FHS Jd #57) Health Manpower Chart Book HNN 1) 3 | f110d{o) 11 1D) {r (Uf U LUD PUB HEALTH / LIBRARY J Jur 1957 UNIV. OF CALIF. U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE [Ut S Public Health Service SEO See SE a Ra = Health Manpower Chart Book By George St.J. Perrott and Maryland Y. Pennell 3 b>. U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE Public Health Service Division of Public Health Methods - This report on health manpower was originally prepared for limited distribution at the October 24, 1956, meeting of the National Advisory Health Council. Since then, the book has been revised slightly. It is being printed for general distribution to the schools of the health pro- fessions and to persons interested in the provision of health services to the people of the United States. The objective is to provide a quanti- tative statement, in numerical and graphic terms, of certain character- istics of the health professions, particularly medicine, dentistry, and nursing. The authors wish to thank Elliott H. Pennell of the Division of Dental Resources and Eugene Levine of the Division of Nursing Resources for their assistance in the preparation of the material on dentistry and nursing. Public Health Service Publication No. 511 UNITED STATES GOVERNMENT PRINTING OFFICE . WASHINGTON - 1957 For sale by the Superintendent of Documents, U. S. Government Printing Office, Washington 25, D. C.—Price 25 cents ‘CONTENTS SUMMARY OF HEALTH MANPOWER Page Personnel in health occupations. . .......................... 1 Employment in selected industries. . ...................... ... 2-3 Employment in selected occupations. ........................ 4-5 Age and sex of persons in several health occupations. .......... 6-7 Work time of persons in several health occupations. . ........ .. 8-9 Income of persons in several health occupations. . ........... .. 10-13 Trend in physicians, dentists, and nurses: graduates and practi- RIONERER, wis svrs doors sinha nat ah 0 P00 sR TR ARTIS ERIE ET 14-15 PHYSICIANS Trend in college-age population and medical school enrollment. . 16-17 Applicants and freshmen enrolled in medical schools. . . ........ 18-19 Gains and losses to the medical profession. . ................ .. 20-21 Regional distribution of physicians........................ . .. 22-23 Physician-population ratios in each State. ................ .... 24-25 Changes in physician-population ratios between 1921 and 1955. . 26-27 Urban-rural differences in physician supply. .................. 28-29 Physicians by type of practice. .............................. 30 Increasing full-time medical specialists. . ..................... 31 Changes in full-time medical specialists between 1923 and 1955.. 32-33 Variation in physicians’ incomes... . . . . Bebe nw 3 vale E14 En Hoe tli id 34-35 DENTISTS Gains and losses to the dental profession... ................ .. 36-37 Regional distribution of dentists. ............................ 38-39 Dentist-population ratios in each State... .... .. Ce 40-41 Changes in dentist-population ratios between 1920 and 1950. . .. 42-43 Urban-rural differences in dentist supply. . ................. .. 44-45 Location of dentists in relation to dental school attended. . . .. .. 46 Dentists by type of practice. . . ............................. AT PROFESSIONAL NURSES Trend in student professional nurses. . ..................... .. 48-49 Regional distribution of graduate professional nurses... ..... ... 50-51 Nurse-population ratios in each State. . ................... ... 52-53 Changes in nurse-population ratios between 1920 and 1950...... 54-55 Graduate professional nurses by field of practice. .............. 56-57 iil RA Big [28 clo. x haar go. 1 = al a a a = x ; 3 A - - oo i I y= oa sad Sor i Ber biL 23 wed oni at 4 Pesan Rh Wi: ¥ Fhe lng oo | . EE = : . olf l Ee . 4 ’ fe - | B . = Is r 1 h RV ~ ou | : 0 . A ‘ A i = of i “, | ne a . i ed : Al i gE 3 Bi | » i . AM q : | a & - B } | a oo ll i 1 Bo . A a . I : i ay a= 4 = La hse ae! oN . - n B- " En. = . 