover, many 

pressures, trends, and influences are at work 

which directly affect nurse manpower supply and 

needs. When these are superimposed on the 

diversity of nurse manpower supply, assessment 

of present and future nurse manpower needs 

becomes an almost impossible task. Nevertheless, we do have considerable information about 

the nurse supply and, in the near future, will 

know even more as the results of the latest 

Inventories become available. 

37 
--- 

--- 

--- --- 

--- --- 

--- 

Table 9. Registered nurses in relation to population: selected years, 1950 through 1968 

- -

Resident TNumber of nurses in practice Nurses per Year population 100,000 in 

thousands Total Pull-time Part-time population 

199,017 659,000 -me ,331 

196,967 640,000 m-m 325 

194,899 621,000 319 

190,169 582,000 450,000 132,000 306 

184,598 550,000 433,000 117,000 298 

178,729 504,000 414,000 90,000 282 

171,922 460,000 268 

165,931 430,000 m-w 259 

159,825 401,600 -mm m-s 251 

150,697 375,000 335,000 40,000 249 L 

'In 50 States and the District of Columbia. 

Sources: Interagency Conference on Nursing Statistics for 1954-1968 estimates; U.S. Bureau of 

the Census for 1950 on nurses (adjusted). 

U.S. Bureau of the Census: Population estimates. Current Population Reports. Series 

P-25, No. 327, Feb. 1966, and No. 389, Mar. 1968. 

Table 10. Field of employment of registered nurses: January 1, 1967 

Number Percent 

Field of employment of of 

nurses total 

Total-------------------------------------------------------------------- 640,000 100 .o 

Hospitals, nursing homes, and related institutions----------------------------- 431,000 67.3 

Public health and school------------------------------------------------------- 41,500 6.5 

Occupational health------------------------------------------------------------ 19,500 3.0 

Nursing education-------------------------------------------------------------- 24,000 3.8 t 

Private duty, office, and other fields----------------------------------------- 124,000 19.4 

Source: U.S. Department of Health, Education, and Welfare, Public Health Service, Division 

of Nursing. Nurse Training Act of 1964. Program Review Report. Public Health Service 

Pub. No. 1740. Washington, U.S. Government Printing Ofrice, December 1967, p. 60. 

38 
Table 11. Number of employed registered nurses and ratio to population for States: 1966 

Employed NurseGeographic division nurses popula- and State (adjusted tion 

figure) ratio1 

United States-------- 613,198 313 

New England-- ------- --- 57,268 509 

Connecticut---------------- 15,444 537 

Maine---------------------- 4,045 414 

Massachusetts-------------- 28,752 532 

New Hmp sh ire -- - - - - - - - - - - - - 3,520 521 

Rhode Island---------------

Vermont--------------------

Middle Atlantic--------

New Jersey-----------------

New York-------------------

Pennsylvania---------------

South Atlantic---------

Delaware-------------------

District of Columbia-------

Florida--------------------

Georgia--------------------

Maryland-------------------

North Carolina-------------

South Carolina-------------

Virginia-------------------

West Virginia--------------

East South Central-----

Alabama--------------------

Kentucky-------------------

Mississippi----------------

Tennessee------------------

West South Central-----

Arkansas-------------------

Loursiana------------------

Oklahoma-------------------

Texas---------------------­

'Number of nurses per lation. (U.S. Bureau of 

3,673 409 

1,834 446 

145,013 395 

24,936 361 

74,286 408 

45,791 395 

78,459 270 

2,098 409 

3,664 454 

21,775 370 

6,956 156 

10,004 277 

12,129 244 

5,619 217 

11,506 258 

4,708 260 

22,635 176 

5,911 168 

6,296 198 

3,672 157 

6,756 175 

34,184 182 

2,607 133 

6,757 187 

4,650 188 

20,170 188 

Employed NurseGeographic division nurses popula­ and State (adjusted tion 

figure) ratio1 

East North Central----- 118,572 306 

Illinois------------------- 35,560 330 

Indiana-------------------- 12,835 259 

M-i& igan-- _ _ _- - - _ _ _ - -_ __ --- 23,447 277 

Ohi0 -________-_-_-__-_----- 32,647 315 

Wisconsm------------------ 14,083 338 

West North Central----- 51,538 323 

Iowa----------------------- 9,981 362 

Kansas--------------------- 6,894 303 

Minnesota------------------ 14,441 404 

Missouri------------------- 11,290 247 

Nebraska------------------- 4,729 329 

North Dakota--------------- 2,114 329 

South Dakota--------------- 2,089 308 

Mountain--------------- 25,738 334 

Arizona-------------------- 5,862 366 

Colorado------------------- 8,315 425 

Idaho---------------------- 1,954 280 

Montana-------------------- 2,483 354 

Nevada--------------------- 1,058 245 

New Mexico----------------- 2,510 250 

Utah----------------------- 2,347 233 

Wyoming-------------------- 1,209 379 

Pacific---------------- 79,791 322 

Alaska--------------------- 593 224 

California----------------- 58,683 312 

Hawaii--------------------- 2,340 322 

Oregon--------------------- 6,814 345 

ijashington----------------- 11,361 374 

100,000 population based on July 1, 1966, estimates of resident poputhe Census, Current Population Reports, P-25, No. 380.) 

Source: ANA Research and Statistics Department, 1968. 

39 
PHARMACIST 

Fred T, Mahaffey, B.S,, R.Ph., 

Approximately 122,000 pharmacists were 

actively engaged in this health profession at the 

beginning of 1967. This estimate is basedonstate 

registrations reported by the individual State 

Boards of Pharmacy to the National Association 

of Boards of Pharmacy (NABP). 

Pharmacy is the health profession which is 

concerned with the preparation and the distribution of medicinal products. It is the art and 

science of preparing, from natural or synthetic 

sources, materials for the prevention, diagnosis, 

and treatment of disease. Pharmacy also includes 

the professional, legal, and economic function of 

distributing medicinal products properly and 

safely. In the distribution of medicinals, the 

pharmacy profession operates within the framework of Federal and State laws and inaccordance 

with ethical principles. Thus the pharmacist promotes and safeguards public health. 

In the early years of this country, only two 

occupations were generally licensed by the 

States-medicine and law. Pharmacy was one of 

the fields that had branched out from medicine 

when institutions of higher learning placed more 

emphasis on functional specialization. This led to 

a desire for occupational and professional selfgovernment. 

Occupational groups began organizing into 

associations at the national level just prior to the 

Civil War. The American Medical Association was 

f Mr. Mahaffey is Executive Director of the National Association of Boards of Pharmacy. Mrs. Pennell is Special 

Assistant to the Director, Division of Allied Health Manpower, 

Bureau of Health Manpower, Public Health Service. She was 

formerly with the National Center for Health Statistics. 

MANPOWER 

and Maryland Y. Pennell, M.SC.~ 

organized in 1847 and was followed by the 

American Pharmaceutical Association in 1852. 

These and other national associations urged State 

legislation to protect public health and safety by 

allowing each profession to control itself from 

within. Through legislation and professional control, codes of conduct and standards of competence were established. Legal rosters of qualified practitioners were also made available 

through State licensing agencies. The profession, 

or peer group, was granted the right to control 

or be represented on the licensing boards set up 

to regulate the profession in question. Before 

1880, statutes were enacted for the licensing of 

three health professions: physicians in 11 States, 

pharmacists in 6 States, and dentists in 8 States. 

By 1910, all States, except Alabama and the 

Territories of Alaska and Hawaii, had licensure 

provisions for pharmacists. 

Pharmacists are among the 11 professions 

and occupations in the health field for which all 

States now have licensing requirements. Pharmacy practice acts are restrictive, embodying 

the principle that no person may practice the 

profession unless he has satisfied specific requirements and then applied for and received a 

license. 