8 Er a | ru i Nearly 2 million persons are employed in occupations usually considered in the health field . . . OCCUPATION OF WORKERS IN THE LABOR FORCE, UNITED STATES Number employed, 1950 Number Number employed, 1950 Number tia AS employed | employed Selected occupations in health Selected occupations in health All Health occupations All Health occupations industries service 1955 industries service 1955 industries industries Total, «vs xmwvssmss 56, 225, 340|1, 629, 134(1, 951, 000 Medical laboratory tech- = CHAN ; sores macs me tan)osommonswaysumess aes 50, 000 Professional, technical, Dental technicians... ....|..........|......... 21, 000 and kindred workers. | 4,909, 241] 851, 578(1, 261, 000 Dental hygienists. .......|..........[......... 5, 000 X-ray technicians. .......|..........[......... 50, 000 Accountants and auditors. . . 376, 459 2,644]... ...... Technicians, testing... ..... 75, 507] 939. ........ Chemists, including bio- Technicians (n. e.c.)....... 26, 882 500). ...invns chemists. ............... 74, 433 2,021 3,000 || Therapists and healers Chiropractors. ............ 12,903 12, 162 25, 000 C0 0) vv 6 rod sn i 2 E00 24, 424 16, 121)... nvis Clergymen................ 167, 471 17200. vice sv Chiropodists. ...........[.........|......... 7, 000 College professors and in- Occupational therapists. .[.........[......... 6,000 SIPNCHOTS. voi sw wvv ss wivvs 124, 686| BOLL. :covinnn Physical therapists. . ....|..ccoicinenmninnn, 7, 000 Dentists. .l: sou svnpramess 74, 855 72,663( ! 98,000 Speech and hearing ther- Dietitians and nutritionists. 22,400 14, 090 22,000 APISLS . sn vssamesomesr mdse merremersmnrane; 4, 000 Draftsmen................ 121, 668 S518|......... Veterinarians. ............. 13, 379 431 17, 000 Engineers, technical... .... 525,256 2,591). ........ All other professional, tech- . Civil engineers, including nical, and kindred sanitary engineers. . . .. 123,318) ss orev one 5, 000 workers. ............. 607, 486) 6,511|......... Lawyers and judges........ 180, 461 678]. .:5 5:00 Health program special- Librarians. .s..osspocsemins 55, 330 3.6320:..0.0004 1918. . . cv ovsnmusnvnssalessmmeremados sms ines 3, 000 Medical record librarians. |. .........|......... 7, 000 Rehabilitation counselors. |. .........|[......... 2,000 Musicians and music teach- CES. 5 00: A i 9 8 ors 0 esp 153, 456 935)......... All other workers. ...[51,316,099( 777,556] 690,000 Natural scientists (n. e. c.). 40, 068 2,989. ........ Biological scientists. . . . .. 9,082; 005 0 | Attendants, physician’s and Physicists, including bio- 4, 000 dentist’s office... ...... 40, 811 39,263]......... physicists... .......... (7,409). ........ Assistants in physician’s Nurses, professional... ..... 398,534] 355,216] 430,000 Office. ..0.00nmssnunssofsnrmusnemllosws eeu 75, 000 Nurses, student professional . 76, 146 74, 766] 2 113, 000 Assistants in dentist’s Optometrists. . ............ 14, 596 6,688 17, 000 office.............. | ooo 55, 000 Osteopathic physicians. . . .. 5,149 4, 826 12,000 || Attendants, hospital and Personnel and labor rela- institution. . . ......... 204,378] 190,267|......... tions workers. ........... 52,086 O20. «0005 00 4 Hosplial attendants... .oj.oanresnv formes sw. 146, 000 Pharmacists. .............. 88,116 3,510] 111,000 Hospital orderlies. . x coo cfs ss vuissme somos snes 25,000 Photographers. ............ 52, 489 B33. hes ois Nursing aides. cco. funds vine some ams mms 138, 000 Physicians and surgeons. . . . 191,947 181,699]! 225, 000 Ward malls. ....... os von vsam]v os monn o]s mesos ams 28, 000 Psychologists, including Managers, officials, and pro- clinmfeal }. ovo ss nvivammins 4, 796 1,331 4, 000 prietors. .............. 5,017, 465 81.644). ..... 00>. Recreation and group work- Health department sani- CEB, ois As nisi ds 8 SoH BEE WETS 4 16, 046) OIBY. ooo 5 vs tarians and sanitation Religious workers. ......... 41, 431 L725]. sams personnel. .ouismmpsnnisrames rpm more wes 8, 000 Social and welfare workers, Hospital and medical except group. ......... 75,487 5,597)......... program directors. . .. |... |. oo. 9, 000 Health education workers. |. .........|......... 1, 000 Midwives... .............. 1,677 1, 343 15, 000 Medical social workers. . .|..........|....... .. 5,000 || Opticians, lens grinders, Psychiatric social workers. |. .........[......... 5, 000 and polishers... ........ 19, 161 950 1, 000 Statisticians and actuaries. . 