With the establishment of the National Association of Boards of Pharmacy in 1904, and 

later through a central office in 1914, came the 

opportunity to assemble national statistics based 

on State registrations. The NABP was the first 

organization composed of State agencies licensing a specific occupation which banded together 

for mutual benefit. The basic purpose of the 

40 
Association was to provide and promote interstate exchange of licenses by reciprocity. This 

same goal remains today, but, as can be imagined, 

the activities have expanded tremendously over 

the years. Beginning in the early forties, the 

secretary of each State pharmacy licensing board 

was asked to provide the NABP with information 

on the numbers of licenses issued during the 

past year and the number in effect as of the first 

of January of each year. These licensure statistics have been published annually in tbe 1”yoceedings of the NABP since 1948. 

Before discussing in detail the 1967 tabular 

data, some of the problems involved in the collection of manpower statistics should be mentioned. The first national statistics on pharmacist manpower are those available from the 

1900 Census of Population. At the turn of the 

century, the decennial census enumerated about 

46,000 pharmacists. By 1960 this count had increased to approximately 92,000. As a measure 

of pharmacist manpower, however, the census returns leave something to be desired. Problems 

of household respondents reporting of occupations 

and coding practices that follow make it difficult to sort out properly the detailed categories 

of health personnel. The census questionnaire 

does not request .information on professional degree or on license to practice, each of which 

would be positive identification for pharmacists. 

Moreover, since the tabulations classify according 

to kind of work, pharmacists who are teachers, 

administrators, and in other managerial positions 

would be excluded from the health field. 

The information presented in the accompanying tables has been gathered through the secretaries of the Boards of Pharmacy in each of the 

50 States, the District of Columbia, thecommonwealth of Puerto Rico, and the Virgin Islands. 

The omissions in the data show that the Board 

did not provide the complete range of information. 

The statistics are reliable enough to make totals 

and percentages significant for the pharmacy 

population as a whole. 

Very few of the State boards have individual 

punchcards on pharmacists registered in their 

States that can be machine processed for information on activity status, type of practice, age, 

sex, and professional education. For some of the 

smaller States, it is often difficult to provide 

information beyond the count of licenses issued 

during the year. In addition to knowing the total 

number of pharmacists in good standing, we also 

want to know the number of pharmacists who are 

residing and practicing within the State. For 

example, the 1966 Proceedings shows a trend 

table for national totals, accompanied by remarks calling attention to unusual differences 

between the 1966 figures and those of the previous 

year. Between these 2 years, Florida, Iowa, and 

Massachusetts substantially increased their figures on resident active pharmacists by 2,800, 

while Michigan reported 14,000 less. The differences mentioned above are attributed to the 

utilization of more efficient record keeping 

methods, which should result in more accurate 

statistics in the future. 

Pharmacist registrations as of January 1, 

1967, numbered 172,635 (table 12). These include 

persons who are licensed in one or morestatessome with as many as nine registrations. When 

those who have out-of-State addresses are exeluded, the number drops to 132,900, which is the 

closest approximation of persons trained in 

pharmacy. When pharmacists who have not renewed their licenses and thus are no longer active are eliminated, this figure drops to 122,421 

active pharmacists. 

In relation to population, there are 61.6 

pharmacists, active and inactive, per 100,000 

population. Significant differences appear among 

the regions of this country. The Northeastern 

Region has the highest ratio, with 75 pharmacists 

per 100,000. In the South, the ratio was 55. The 

North Central and West Regions had ratios of 

56 and 62, respectively. 

The District of Columbia and Massachusetts 

each exceed 100 pharmacists per 100,000 population. At the other end of the scale are Alaska 

and Hawaii with about 30 per 100,000. 

Nearly 8 percent of the active pharmacists 

are women (table 13). Among the reporting 

States, female pharmacists account for less than 

5 percent of the total in Arkansas, Connecticut, 

Nevada, New York, and Vermont. The proportion 

of pharmacy students who are women is increasing and should be reflected soon with larger 

active numbers in the profession. 

Only 30 of the 53 jurisdictions were able to 

provide information on educational qualification, 

41 
and too few of the Northeastern States are included to warrant regional comparisons. Maine 

and Vermont, which did report, show relatively 

large numbers on nongraduates, since these 

States were among the last to raise minimum 

levels for licensure. For the Nation as a whole, 

7 out of 10 pharmacists have 4, 5, or 6 years of 

post-high-school education. Current educational 

requirements call for a bachelor’s degree from 

a recognized college of pharmacy, representing 

at least 5 years of study beyond high school. The 

level was raised from 4 to 5 years in 1960. 

According to the age distribution of pharmacists in table 14, about 19 percent are under 

30 years of age and 8 percent are 65 or older. 

How reliable this information is cannot be determined. Some of the States reported considerably different distributions in earlier Proceedings. 

About 98,000 or 86 percent of the active 

pharmacists practice in community-that is, retail-pharmacies. In our data, hospital pharmacies account for about 6,700- pharmacists. However, the American Society of Hospital Pharmacists estimates that a total of approximately 

10,000 pharmacists are practicing full time or 

part time in hospitals. Pharmacists employed 

by manufacturers and wholesalers account for 

4,500; teachers in colleges of pharmacy, government, and other personnel make up the balance (table 15). 

The proportion of pharmacists who practice 

in community pharmacies ranges from about 88 

percent in the South and the West to 85 percent 

in the North Central and 81 percent in the Northeastern Regions. Maine, with 96 percent in retail practice, has the highest State proportion. 

Many other rural States also have relatively 

large numbers in this type of practice, for 

example, Alaska, Idaho, and Wyoming. 

Pharmacists who are employees in community pharmacies only slightly outnumber those 

who are owners, parmers, or stockholders of 

community pharmacies. As shown in table 15, 54 

percent of the 98,000 pharmacists practicing in 

community pharmacies are employees. This 

proportion is considerably higher in the Northeastern Region (63 percent) and lower in the 

West (48 percent). The District of Columbia and 

Maryland each report that more than threefourths of their community pharmacists are 

employees, indicating a different employment 

pattern from that in the States with lower percentages. 

Information on the numbers of community 

pharmacies and hospital pharmacies has also 

been supplied by the State Boards of Pharmacy 

where they are the licensing agencies for those 

outlets. However, in some States, the Board of 

Health or some other agency licenses hospital 

pharmacies. Inasmuch as we do not have data 

from the latter agencies, there is an understatement of the numbers in table 16. The number of 

hospitals with pharmacies attended by a registered pharmacist reported in the Guide issue of 

the Jownal of the Am&can Hospital Association 

differs considerably from some of the statistics 

presented here. 

When the number of community pharmacies 

is related to the number of pharmacists in attendance, it becomes apparent that about 22 percent of the pharmacists practice in one-person 

outlets. In the South, the proportion reaches 25 

percent; in the Northeastern Region, it is as low 

as 18 percent. Conversely, 42 percent of the 

community pharmacies operate with one pharmacist. In Puerto Rico the proportion is 94 percent, markedly higher than that in any of the 

States. 

The NABP, under contract with the U.S. 

Public Health Service, is completing an Inventory 

of Pharmacy Manpower in the United States. Every 

licensed pharmacist in this country has been contacted through the mechanism of State license renewal. The roster of all pharmacists inthe United 

States being developed from this survey willprovide data similar to those in the accompanying 

State tables. However, the information will be 

more reliable and complete since it is based on 

a standardized questionnaire. Nevertheless, there 

exist problems of collection over a period oftime 

due to lack of uniformity of license renewal 

dates. 

To check on the accuracy of licensure as a 

measure for gathering valid manpower statistics, 

we plan to assemble the names of graduates of 

our colleges of pharmacy over a period of years 

and to check these against the master file. A 

special study will be made to determine the 

whereabouts of those who are missing from the 

42 
master file. This will give us a means of determining those graduates who are lost to professional practice by going into some other field. 