18, 366) 582 2, 000 Practical nurses. . . ........ 135, 902 54,270 175, 000 Teachers (n.e.c.)......... 1, 120, 605 2.4070. .....s ue. All other occupations. ...... 45,896, 705 459,819|......... Technicians, medical and Medical record personnel dental. ............... 76, 323 69,208. ........ other than librarians. . .|..........[......... 15, 000 1Total number, including 1955 graduates and those retired and not in practice. 2 Approximately 76,000 undergraduates enrolled in schools for other health professions. Source: 1950 Census of Population, vol. II, Part I, table 124; PHS Pub. No. 263, section 5, table 1; 1955 estimates by Division of Public Health Methods. The 1950 Census of Population reports a total of 56 million employed persons, of whom 1.6 million were in health services . . . Nearly 3 percent of the total number of persons employed in the con- tinental United States in 1950 were in the census classification of medical and other health services, including hospitals. In terms of number of workers, health services ranked seventh among the 77 categories in the intermediate industry classification list. PERSONS EMPLOYED IN SELECTED INDUSTRIES, 1950 AND 1940 Industry 1950 1940 Change All industries. ......... 56,225,340 | 44, 888,083 | + 11,337,257 AgrioulIre, sive rrr vrs mnssnmss mun suman nm 6,875, 801 8, 391, 022 —1, 515,221 CONBITMCHION: 20 cuss omar Gast y ERS SERRE RASS #50 3, 440, 690 2,075,274 +1, 365,416 Wholesale trade. . . ........... .... .............. 1,980, 244 1,204, 761 +775, 483 Food and dairy products stores, and milk retailing. . 1,719, 403 1,489, 303 +230, 100 Eating and drinking places. ................ .... .. 1,686, 108 1, 114, 002 +572, 106 Private households... ............... .. .......... 1,631, 694 2.326, 879 — 695, 185 Medical and other health services, including hospi- BABE. orn hm Bia EAR ARIE ERAN EEE EE 1,629, 134 1,022, 815 +606, 319 Source: 1950 Census of Population, vol. 11, Part 1, table 131. In addition to the 1.6 million persons in the health services, about 317,000 persons in occupations usually considered in the health field were em- ployed in industries other than health services. For example, health services claimed only 4 percent of the pharmacists and 3 percent of the veterinarians. Persons in such other industries as manufacture, wholesale trade, and retail trade of drugs, health appliances, etc., bring the total number in health services and related industries to considerably over 2 million persons. Between 1940 and 1950 the health service industries showed a gain of 600,000 workers . . . The number of persons employed in health services increased by 59 per- cent during the decade between the 1940 and 1950 censuses, due in large part to gains among professional nurses, medical and dental technicians, and hospital attendants. During this same period the number of em- ployees in all industries gained by 25 percent. Among the seven top ranking industries, two—construction and whole- sale trade—showed slightly larger percent increases than did health services. Two had sizable percent decreases. EMPLOYMENT CHANGES IN SELECTED INDUSTRIES Industry Employees, 1950 1940-50 Change Agriculture 6,876,000 -18% Construction 3,441,000 |+e6% Wholesale Trade 1,980,000 |+ea% Food and Dairy Products Store ERY en Eating and Drinking Places +51% 1,686,000 Private Households ICEY Rll 209, Health Services Nee RYE Recent censuses show a relatively greater increase in employment in professional nursing than in medicine... in medicine than in dentistry... Between 1940 and 1950 the number of employed professional nurses (graduate and student) increased 35 percent; the number of employed physicians, 16 percent; and the number of employed dentists, 7 percent. In comparison with a few other professional and technical occupations only dentists and lawyers did not show a net gain as great as the 15-per- cent increase for the total population INCREASE IN EMPLOYMENT IN SELECTED OCCUPATIONS Occupation Employees, cover. ED a ZR \ and Auditors ne Chemists 38% Professional Naar 475,000 359, Architects 25,000 249 Physicians 192,000 i Dentists 7% one, EXER Population 15% Physicians’ services are increasingly augmented by services of LT health personnel . . . Between 1900 and 1950 the number of college educated or professionally trained health personnel increased from about 206,000 to 969,000. The greatest gains were in the professions other than medicine and dentistry. In 1900, 3 out of 5 professional health workers were physicians; in 1950, 1 out of 5. Physicians have not increased at the same rate as total population (99 percent) or the labor force (103 percent). Health professions 1900 1950 Percent increase TRORAL. 5 1 5 2m mauve me Fuainn whiny 1.206, 000 1.969, 000 370 Physicians. ... crus rvscaomecmsnerminss 121, 500 192, 317 58 Dentists. . oo ooo 29, 368 75, 241 156 Professional nurses. . . . ................ 11, 804 480, 464 3,970 Pharmacists and others. . .. .......... .. 143, 328 1220,978 410 I Estimates by Dr. Wolfle in America’s Resources of Specialized Talent. Other numbers are from the censuses. GROWTH OF SELECTED HEALTH PROFESSIONS Persons (Thousands) 1,000 800. —— 600 400 200 : Dentistry Medicine 420535 O—5H7——2 Women are predominant in several of the health occupations . . . Among those employed as professional nurses (excluding students), practical nurses and midwives, office attendants, and dietitians and nu- tritionists, more than 9 out of 10 are women. The proportion of women is least among dentists, optometrists, veterinarians, and physicians. WOMEN EMPLOYED IN HEALTH OCCUPATIONS 0 +i Percent Female of Total Employees, 1950 ccupation 0 20 40 60 80 100 : | Nurses, Professional mame III I I I ITI TTT | | | Office Attendants AAAAANMHHIIIMMMMMIMMNTTMMMNNNN Breer? EEE YY a. Medica and Deno i prepottic III | Chiropractors ANN Opticians ANN Pharmacists NN Physicians NY Veterinarians NN Optometrists NN Dentists AN 6 The health occupations where women are predominant tend to be those - with relatively more young employees . . . Among the health employees for whom data on age and sex are available from the 1950 Census of Population, those in occupations with the largest proportion of females usually show the lowest median ages. These occupations include dietitians and nutritionists, professional nurses, medical and dental technicians, hospital attendants, and office attendants. On the other hand, practical nurses and midwives, of whom 96 percent are female, have the highest median age of all. AGE AND SEX OF PERSONS EMPLOYED IN 15 HEALTH OCCUPATIONS Median | Percent | Percent 2 Total Percent Health occupation age under | 65 years number female (years) | 35 years | or over Professional and technical: Chiropractors. ..cc sume «nso mmo vam ns sa 12,903 14 47.3 24 12 Clinical psychologists. ................. 4,796 44 34.6 52 2 Dentists. . ..omii7a 958 0m 5s wwe ww sss we 74, 855 3. 46.6 22 10 Dietitians and nutritionists. . ........... 22, 400 94 38.8 42 4 Nurses, professional . . ................. 398, 534 98 135.6 49 3 OPROMBIAIBES.. « «+ «oo v 0 ws oe min 1 0 vm 0 im 0 14, 596 6 40. 8 38 10 Osteopathic physicians. ................ 5, 149 15 46. 8 7 15 PharmaciSis. «vo «ows us 55s «mss aww sx womow » 88,116 8 45.0 22 8 Physicians. ...coeovessmesnmnr ness ons 191, 947 6 42.8 28 11 Technicians, medical and dental... ..... 76, 323 57 31.0 64 1 Veterinarians. . ..........oeennnneonn.. 13,379 6 41.8 36 12 Clerical, craft, and service: Hospital attendants. . ................. 204,378 59 31.5 45 4 OMce attendants... so wu ss wn ses mazanvan 40, 811 95 29.7 64 1 OPHCIING, . ons svn de pa EE BER SPEER S35 19, 161 13 34.7 51 3 Practical nurses and midwives. . ........ 137,579 96 49.0 22 11 1 Data for females only. Sourck: 1950 Census of Population and PHS Pub. No. 263, section 5. Predominantly female health occupations show a low percentage who work a full year . . . Only 55 percent of the professional nurses (excluding students) worked 50 to 52 weeks during 1949 as compared with 86 percent of the pharmacists. LENGTH OF WORK YEAR IN HEALTH OCCUPATIONS 0 MORE THAN HALF ARE WOMEN Nurses, Professional Practical Nurses B and Midwives Dietitians and Nutritionists Hospital Attendants Technicians, Medical and Dental LESS THAN 10% ARE WOMEN | Pharmacists oo Veterinarians ~~~ Optom etrists fms, sn AS oh vs 2 v2 Dentists «= = - ==» = sos vise sews a 0 Pharmacists