Additional studies could also be done on professional education, work experience, and site of 

practice as these relate to the location of our 

colleges of pharmacy throughout the United States. 

The limited information available indicates 

that there are numerous employment opportunities for pharmacists throughout the country. There 

are some indications from the Board of Pharmacy secretaries that serious shortages exist 

in some areas. These shortages seem to bemore 

acute in the rural States than in States having 

large metropolitan areas. Information available 

on staffing in hospital pharmacies obtained through 

the 1966 American Hospital Association-Public 

Health Service survey of registered hospitals 

indicates a need for about 600 pharmacists in 

this area. 

Employment possibilities for pharmacists 

are expected to show a small increase within the 

next few years, according to the Bureau of Labor 

Statistics.* This increased need will be approximately 5 percent between 1966 and 1975, representing a slightly slower rate of growth than for 

the 1955-66 period. 

The extended use of the pharmacist’s expert 

knowledge on drugs and their control will be 

greatly needed in the expanding area of hospital 

practice. The profession itself is taking steps to 

orient the community pharmacist toward assuming additional responsibilities in institutional 

practice. This would include hospitals of varying 

sizes, extended care facilities, and nursing or 

custodial homes. Acting as a consultant to the 

professional staff of a home or small hospital, 

the pharmacist can increase the efficiency of the 

overall drug utilization program of the institution, 

leaving other professional personnel with additional time to do a more thorough job of improving patient care in their otin areas of 

practice. 

There are increasing signs that the pharmacy 

curriculum is and in the years ahead will continue 

to become more patient oriented. Actual clinical 

experiences are being encountered bymanyof our 

newer graduates. These experiences are gained 

through broad exposure to hospital pharmacy and 

observation of the effect of prescribed medication 

on the patient. Many feel that it will be only a 

matter of a few years until pharmaceutical education will include a required course in hospital 

pharmacy, giving the student a broad taste of 

clinical exposure to patient care. 

If pharmacy and pharmaceutical education 

meet these challenges properly, enrollments in 

our colleges of pharmacy should continue to increase not only to the high levels that have 

been predicted but possibly beyond. The problem 

will be in producing an adequate number of 

graduates to replace those who die, as well as 

for the additional growth needed to meet the demands of an intensified medical care program. 

43 
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Table 12. Pharmacist registrations according to residence and activity status and ratio of phar­ macists to population: January 1, 1967 

Active Pharmacists resident 

Pharma- pharma- Total in State 

Location regis- cists cists 

per trations 

Total Active Not out of 100,000 in

practice praZice 

State P;yV;;-

Total-------------------------- 172,635 2132,900 122,421 10,479 39,735 61.6 

Alabama------------------------------ 2,242 1,751 1,613 138 491 45.9 Alaska------------------------------- 177 32'.4 Arizona------------------------------ 2,313 1,lE 9;; 172 l,lE 61.9 Arkansas----------------------------- 1,609 1,149 946 203 48.4 California--------------------------- 12,600 11,790 10 720 1,070 Fl: 57.0 Colorado----------------------------- 3,042 1,862 , 616 246 1,;g 82.7 Connecticut-------------------------- 3,094 2,575 : ‘, 498 86.8 Delaware----------------------------- 443 258 234 :z 185 45.6 District of Columbia----------------- 1,805 954 862 851 106.9 Florida------------------------------ 5.828 4,805 4

9

‘3 697 1% 1,023 79.7 

Georgia------------------------------

Hawaii-------------------------------

31432 2,651 &,405 246 781 54.1

250 200 200 27.6 Idaho-------------------------------- 1,332 518 450 8:s: 64.6 Illinois----------------------------- 8,818 6,714 5,889 862; 2,104 54.6 Indiana------------------------------ 4,719 3,376 2,978 398 1,343 60.1 Iowa--------------------------------- 2,903 1,789 1,621 168 1,114 58.7 Kansas------------------------------- 2.286 1,501 1,326 175 785 58.3 Kentucky----------------------------- 21074 1,658 1,560 416 49.0 Louisiana---------------------------- 2,490 2,030 2,000 '3: 460 55.3 Ma=ne-------------------------------- 791 434 434 357 44.4 Maryland----------------------------- 2,659 2,368 2.109 259 291 58.4 Massachusetts------------------------ 6,475 5,616 5;616 859 103.9 Michigan----------------------------- 5,685 5,175 428 61.1 Minnesota---------------------------- 3,247 

5,603 

2,126 253 8:; 59.5 Mississippi-------------------------- 1,383 Z'Z 1,037 307 44.4 Missouri----------------------------- 4,510 31069 2,609 4% 1,441 57.2 Montana------------------------------ 817 512 397 115 305 56.6 Nebraska----------------------------- 2,018 ,1,168 1,007 161 850 70.0 Nevada------------------------------- 2,366 328 3i6 12 2,038 73.3 New Hampshire------------------------ 473 364 361 109 53.3 New Jersey--------------------------- 5,980 4,784 4,198 58: 1,196 60.8 New Mexico--------------------------- 1,118 598 566 520 56.5 New York----------------------------- 18,068 15,256 1:,;;; 1,5% 2,812 75.4 North Carolina----------------------- 2,347 2,019 143 328 37.7 North Dakota------------------------- 1,084 408 '340 676 52.9 Ohio--------------------------------- 8,095 6,841 6,474 3:; 1,254 Oklahoma----------------------------- 2,001 1,972 947 E 

Oregon------------------------------- f% 1,667 1,509 1;: 534 7615 Pennsylvania------------------------- lo:716 8,216 8,216 2,500 70.8 Puerto Rico-------------------------- 918 918 918 v-m -mm 34.4 Rhode Island------------------------- 1,081 816 717 265 80.0 South Carolina----------------------- 1.410 1,287 1,250 ;; 123 48.3 South Dakota------------------------- ,937 480 480 457 70.7 Tennessee---------------------------- 3,069 2,388 2,388 681 61.8 Texas-------------------------------- 7,826 6,495 5,783 712 1,331 53.8 Utah--------------------------------- 1,181 601 601 580 59.7 Vermont------------------------------ 800 209 201 591 48.9 Virginia----------------------------- 2,408 1,967 1,783 18: 441 39.9 Virgin Islands----------------------- 25 42.4 \ Washington--------------------------- 3,512 2,6:: 2,2f3 326 904 75.1 West Virginia------------------------ 1,036 706 706 m-e 330 39.0 Wisconsin---------------------------- 3,183 2,567 2,257 310 616 54.2 Wyoming-*---------------------------- 811 296 277 19 515 86.8 

IRates based on provisional estimates of total resident population as of July 1, 1966. U.S. Bureau of the Census: Population estimates. Current

Sept. 5, 1967,and Series P-25 No. 358, January 18, 1967.Population Reports. Series P-25, No. 373, 

2Data on activity status not availablefor 8,922 pharmacists in Pennsylvania and West Virginia,

counted here as in practice. 

44 
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Table 13. Sex and education of resident pharmacists engaged in practice: January 1, 1967 - - - =

TResident T T Professional education Percent

with pharma- 5, 5, Location cists Non- 6 years' 

or

Per- c, 5, 3 2 grad- educa­ pra%ce Male Female cent or 6 years years female rears uate tion

Total------------- l122,421 82,432 7,092 7.9 LO,230 5,843 5,884 3,444 71.3 

Alaba~---------- __--___ 1>g;; 1,505 108 6.7 1,566 16 20 11 97.1 Alaska------------------ 18.6 mm- s-m m-s meArizona----------------- 9;: Arkansas---------------- ;:62 914 :1” 5.1 610 104 224 61.5 

California-------------- 618 4: 86 220 65.3 

Colorado---------------- y, if; 9,950 -s7% ;:% 5,902 2,670 L,754 394 55.1 mm- a-- -mm -SD emConnecticut------------- 2:498 w; 2.2 m-e e-m Delaware---------------- 234 1: 6.4 -se -se 

District of Columbia---- 862 717 145 16.8 -a- -v- emFlorida----------------- 4,697 m.-- me- --a --a 

Georgia----------------- 2 405 2,225 180 7.5 -..- -a- mm- s-m

Hawaii------------------ 9200 m.-- m-m mm- -mm

Idaho------------------- 450 385 65 14.4 383 34 20 13 85.1 Illinois---------------- 5,889 -se -mm es- -em

Indiana----------------- 2,978 2,711 267 2,347 228 267 78.8 Iowa-------------------- 1,621 1,479 142 t:: 1,110 470 % Kansas------------------ 1,326 125 772 ii 121 345 2: . 

Kentucky---------------- 1,560 P% 151 3*ft -mm e-m s-e

Louisiana--------------- $,OOO 1:;;; 227 11:4 1,347 240 240 173 67.4 Maine------------------- 434 6.0 205 181 

Maryland---------------- 2,109 1,946 1:: 7.7 1,549 3% 1;; 16 4;;* . f

Massachusetts----------- .25,616 w-m em- m-m --a -s- -we 

Michigan---------------- 5,175 Minnesota--------------- 2,126 ';m 

398 3,843 L,O36 134 74.3 

81.6 

Mississippi------------- 1,037 '971 

180 2; 1,;;; 2: 

84 

155 

136; 65.8 Missouri---------------- 2,609 w57 1% 24 2,264 ‘2% 86.8 Montana----------------- 397 8:l 316 260 13 zi 79.6 Nebraska---------------- 1,007 900 1% --a mm- -em 

Nevada------------------ 316 303 13 % . s-m a-­

New Hampshire----------- 361 ..-- -se -a- 231 50 40 40 64.0 New Jersey-------------- 4,;;; -mm -mm .--m -mm --a meNew Mexico-------------- 516 -TV- -be mm- w-- New York---------------- 13,723 .p;;; 6240 E --e me- -we --w 

North Carolina---------- 1,876 140 1,480 118 156 122

North Dakota------------ 340 '317 28’ 239 E Ohio-------------------- 6,474 5,918 5% 8:6 5:: 782: 23: ;7:; Oklahoma---------------- 1,972 1,834 138 4% 109 219 278 

Oregon------------------ 1,509 1,310 199 1;:: 1:129 183 127 70 7418 Pennsylvania------------ 28 216 we- -A e-w m-m w-e w-m

Puerto R-&o------------- $918 m-v 812 70 30 6 88.4 fiode Island------------ 717 569 148 20.6 -w- a--

South Carolina---------- L 2;; 1,183 67 5.4 916 9 241 84 73.3

South Dakota------------ -em -me mm- e-m s-m 

Tennessee--------------- 22,388 2,173 215 -mm --a 

Texas------------------- 5,783 5,251 2; --m -em -mm -aUtah-------------------- 2 601 560 5z: 476 79.2 Vermont----------------- 201 196 82 94 221 :z % 46.8 

Virginia---------------- 1,783 1,635 14: 1,338 195 135 115 75.0

Virgin Islands---------- 221 3% 81.0 

Washington--------------

22a$2 1,891: 3974 17:2 1,8;1 22; 192 393 80.2 West Virginia----------- --a -w- -em -se m-w e-s

Wisconsin--------------- 2,257 2,079 178 -em -mm -Be 

Wyoming----------------- 277 186 91 372:; 159 1 5 112 57.4 

lData not available on sex of 32,897 pharmacists or an education of 66,020 pharmacists. 

21ncludes some pharmacists not in practice. 

45 
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--- --- --- --- --- --- --- --- 

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Table 14. Age distribution of resident pharmacists engaged in practice: January 1, 1967 - Resident Number by age T Percent - phanna- Location cists

in Under 30-39 40-49 SO-59 SO-64 65 years Under 65 years 30 30 practice years years years years years and over years and over 

Total---------. '122,421 16.386 20,782 16,817 L7,163 5,061 7,286 318.9 38.4 -

Alabama-------------- 298 499 318 170 135 193 18.5 12.0 Alaska--------------. -mm we- m-w m-w -mm -me 

Arizona-------------- 67 224 252 240 124 85 6.8 8.6 Arkansas _-__---___--_ 946 142 247 172 114 116 155 15.0 16.4 California -_------ --. 720 2,585 2,200 2,450 2,085 900 500 24.1 4.7 Colorado------------. 616 137 351 370 448 156 154 8.5 9.5 

Connecticut---------- m-s -em -mm. m-e a-.. 

Delaware------------. 12: m-m -mm me- m-w m-e 

District of Columbia- 862 w-m -e- m-m --.. Florida-------------- , 697 -mm m-w -em 

Georgia-------------- 405 m-m -aHawaii--------------- 200 -mm w-w -mm 

Idaho---------------- 450 60 174 125 48 -;i 15 13.3 3.3 Illi*ois------------. 5,889 w-e mm- me- --.. e-w 

Indiana-------------- 2,978 539 755 682 483 263 256 18.1 8.6 lowa----------------- 1,621 298 365 306 301 201 18.4 12.4

Kansas--------------. 1.326 149 291 248 253 2; 218 11.2 16.4 Kentucky------------. 1;560 -me -me -me 

Louisiana------------

Maine----------- . .--- 2,;;; 660 400 415 340 50 33.0 2.5 

103 10.8 13.6 Maryland------------- 2,:!09 44; 6:; 4:: 437 

%

87 ;"9 19.9 2.8 

Massachusetts-------- 5,616 -mm mm- m-s -mm -em -es Michigan------------- 5,175 990 1,329 1,038 1,052 363 403 19.1 Minnesota------------ 2,126 350 543 400 385 200 248 16.5 1:*; Mississippi- _----- 1.037 244 274 197 163 23.5 6:L Missouri------------- 2;609 304 449 403 597 3q$ 4;:

36 

18.4 Montana-------------- 397 108 108 79 "% Nebraska------------. 1,007 2% 210 112 168 86 147 28:2 1::; Nevada--------------- -me -mm -mm -em weNew Hampshire-------- % 193 11.1 

New Jersey----------. 92 1,083 7% 7% 329; 289 22.5 6.9 

New Mexico----------- m-m me- v-m mmNew York------------- 13,723 1,921 2,806 2,034 4,002 137;: 1,245 14.0 9.1 

North Carolina------- 1'8g 286 549 498 234 208 15.2 11.1 

North Dakota--------- 96 109 28.2 Ohio----------------. 

439 l,lZ321 1,3:44 3:: 291; 28.4 E

Oklahoma------------. 6,474 1,842 1,502 543 395 27.5 4:o Oregon--------------- x: 158 392 383 293 % 1;: 10.5 9.1 

Pennsylvania--------- 8:216 mm- -mm -w- -em -mm -aPuerto R-ice---------- 918 200 300 220 93 30 75 21.8 8.2 

Rhode Island--------- 717 -mm -mm em- --^ -mm a-­

South Carolina------- 1,250 248 335 332 177 80 78 19.8 6.2 

South Dakota--------- 480 -em mm- -mm me- -me a-- -mm 

Tennessee------------ 2,388 486 661 442 355 298 146 20.4 6.1 Texas---------------- 5.783 1,082 1,538 1,057 914 602 590 18.7 10.2 Utah----------------- '601 -mm m-w -me 

Ve~(-jnt-------------- 201 45 39 21 34 12.4 16.9 Virginia-------------

Virgin Islands------- 4.8 m-m 1,783 2;: 509 4% 270 117

2 

186 16.4 10.4 

Washington4---------. 2,282: 36: 59; 53: 3332 213 25; 15.9 11.1 

West Virginia-------- 706 --a 

Wisconsin------------ 2,257 245 561 364 472 283 332 10.8 14.7 Wyoming-------------- 277 mm" -mm m-e -em 

IData not available on age of 35,926 pharmacists. 