lead the health occupations in long working hours . . . Among the self-employed workers, relatively more of the pharmacists, physicians, and veterinarians than of those in other health occupations report that they worked 49 or more hours during the census week. In these three occupations 3 out of 4 persons said that they were employed for that length of time. As compared with the self-employed, the salaried workers show shorter work hours. WORK TIME OF PERSONS EMPLOYED IN 15 HEALTH OCCUPATIONS Percent who worked 49 or more hours during the census week Percent who Health occupation worked 50 to 52 weeks Total Sens Salaried | in 1949 employed Professional and technical: Chiropractors. ..............cornrranessons 34 35 30 75 Clinical psychologists. . .................... 13 30 12 62 IDCITLABEB. «5c 5 5 wieiw s 3 own in vk mw 3 cw cm 29 31 19 176° Dietitians and nutritionists. . ............... 14 2) 14 64 Nurses, professional. ....................... 14 ®) 13 25% Optometrists. . .......ovnuinir eee 23 26 16 80 Osteopathic physicians... .................. 57 60 45 74 Pharmacists. ..... coven 59 82 42 186 Physicians. .......ovuvsnnceivvranmesanmnns 70 76 58 183 Technicians, medical and dental. ............ 9 30 7 368 Veterinardans. .....s ws rian eiznss pwassvms ss 60 5 33 80 Clerical, craft, and service: Hospital attendants. ....................... 10 ® 10 65 Office attendants. . .............oounenennn. 6 ¢ 6 *) OPpHCIans. . ooo cvvnrsivmrssnesenvinnnsesms 7 29 4 82 Practical nurses and midwives. .............. 31 47 30 342 1 Data for males only. 2 Data not shown where 5 percent or less are self-employed. 3 Data for females only. 4 Data not available. Source: 1950 Census of Population and PHS Pub. No. 263, section 5. Annual incomes in the female health occupations rank low . . . The health occupations where more than half of the persons employed are female have markedly lower median incomes than those with fewer women. MEDIAN INCOME IN 1949 IN HEALTH OCCUPATIONS 0 MORE THAN HALF ARE WOMEN Nurses, Professional Practical Nurses and Midwives Office Attendants Dietitions and ~~ Nutritionists Hospital Attendants Technicians, Medical and Dental LESS THAN [0% ARE WOMEN Pharmacists Ss 5 8 Physicians oo Veterinarians Optometrists soe wn wn Dentists I | N= 0 | 10 Physicians and dentists report the highest average salaries . . . Median incomes are higher for those health occupations where a large proportion of the individuals are self-employed rather than salaried. In addition to this factor, data on income reflect the distribution of individ- uals at different salary levels corresponding to their various positions, the amount of time they work, and income from sources other than gainful employment. INCOME IN 1949 OF PERSONS EMPLOYED IN 15 HEALTH OCCUPATIONS Percent with income— Percent Health occupation self- Medion employed | ""°™¢ | Under | $7,000 $2,000 or more Professional and technical: CHICOPTACUOTE. 15500 v5 5 wn wr sx 2 mown ecmim am 86 $3,193 30 12 Clinical psychologists... ................. 10 3,572 23 13 Dentists. ... conse vss inmisa@dismosisassnm 87 16,232 6 45 Dietitians and nutritionists. . ............. 1 1,990 52 (2) Nurses, professional... ................... 4 $92.127 44 ®) OPEOMEIIBIS.. . . «ov = mmm on sr seen = sion is 75 4,191 21 20 Osteopathic physicians. .................. 84 5,408 15 36 Pharmacist. vos somes amps snes omnes ws 45 14,246 10 15 Physicians... ....c co consismsis saa mas aanms 65 7,724 13 53 Technicians, medical and dental. .......... 7 2,437 35 2 Veterinarians. ..........oovuuuueane enn 63 4,310 18 20 Clerical, craft, and service: Hospital attendants. ........oooovnnnnnnn. 1 1, 590 65 =) Office attendants. .. visu ramesssms es ws 5 1, 565 70 1 Opticians. . ............c.ovvinnniienn. 11 3,029 19 4 Practical nurses and midwives. ............ 8 31,056 84 ®) ! Data for males only. 2 Less than 0.5 percent. 3 Data for females only. Source: 1950 Census of Population and PHS Pub. No. 263, section 5. 