'Includes some pharmacists not in practice. 

3Adjusted for "Age not reported" in reporting States. 

4Data on age not reported for 92 respondents. 
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-- 

------- -- 

--------- 

--------- --- - - - 

--- 

--- 

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Table 15. Type of practice of resident pharmacis. in practice: January 1, 1967 

Percent in 

Number by type of practice community 

Resident pharmacies 

pharma- Location cists Community pharmacy Manufac- Teaching, Who

prazice Hospital turing govern- Total are and Owner Em- pharmacy whole- ment, Total and p$ees paZner ployee sale other 

Total- ---------. '122,421 297, 988 38,407 45,395 6,734 4,496 4,281 85.6 54.2 

Alab---------------- 1,613 1,344 “E 705 128 90 2: 50.0 

52.5 Alaska- --_-----------_ 

Arizona--------------- 99"; 82 244 5:: 9: 2; 83:l 70.4 Arkansas-- -_-------_ 855 456 399 9O.L California------------ ti,% 5,484 4,026 6;; 3:; 88.7 z . Colorado-------------- 1,616 x9': m-v 112 86.L

Connecticut----------- 2,498 lZ948 957 991 136 1% 78.C 50.9 Delaware-------------- 234 206 114 88.C 55.3 District of Columbia-- 862 682 12 545 6': E 79.9 Florida--------------- 4,697 4,204 m-m 117 240 12 %' 

Georgia---------------

Hawaii---------------- 2’4;; 1,895 996 899 125 

9 

235 

7 

15c 

7 

78:: .47.4

177 Idaho----------------- 450 414 211 203 E-i Illinois-------------- 5,889 2,138 611: 27123 8214 Et Indiana--------------- 2,978 4% 996 2254 198 240 

15; 

82.9 59:6 Iowa------------------ 1,621 11375 757 '618 106 112 '2: 84.8 44.9 Kansas--- ------------_ 1,326 1,173 596 577 85 45 23 88.5 49.2 

Kentucky-- -----------_ 1,560 1,431 84 30 15 Louisiana---- --------_ 2,000 1,;;; 1,083 747 2S z:*: mine-------- 434 153 264 pg "Z 96:l Maryland---'----------- 2,109 415 1,507 80 31 91.1 Massachusetts--------- 5,616 2E 1,872

Michigan-- ---_ -------_ 5,175 4:475 2,135 32cio4 545 110 45 86.5 52.3 Minnesota------------- 2,126 1,651 927 150 244 77.7 43.8 

Mississippi----------- 1,037 934 568 22 ii 90.1 39.2 Missouri-------------- 2,609 2,205 961 1,244 252: 160 z 56.4 Montana--------------- 397 354 219 135 i:-: 38.1 Nebraska-------------- 1,007 843 2 479 6; 8317 Nevada---------------- 316 290 "2: E 1 91.8 ii;*; New Hampshire--------- 361 211 150 61 2 4: 28:9 New Jersey------------ 4,198 3,;;; w-m 2% 153 E v-m New Mexico------------ 566 303 180 io5 8513 37.3 New York-------------- 13,723 10,983 3,;;; 7,245 876 9:; 932: 80.0 66.0 North Carolina-------- 1,876 1,732 883 100 31 13 North Dakota---------- 340 304 161 143 E 2.: Ohio------ -_--------__ 6,474 5,735 2,;;; 3,035 3;: 2% 19; 88:6 52:9 Okl&o~----- 1,810 1,050 91.8 

Oregon---------------- :% 1,330 493 837 :9" z1 2; 88.1 i2: . Pennsylvania---------- 8:216 -mm m-w Puerto Rico----------- 918 750 400 143 81.7 53.3 Rhode Island---------- 717 622 2:; 365 E % 86.8 58.7 South Carolina-------- 1,;;; 1,;;; 514 618 3": 90.6 54.6 South Dakota---------- m-v z31 89.4 Tennessee------------- 2,388 2,109 124 

:; 

612 88.3 Texas----------------- 5,;;; 5,105 3,040 2,065 334 xi 88.3 40.5 Utah--------- 531 Vermont--- -_____--- 201 188 m-m 

31 23 3012 88.4 

93.5 

Virginia -_ - -- - - - -_ - 1,783 1,398 636 762 11; 3: 23; 54.5 Virgin Islands-------- 568'; 68.8 

Washington------------ 2,282; l,SE 76: l,OG 22: 6; 1731 79:5 57.8 West Virginia--------- 706 -m- m-m

Wisconsin--- ________ __ 2,257 1,946 951 211 67 33 86.2 51.1 

Wyoming--------------- 277 265 117 '12: 6 3 3 95.7 55.8 

lData not available on type of practice of 8,922 pharmacists. 

"Data not available on nature of employment of 14,186 retail pharmacists, 

47 
Table 16. Pharmacists in community pharmacies and in hospital pharmacies, by size of staff: 

January 1, 1967 

Hospital Community pharmacies pharmacies 

Number of outlets . TPercent Percent Location 

Total -I of of 

I

phanna- outlets Total Total 

pharma- 1 2 or 3 4 or /cists in with 1 pharma- pharma­ cists Total pharma- phanna- more pharina- cists cies 

cist cists pharma- ,22~:" cist cists 

Tot-l----------- 97.988 44.941 11.725 14,273 1,901 '21.8 242.0 7,461 32,836

Alabama---------------

Alaska----------------

Arizona---------------

Arkansas--------------

California------------

Colorado--------------

Connecticut----------- Delaware--------------

District of Columbia-- Florida---------------

Georgia---------------

Hawaii----------------

Idaho-----------------

Illinois--------------

Indiana---------------

Iowa------------------

Kansas----------------

Kentucky--------------

Louisiana-------------

Maine-----------------

Maryland--------------

Massachusetts--------- Michigan--------------

Minnesota-------------

Mississippi-----------

Missouri--------------

Montana---------------

Nebraska--------------

Nevada----------------

New Hampshire--------- New Jr=,-sey------w--m 

New Me&-o------------

New York--------------

North Carolina--------

North Dakota---------- Ohio------------------

Oklah~--------------

Oregon----------------

Pennsylvania---------- Puerto Rico-----------

1,344 

8;:

855 

9,510 

'1%: 

'206 

682 

4,204

1,895

177 

414 

xi 

1:375 

1,173

1,431 

1,;:; 

1,922

5,616

4,475

1,651

934

2,205 

22 

290 

211 

3,721 483 

10,983

1,732

304 

5,735

1,810

1,330 -mm 

750 

g93zJ

418 

555 

4,348

642 

891 

122 

240

--- 1,181 

2187 

2,608

1,262 760 

661 

764 1,;;; 

788 

1,872

2,108 

2: 

1,245

237 

496 

138 

147 

1,857 265 

m-m 

1,035

186 

2,739 

"5% 

3,290

706 

---

---

180 

333 

1,800 m-w 

256 

-em 

-mm 

-mm 

602 

-a86 

---

395 

340 

360 

---

500 

125 

15 

---

---

355

360 

556 

:2: 

40 

31 

-mm 

139 

-mm 

560 

104 

699 

196 

--w 

mm666 

m--

---

204 

207 

1,831 ---

538 

-mm 

-mm 

---

556 

m-m 

142 

---

827 

386 

289 

-mm 

380 

115 

751 

---

---

518 

251 

608 

2;; 

1:: 

---

120 

-a465 

1,;;; 

m-w 

---

40 

---

---

34 

7:;

-mm 

97 

---

---

---

23 

---

---

---

it 

12 

---

134 

2; ^--

---

37 

89 

1 

:;

15 

---

6 ---

10 

3zg 

-s-

---

---

-a-

---

21.8 

38.9 

18.9 ---

13.1 

--a 

a--

---

31.8 

---

20.8 

---

::*;

30:7 

---

27.3 

30.0 

0.8 

---

---

E

25:2 

x 

13:8 

14.7 

-me 

28.8 S^^ 

32.3 

34.2 

12.2 

10.8 ---

-a88.8 

---

---

43.1 

60.0 

41.4 ---

28.7 

---

---

-mm 

51.0 

---

37.7 

s-m 

31.3 

44.7 

54.5 

---

K 

1:9 

w-s 

---

3598’; 

;‘;:; 

49:6 

29.0 

21.1 

---

52.4 

m-m 

54.1 

55.9 

25.5 

23.8 

a--

--a 

94.3 

128 

1 

2 

699 

112 

136 

~~ 

117 

125 

9 

6;:

198 

106 

8;: 

;a 

---

545 

150 

2:; 

:; 

53 

8% 

100 

32313 

289 

mm15 

32 

1 

;:

289 

33 

mm196 

---

:z 

2;;

104 

---

2;

60 

3: 

---

312 

;9’ 

120

‘2: 

7

1,:

15 

m-m 

2 

194 

ii 

216 

15 

Rhode Island----------

South Carolina--------

South Dakota---------- Tennessee-------------

Texas-----------------

Utah------------------

Vermont---------------

Virginia--------------

Virgin Islands-------- Washington------------

West Virginia--------- Wisconsin-------------

Wyoming---------------

622 

1,;;; 

2,109

5,105

531 

188 

1,398 

1,811; m-m 

1,;;; 

22 

227 

1,085

2,876

276 

105 

854 

11 

-mm 

372 

1,059

118 

---

204 

m-m 

---

1,286 ---

3%

6 ---

180 

453 

38 

-mm 

379 

---

---

1,456 m-v 

4:; 4 ---

179 

578 

80 

---

21 

---

m-w 

134 

m-w 

1; 

---

13 

28 

---

---

18.0 

---

---

25.2 

m-m 

42.6 

28.4 

37.5 

---

m-m 

23.3 

14.3 

---

33.8 

---

m-s 

44.7 

-a76.2 

46.5 

54.5 

---

48.4 

42.8 

32.2 

27 

1;:

334 

31 

1195 

22: 

---

Y 

‘3: 

169 

18 

---

85 

1 -

lBased on 53,775 pharmacists. 

'Based on 27,899 total outlets in 33 locations. 

"Probably understated. AHA hospital statistics indicate about 4,500 pharmacies with registered pharmacists. 

48 
MANPOWER IN HOSPITALS AND NURSING HOMES 

Margaret D. West, B.A., and James P. Cooney, Jr., M.A.g 

Hospitals are a major component of the 

health services industry, one of the largest and 

fastest growing industries in the United States. 

Based on data from the decennial censuses of 

population and from annual statistics published 

by the American Hospital Association, hospital 

personnel account for two-thirds of all workers 

employed in the total health services industry. In 

1966, more than 2 million people were working 

in the Nation’s hospitals (table 17). 

The tremendous increase in hospital personnel over the past two decades may be illustrated with the following statistics from the 

Guide issue of Hospitals, the Journal of the 

American Hospital Association (AHA). In 1947, 

there were 882,600 employees in hospitals registered by the AHA; this represents an average 

work force of 143 per hospital or 63 employees 

per 100 hospital beds. In 1966, employment in 

registered hospitals had increased to the equivalent h of 2,039,300 persons, the average work 

force to 285 per hospital, and theaveragenumber 

of employees to 121 per 100 hospital beds. 

In the 1940’s, hospitals had approximately 

one professional nurse for every 15 beds and 

gMrs. West is Director of the Office of Program Planning 

and Evaluation, Bureau of Health Manpower, Public Health 

Service. Mr. Cooney is Director of the Bureau of Research 

Services, .American Hospital Association. 

h The American Hospital Association reports personnel 

data in full-time equivalents. To calculate this statistic, two 

part-time employees are equated with one full-time employee. 

The resulting figure does not represent, therefore, the actual 

number of both full-time and part-time people employed; it 

represents their equivalent in full-time employees. 

one practical nurse, aide, or attendant for every 

18 beds. Twenty years later there was one professional nurse for every 5 beds and one auxiliary person for every 3 beds. In addition to 

nursing personnel, hospitals have been increasing the number of personnel in other occupational 

categories at a rate that exceeds thegrowthrates 

in both hospital beds and total annual admissions 

to short-term general hospitals. 

Quite obviously this growth pattern is related to the community’s expanding use of a 

greater number of hospital services. Many social, 

economic, and technological factors affect demands for health services. Population growth and 

change in age composition are significant. The 

15 years from 1965 to 1980 are expected to bring 

about a net increase of 50 million in the Nation’s 

population, including 5 million more people over 

65 years of age and 2 million more babies in the 

year 1980. Increased demands for health services 

could result in the employment of 1 million 

more workers in the coming decade. 

Despite the magnitude of the hospital work 

force, surveys have indicated that the present 

number is not adequate to provide optimum care 

to the 171 million annual hospital cases (29 

million inpatient admissions and 142 outpatient 

visits). There is a great deal of talk about health 

manpower shortages-a term that means many 

things to many people. One concept is the difference between the supply and the number needed 

to meet a minimum standard established by a 

profession. Professional groups as well as the 

public speak about urgent needs for more physicians, dentists, nurses, medical record librar49 
ians, medical technologists, occupational therapists, physical therapists, and so on through the 

range of health occupations. 

The hospitals also are showing increasing 

concern about these matters. For quantification 

of this concern, the American Hospital Association and the Public Health Service Bureau of 

Health Manpower in 1966 conducted a joint study 

of staffing and staffing needs of hospitals. At the 

same time, the Division of Nursing of that Bureau undertook a parallel study of nursing homes 

and hospitals not registered by the American 

Hospital Association. 

In these studies, each hospital or institution 

reported by occupation on its present staffing, 

budgeted vacancies, and the estimated additional 

personnel needed on the basis of current services 

and patient load to provide “optimum” care for 

their present load. To provide such care, hospitals reported a need for 257,200 professional 

and technical workers in addition to the 1,332,lOO 

employed. This represents an average increase 

of 19 percent (table 18). In general, the needs 

for professional workers are proportionately 

higher than for technical workers. In the parallel 

study, nursing homes and other extended care 

facilities reported the need to increase their 

present staffing total by about 12 percent (table 

19). In view of the serious shortage of nursing 

home beds, these figures probably understate the 

problem. 

SURVEY FINDINGS 

In the spring of 1966,1.3 million professional 

and technical persons were working in the registered hospitals in the United States, 17 percent 

of them as part-time workers. The universe of 

the hospital study was the 7,000 hospitals registered by the AHA. The returns from 5,300 hospitals have been used to estimate data for that 

total. 

More than 1 million employees were in 

nursing services-three-fourths of the total work 

force. The largest single group was that of 

nursing aides, orderlies, and attendants-492,000. 

Registered nurses made up the next largest 

group-361,000. Licensed practical nurses numbered 150,600. 

Among nonnursing personnel, the largest ‘. 

groups were medical technologists, 54,500, and:. 

radiologic technologists, 24,000. Other categories 

with more than 10,000 workers were surgical’: ,” 

technicians, 17,600; laboratory assistants, 14,600; 

dietitians, 12,700; social workers, 10,700; and’ c 

medical record technicians, 10,100. 

Of the 1.3 million professional and technical 1 

workers in registered hospitals, about 118,000 

were employed in Federal hospitals, 213,000 

in State and local governmental short-term gen- 1. 

era1 and special hospitals, 746,000 in nongovern- ’ 

mental (voluntary and proprietary) short-term !” 

general and special hospitals, 106,000 in long- ” 

term general and special hospitals, and 150,000 L 

in psychiatric hospitals. The ratio of workers 

to every 100 patients varied from 32 in psychiatric hospitals to 173 in nongovernmental shortterm general and special hospitals. 