11 Within the same health occupations, women have lower average incomes than men . . . For a few health occupations where both men and women are sufficient in number for the computation of their median incomes in 1949, the average for women is only two-thirds to three-fourths that of men. For physicians the differential is considerably greater. MEDIAN INCOME IN 1949 OF MEN AND WOMEN IN 5 HEALTH OCCUPATIONS ( Thousands of Dollars) 0 2 4 6 8 10 NY Women Attenda NY |] Men MEDIAN INCOME IN 1949 OF MEN AND WOMEN IN 5 HEALTH OCCUPATIONS Percent Women’s Men’s women ® Occupation : : income income income of men’s income Physicians... ............... $3,475 $8,115 43 Technicians, medical and dental. . . ........ .... .. .. .. .. .. 2,122 2.915 73 Dietitians and nutritionists. . . ........................... 1,951 2. 562 76 Officeattendants. ....................ccooviiuiininiiin. 1, 545 2.230 69 Hospital attendants. ................................... 1, 320 2,029 65 Sourck: 1950 Census of Population and PHS Pub. No. 263, section 5. 12 Between 1940 and 1951 physicians’ mean net income tripled . . . In this 11-year period nonsalaried physicians showed a considerably greater gain in net income than did dentists and lawyers. Percent Occupation 1940 1951 increase Nonsalaried physicians. .................... $4,441 $13,432 202 Nonsalaried dentists. . . .................... 3, 314 7, 820 136 Nonsalaried lawyers. . ..................... 4, 507 8,730 94 INCREASE IN MEAN NET INCOME IN 3 OCCUPATIONS ( Thousands of Dollars) o 3 6 9 12 15 . i 1940 Gain by 195I ——— In 1951 physicians’ net income greatly exceeded that of dentists and lawyers and was more than three and one-half times the income of those in all occupations or business. In the period from 1936 to 1951 the percentage increase in mean net in- come of physicians, although greater than that of dentists and lawyers, was still less than that of all earners as a group. Percent Occupation 1936 1951 increase All physicians. co srrvn cme vv smn nine amen $4,365 $12,518 187 All dentists. . . oo 2,769 7, 743 180 AN JAWYOIR. vv vinnsmn smriss mame sma on 4,411 9,375 113 ATI QATIIOTS. «con cnx n wmeonin vmninin tins uc BIEE 18 1, 141 3,384 197 Source: U. S. Department of Commerce, Office of Business Economics. Mail questionnaire surveys. (See summary in Building America’s Health, vol. 4, p. 251.) 13 420535 O—H7T——3 The ratio of nurses to population has shown an upward trend, in contrast to physicians and dentists . . . The ratio of physicians to population has declined from 158 per 100,000 population in 1900 to a rate of 126 in 1930; since 1940 the rate has been between 133 and 135. The total of 6,935 graduates of medical schools in the continental United States in 1955 is the largest number to date, except in 1944 when two classes were graduated. The census findings on dentists in the labor force show a slight decline from the 1930 high of 58 per 100,000 population. Recent directories give a constant ratio of 59 total dentists per 100,000. The present rate of graduating 3,000 or so per year has been exceeded three different periods during the past 40 years. Active graduate professional nurses number about 430,000 (exclusive of 113,000 students in State accredited schools in the fall of 1955). Between 1920 and 1940 the ratio to population was doubled. The annual number of graduates rose steadily until the midthirties, followed by a decline and a rise to a peak of 41,000 graduates in 1947. In recent years the number has been about 29,000. TREND IN PHYSICIANS, DENTISTS, AND NURSES Profession 1910 1920 1930 1940 1950 1955 Physicians, number !. . | 135,000 | 146,200 | 154,500 | 175,163 | 204, 400 218, 061 Per 100,000 population. . . . . .. 146 137 126 133 135 133 Medical schools: Number. ............... .. 131 88 76 77 79 80 Graduates... ........... .. 4, 440 3,047 4, 565 5,097 5,553 6,935 Dentists, number 2... .... . | 39,997 56, 152 71,055 69, 921 89, 441 97, 529 Per 100,000 population... . ... 43 53 58 53 59 59 Dental schools: Number. c:i:vvvemmsenmne 54 46 38 39 41 43 Graduates. . ............ .. 1, 646 906 1,561 1, 757 2,565 3,081 Nurses, number3. ....... | 50,500 | 103,900 | 214,300 | 284,200 | 375,000 | 430, 000 Per 100,000 population. . .. . .. 55 98 175 216 249 258 Nursing schools: Number. ; wwe: smmas ine. an 1, 105 1,755 1, 885 1.311 1, 190 1,126 Graduates. . .......... .. .. 7,622 14, 980 23,810 23, 600 25, 790 28,513 ! Data from the American Medical Directories, interpolated for the years 1920, 1930, and 1950. Includes retired physicians; excludes graduates of the years concerned. 2 The 1910-40 data are from the decennial censuses; the 1950 census shows 74,855 employed civilian dentists, or 50 per 100,000 population. The 1950-55 data are from the American Dental Directories; they include retired dentists and graduates of the years concerned. 3 Active graduate nurses, exclusive of students; estimated from the 1910-50 decennial censuses. The latest figure shown is as of 1/1/56, published in the 1956-1957 edition of Facts About Nursing. 14 Thousand of Groduates Per Year 40 20 Rate 250 200 150 100 TREND IN PHYSICIANS, DENTISTS, AND NURSES GRADUATES Per 100,000 Population 1930 1940 50 - PRACTITIONERS _ ~~ rd A 7 —_ ZT 1 | ee 7 2 7 ~~ 7 — | m— 1910 1920 Ek} 1940 1950 THM Dentists Nurses Physicians DET 15 In 1955, medical school enrollment was at its highest level, although the number of college-age persons was fewer than in 1930 . . . In mid-1955 there were 15.1 million persons 18 to 24 years of age in the continental United States, the lowest point in 25 years. The college-age population is now made up entirely of persons born during the low birth- rate years of the depression. In contrast, enrollment in institutions of higher education has risen steadily. In 1920 nearly 5 percent of the college-age population were college students; in 1930, 7 percent; and in 1955, 18 percent. The number of undergraduate students enrolled in U. S. medical schools is the highest in our history. Between 1930 and 1955 medical school enrollment increased from about 22,000 to nearly 28,600. However, over the years a decreasing proportion of college students has entered the field of medicine. In 1920, 1 in 42 of all college students was enrolled in medical schools in this country; in 1930, 1 in 50; in 1955, 1 in 96. TREND IN COLLEGE-AGE POPULATION AND IN COLLEGE ENROLLMENT, UNITED STATES Total college Medical school enrollment enrollment Population Year 18 to 24 years old Percent of Percent of Number college-age Number total college population enrollment O20. ivvnvssnmesamanns 12, 989, 000 598, 000 4.6 14, 242 2.4 1930. crmensnmensnmate 15, 482, 000 1,101, 000 7.1 21, 964 2.0 1940. .................. 16, 607, 000 1,494, 000 9.0 23,255 1.6 BO30....00: «i i sis we smimninin 16,014,000 | 2,659, 000 16. 6 27,005 1.0 1955... 15, 106,000 | 2,755, 000 18.2 28, 564 1.0 1960... ...ovinininsspis 16,237,000 | 3,778,000 23.3 30, 000 «8 V963. 0550 53 ws 5 sma 20,043,000 | 4,860,000 24.2 30, 500 0 JOO, oe ss om ssnm usa monde 24,694,000 | 6,443, 000 26. 1 @ @ tens Bits wi cs ee et» ZO B00, 000 [I iui ec cons to sive onsen wis sn finin is sent 3 ins elf 3. rs in Source: U. S. Bureau of Census figures on college-age population: Current Population Reports, Series P-25, Nos. 98, 114, 132, and 146. U. S. Office of Education. Biennial Survey of Education in the United States, 1952-54. Chapter 4, section 1, p. 7. With projections (dated June 1, 1956). Medical school enrollment figures prior to 1955 are those used in deriving total college enrollments. The 1955 figure is from the J. A. M. A. Education Number, Aug. 25, 1956, p- 1652; 1960 and 1965 projections are based on information on p. 1643 of that issue. 16 : 1965 persons of college age will number 33% more than in 1955... College students may increase by 76%; medical students, by 7%... For every three persons of college age in 1955, there will be one additional person by 1965, two additional persons by 1970, and three additional persons by 1973. Medical students now number 1 in 529 persons of college age. By 1965 college-age youths enrolled in medical schools will number about 1 in 657, under the present plans for medical school development in this country. What proportion of the youths of 1970 and 1973—those born during the past few years—will attend the medical schools in this country? TREND IN HIGHER EDUCATION Percent Increase Since 1920 1,000 ! / / / / / / / 800 / / / / / / / / 600 pea— / J / / / / / / 400 / College Enroliments J \\ / v4 / 4 200 Sf _-=" Medical Students - | ——— — asl A= — Pe ii Population age 8-245 1920 1930 LLY) 1950 '55 1960 65 1970 17 In the academic year 1955-56 there were fewer than 2 medical school’ applicants per freshman enrolled . . . 