More than 130,000 budgeted positions for :,.’ 

professional and technical personnel ,in regis- ‘;i 

tered hospitals were vacant in the spring of 1966. 

This represented a vacancy rate of almost ;9 ‘.’ 

percent. The highest number of vacancies was , . 

for registered nurses-46,500. Among nonnursing personnel, the greatest number of 

budgeted vacancies was for ,medical technolo- ‘. 

gists-4,600. 

The hospitals reported a need for 257,200 ‘1 

professional and technical personnel to provide 

optimum care to the present patient load. This ‘. 

number represents a 19-percent increase inpersonnel presently employed. While the 7.9,500 ‘.‘. 

needed registered nurses represented the great- :,:’ 

est numerical shortage, the required proportional 

increase of 22 percent was not the largest in .‘i ,’ 

terms of either nursing service personnel or all “;y 

hospital professional and technical personnel. A .. , 

27-percent increase.in licensed practical nurses ,’ 

represented the greatest proportional need in &I,; 

nursing service, and a 39-percent increase in i$ 

therapeutic service personnel represented the z\ 

greatest proportional need in the hospital. Within “:-

the therapeutic services, hospitals reported a ,‘J,( 

need for 56 percent more occupational therapists, . .$, 

48 percent more social workers, 47 percent more $ 

speech pathologists and audiologists, and 42 per- ‘ii; 

cent more recreation therapists.’ ,Tc2 . .‘A 

>-.. 

50 
In response to the query of its five most 

urgent perceived needs, hospitals gave the first 

three priorities to registered nurses, nursing 

aides, and practical nurses, in that order. The 

relative needs, however, are greatest in the newer 

fields, reflecting the broadening role of the hospital in providing more comprehensive services. 

Need for at least double the present number of 

occupational therapists and social workers was 

perceived. Inhalation therapists, physical therapists, recreation therapists, and speech pathologists are other groups for which relatively large 

increases are urgent. 

With regard to nursing homes, the material 

for these institutions is not yet completely processed. Based on preliminary returns for a 

small sample, the most important characteristic ‘shown by the study is that 2 out of 3 workers 

in these institutions are aides, orderlies, or 

attendants. However, two-thirds of the need is in 

other categories. Following the aide group, numerically the most important needs were for 

licensed practical nurses, registered nurses, 

physical therapists, dietitians, recreation therapists, and occupational therapists, in that order. 

Despite variations in numbers and proportions of personnel needed, the survey data indicate 

an overall insufficiency in professional andtechnical personnel to meet present patient load demands. Future growth appears to hold little promise for narrowing the gap between the need for 

personnel and the personnel available, at least 

under present educational outputs and use of 

personnel. 

DISCUSSION 

The Survey of Manpower Resources measured 

at one point in time the distribution of the hospital work force among about 30 categories of 

hospital employees. At the same point in time, 

data were also obtained on use of selected hospital services. The merging of these data permits description of the availability of personnel 

by skill levels in hospitals classified by control, service, bed size, and geographic location. 

The description that can be accomplished by 

the use of the survey data is recognized to be 

superficial in terms of the knowledge that is 

needed for effective development and utilization 

of personnel. As an example, the survey gives no 

insights into the services provided in relation to 

the clinical characteristics of the hospital or the 

demands for such services not currently being 

met. The survey provides a brief description 

of the number of personnel used and should not 

be confused with a study of the use of hospital 

personnel. 

In addition to counts of presently employed 

personnel, the survey also obtained data on the 

number of vacant but budgeted positions, the 

number of workers required to provide present 

optimum care, and the number required to provide optimum care a year from the date of the 

survey. These data provide some insight into 

shortages, but they must be used with caution. 

The budgeted vacancies may represent desired 

rather than critical personnel. The data responses concerning present and future optimum needs 

are opinion responses. Further, they are opinion 

that was given just prior to the implementation 

of Public Law 89-97 when the demands for hospitalservice created by the law were conjecture, 

rather than fact. There is nothing wrong with 

opinion data as long as they are used as such and 

are not interpreted as factual measurements. 

While there are limitations to the use of the 

survey data, there are descriptive analyses of the 

data that have yet to be done. As examples, the 

use pattern of full-time versus part-time employees has not been fully explored; the need 

for and availability of certifiedversus noncertified 

technicians still must be analyzed. In brief, while 

there are descriptive interpretations of the Manpower Survey that should only be done with extreme caution, there are other quite logical 

descriptive uses of the data that have been untapped to date. 

Interpretations that misuse the data are 

beginning to appear. For example, there have 

been attempts to construct staff ratios. Information on hospital services and on important variables of the individual hospitals (e.g., physical 

plant design) are critical to the construction of 

staffing ratios. Furthermore, such ratios should 

only be used as guidelines for staffing, not as 

mandatory levels. 

51 
Misuse of the manpower data stems, by-inlarge, from viewing the data as an end in itself, The 

survey is only the beginning of our knowledge concerning the use of hospital manpower. This study 

describes the supply; we must now begin research into how to use the supply. This “yet to 

be done” research must: 

(1) Focus on the total institutional use of manpower, Studies limited to manpower in the 

hospital segment block understanding of the 

supplementary relationships that exist among 

the work forces of the various components. 

(2) Use research techniques other than mailed 

questionnaires. This technique is inappropriate to much of the information now needed 

concerning hospital manpower. Future studies 

in the hospital setting should draw upon research tools, such as those developed by 

industrial engineering. 

(3) Develop methods of more intensive studies 

of smaller samples of hospitals, demonstrate the use of techniques appropriate for 

such studies, and educate people as to the 

need for information on manpower functions 

and capabilities. 

In summary, the 1966 survey of hospital 

manpower resources indicated present and future 

shortages of hospital manpower. Our study efforts 

do not stop with the survey; this is only a beginning step. Research efforts must be directed 

toward understanding present patterns of use, the 

design of more effective patterns of use for a 

limited supply of personnel, and the development 

of more effective educational programs. 

52 
--- --- 

Table 17. Personnel employed in the health services industry: 1940-75 

Workers in 

i health services industry

Year 

Total Hospitals Other 

'5,350,ooo 3,375,ooo 1,975,ooo 

l3,672,000 2,363,OOO 1,309,000 

2,642,300 1,726,630 915,730 

1,698,90,3 1,009,000 689,900 

1,059,ooc 

'Estimated by Bureau of Labor Statistics, 

Sources: U.S. Bureau of the Census: Comparative Occupation Statistics for the United States,

1870 to 1940. Washington, U.S. Government Printing Office, 1943. 

Prindle, R.A., and Pennell, M.Y.: Industry and occupation data from 1960 census, by

State. Health Manpower Source Book 17. PHS Pub. No. 263, Section 17. Public Health 

Service, U.S. Department of Health, Education, and Welfare. Washington. U.S. Government Printing Office, 1963. 

U.S. Department of Labor, Bureau of Labor Statistics: Health Manpower 1966-75. A 

Study of Requirements and Supply. Report No. 323, Washington, U. S. Government 

Printing Office, 1967. 

53 
Table 18. Personnel employed in hospitals: 1966 

, Additional 

Category of personnel Present needed to Percent 

staff1 give opti- additional 

mum care 

Total professional and technical------------------------ 1,332,100 257,200 19 

Nursing service: Nurse-R.N-------------------------------------------------- 361,000 79,500 22 Licensed pract-,--l nurse------------------------------------ 150,600 41,400 27 

Surgical technician----------------------------------------- 17,600 3,900 Aide, orderly (except in psychiatric hospitals)------------- 374,400 51,300 ff

Aide, orderly in psychiatric hospitals---------------------- 117,600 18,500 16 

Diagnostic services: Medical technologist---------------------------------------- 54,500 9,200 Laboratory assistant---------------------------------------- 14,600 2,500 

Cytotechnologist-------------------------------------------- 1,600 500 Histologic technician--------------------------------------- 3,900 700 Electrocardiograph technician------------------------------- 5,900 800 

Therapeutic services: 

Occupational therapist-------------------------------------- 4,100 2,300 56 

Occupational therapy assistant------------------------------ 3,800 1,200 32 physical therapist------------------------------------------ 8.500 2.900 34 physical therapy assistant---------------------------------- 5;200 1;100 Social worker----------------------------------------------- 10,700 5,100 Social work assistant--------------------------------------- 1,500 500 Recreation therapist---------------------------------------- 3,800 1,600 Inhalation therapist---------------------------------------- 5,600 2,200 Speech pathologist and audiologist-------------------------- 1,200 500 

Radiology: Radiologic technologist-------------------------------------

X-r-y assistant--------------------------------------------- 24,000 3,900

6,000 900 

Pharmacy: Pharmacist--------------------------------------------------

pharmacy assistant------------------------------------------ 9,400

5,600 

1,900

900 

20 

16 

Medical records: Medic-1 record librarian------------------------------------

Medical r-cord technician----------------------------------- 6,300

10,100 

1,800

1,800 

Dietetics: Dietitian---------------------------------------------------

Food service manager----------------------------------------

12,700

5,400 

28 

15 

All other professional and technical-------------------------- 106,500 16,000 15 

ISurvey week of April 17-23, 1966. Returns from 5,300 hospitals have been used to estimate 

data for the total of 7,000 hospitals. 

Sources: U.S. Department of Health, Education, and Welfare, Bureau of Health Manpower: Health 

Manpower Perspective: 1967. PHS Pub. No. 1667. Public Health Service. WashiU.S. Government Printing Office, 1968. 

Manpower Resources in Hospitals-1966. Chicago, American Hospital Association, 1967. 

54 
Table 19. Personnel employed'in nursing homes: 1966 

Additional 

Category of personnel Present needed to Percent 

staff1 give opti- additional 

mum care 

Total professional and technical--------------------------

Nursing service: 

Nurse-R.N----------------------------------------------------

Licensed practical nurse--------------------------------------

Aide, orderly, attendant--------------------------------------

Therapeutic services: 

Occupational therapist---------------------------------------­

@--upat-onal therapy assistant--------------------.-----------­

physical therapist-------------------------------------------­

physical therapy assistant------------------------.------------

Social worker-------------------------------------.------------

Recreation therapist------------------------------.------------

Speech pathologist and audiologist-----------------------------

Medical records: 

Medical r-cord librarian--------------------------------------

Medical record technician------------------------..------------

Dietetics: 

All other professional and technical-----------------------------

275,000 31,900 12 

31,000 6,000 19 

33,600 9,400 28 

177,400 10,700 6 

1,600 800 50 

1,300 300 23 

2,000 1,200 60 

900 300 33 

1,200 500 42 

2,600 900 35 

300 400 133 

300 100 33 

800 100 12 

4,600 900 20 

17,400 300 2 

'Estimates for all known extended care facilities basedon returns in Public Health Service 

Survey. 

Source: U.S. Department of Health, Education, and Welfare, Bureau of Health Manpower: Health 

Manpower Perspective: 1967. PHS Pub. No. 1667. Public Health Service. Washim 

U.S. Government Printing Office, 1968. 

55 
REFERENCES 

IDivision of Public Health Methods: Health Manpower 

Source Book, Section 17, Industry and Occupation Data From 

the 1960 Census, 6y State, by R. A. Prindle and M. Y. Pennell. PHS Pub. No. 263, sec. 17. Public HealthService. Washington. U.S. Government Printing Office, 1963. 

‘Kissick, W. L.: Forecasting health manpower needs. Hospitals 41:47-51, Sept. 16, 1967. 

3National Center for Health Statistics: Health Resources 

Statistics, 1965. PHS Pub. No. 1509. Public Health Service. 

Washington. U.S. Government Printing Office, 1966. 

4

National Center for Health Statistics: State Licensing of 

Health Occupations. PHS Pub. No, 1758. Washington. U.S. 

Government Printing Office, 1968. 

5Klarman, H. E.: The Economics of Health. New York. 

Columbia University Press, 1965. See also Fein, R.: The 

Docto T 8hoTtage, an Economic Diagnosis. Washington, D.C. 

The Brookings Institution, 1967. 

‘Rayack, E.: Professional Power and American Medicine, 

the rconomics of the American Medical Association. New 

York. The World Fublishing Company, 1967 

7Theodore, C. N., and Sutter, G. E.: A report on the first 

Periodic Survey of Physicians. J.A.M.A. 202(6):516-524, Nov. 

6, 1967. 

‘Bureau of Labor 

Report No. 323. US. 

Government Printing 

56 

Statistics: Health Manpower, 1966-75. 

Department of Labor. Washington. U.S. 

Office, June 1967. 
OUTLINE OF REPORT SERIES FOR VITAL AND HEALTH STATlSTiCS 

Public Health Service Publication No. 1000 

Series 1. Programs and collection procedures .-Reports which describe the general programs of the National 

Center for Health Statistics and its offices and divisions, data collection methods used, definitions, 

and other material necessary for understanding the data. 

Series 2. Data evaluation and methods research. -Studies of new statistical methodology including: experimental tests of new survey methods, studies of vital statistics collection methods, new analytical 

techniques, objective evaluations of reliability of collected data, contributions to statistical theory. 

Series 3. Analytical studies.-Reports presenting analytical or interpretive studies based on vital and health 

statistics, carryingthe analysis further than the expository types of reports in the other series. 

Series 4. Documents and committee reports .-Final reports of major committees concerned with vital and 

health statistics, and documents such as recommendedmodelvital registration laws and revised birth 

and death certificates. 

Series 10. Data from the Health Interview Survey. -Statistics on illness, accidental injuries, disability, use of 

hospital, medical, dental, and other services, and other health-related topics, based on data collected 

in a continuing national household interview survey. 

Series 11. Data from the Health Examination Survey .-Data from direct examination, testing, and measurement of national samples of the population provide the basis for two types of reports: (1) estimates 

of the medically defined prevalence of specific diseases in the United States and the distributions of 

the population with respect to physical, physiological, and psychological characteristics; and (2) 

analysis of relationships among the various measurements without reference to an explicit finite 

universe of persons. 

Series 12. Data from the Institutional Population Surveys .-Statistics relating to the health characteristics of 

persons in institutions, and on medical, nursing, and personal care received, based on national 

samples of establishments providing these services and samples of the residents or patients. 

Series 13. Data from the Hospital Discharge Survey .-Statistics relating to discharged patients in short-stay 

hospitals, based on a sample of patient records in a national sample of hospitals. 

Series 14. Data on heaZth YesouYces: munpowev and facilities.-Statistics on the numbers, geographic distribution, and characteristics of health resources including physicians, dentists, nurses, other health 

manpower occupations, hospitals, nursing homes, and outpatient and other inpatient facilities. 

Series 20. Data on mortality.-Various statistics on mortality other than as included in annual or monthly 

reports- special analyses by cause of death, age, andother demographic variables, also geographic 

and time series analyses. 

Series 21. Data on natality, marriage, anddivorce . -Various statistics onnatality, marriage, and divorce other 

than as included in annual or monthly reports -special analyses by demographk variables, also 

geographic and time series analyses, studies of fertility. 

Series 22. Data from the National Natality and Mortality Suurveys . -Statistics on characteristics of births and 

deaths not available from the vital records, based on sample surveys stemming from these records, 

including such topics as mortality by socioeconomic class, medical experience in the last year of 

life, characteristics of pregnancy, etc. 

For a list of titles of reports published in these series, write to: Office of Information 

National Center for Health Statistics 

U.S. Public Health Service 

Washington, DC. 20201