5 In 1948-49 the number of applicants to medical schools in the United States was more than three and one-half times the number of freshmen enrolled. Since then the ratio of applicants to freshmen has been steadily decreas- ing. By 1953-51 the ratio was 2 applicants to each freshman place, the same as in 1939-10 and 1934-35. RATIO OF MEDICAL SCHOOL APPLICANTS TO FRESHMEN ENROLLED Ratio 4.0 3.0 2.0 0.5 1934-35 1936-37 1939-40 19 1947-48 1955-56 Academic Years 18 The number of freshmen enrolled in approved medical schools has been increasing steadily . . . The number of freshmen enrolled in medical schools in the United States has increased steadily, to a peak of more than 7,700 in 1955-56. The largest number of applicants occurred during the academic years 1948-49 and 1949-50, when more than 24,000 persons applied each year for the 7,000 or so freshman places in medical schools. These peak years reflect the postponement of educational opportunities during the World War II. The number of applicants in 1955-56, totaling 14,937, is about at the level of the early 1940’s. NUMBER OF APPLICANTS AND FRESHMEN ENROLLED IN U. S. MEDICAL SCHOOLS Academic year Applicants Freshmen pa 1934-85.L .crsamuntnnurs ones Hav Maes oa tan eden 12,779 6,356 2.0 VOBOB rr vi vr wows Hone 6 REE EE AMER ERI D8 BE 0 4B 12,192 5,910 2.1 L150 || SHEEP pp pp 11, 800 5,794 2.0 WORD BBL cn re 050 0 ns 8 a noni 38 ron Stl wo ed 14, 043 6,425 2.2 AOBTAD cin» cr ww 30 250m 5 009 rn i + 0 0 18, 829 6,487 2.9 AGAR vn mag aims vue 4 ows en wn ow 0 i 24, 242 6,688 3.6 VOND-B0 Linus mca nim as FES FEBS 8 MPU E E07 03 3 om we vw 24,434 7,042 3.5 1950-Bh cree vom oi i BABS RRB RE RAE RR 6d EE 52 TW 22,279 7.177 3.1 BOBBLE os 6 GS BRE 19, 920 7,436 2.7 1952-53. ot 16, 763 7,425 2.3 ROBT rr» or oe vm 23 os a 5 so es oe soon he 14, 678 7, 449 2.0 LL TTT 14, 538 7,576 1.9 YO3B-86.)...c: ssmazsam saan sa iH aS WOE MO EE RPR EE HWS 14,937 7,742 1.9 Source: J. A. M. A. Education Number (annual); Stalnaker, John M. Study of Applicants . . . (annual through 1954-55). J. Med. Educ.; and Gee, Helen H. The Study of Applicants, 1955-56. J. Med. Educ. A report on applicants for the study of medicine in the academic year 1955-56 shows a slightly higher number than in the two past years. The number of applicants per freshman enrolled is 1.9, the same ratio as in 1954-55. Apparently the downward trend during the past six years has reached a plateau. 19 The number of newly licensed physicians has exceeded ERT RTT from 1953 on. . . The majority of physicians who obtain their first licenses to practice in the United States are recent graduates of approved medical schools in this country. The others—fewer than 1,000 annually—are licensed after training in Canadian or other foreign schools. GAINS AND LOSSES TO THE MEDICAL PROFESSION (Annual Average Number — Thousands ) WL UAT WIIG The net gain to the medical profession was about 3,700 in 1955. Deaths among physicians were approximately 4,000 . .. Less than half the annual number of newly licensed physicians repre- sents a net gain in the total number of physicians, when account is taken of deaths that reduce the ranks of the profession. GAINS AND LOSSES TO THE MEDICAL PROFESSION IN THE UNITED STATES AND ITS DEPENDENCIES Average annual numbers for period Item 1935-39 | 1940-49 | 1950-54 1955 Licentiates representing additions to the pro- fESSION . Lo. ovine 6, 100 6, 300 6,900 7,700 United States and Canadian schools. . . . . .. 5,200 5, 900 6, 300 6, 800 Foreign schools. . ....................... 900 400 600 900 Deaths among those in the profession. ......... 3,500 3,500 3,900 4, 000 NEUGAL. .. ssuursmpremwessmmcsmncsomsnsmmes 2, 600 2, 800 3,000 3,700 Source: J. A. M. A. State Board Number (annual). Between 1949 and 1955 the total population of the United States and its dependencies increased 10.4 percent; the number of physicians, 8.5 percent. Therefore the ratios declined from 133.7 to 131.4 physicians per 100,000 population. Had the 1949 ratio been maintained during 1950-54, an average annual net gain of nearly 3,400 physicians would have been required, instead of the 3,000 that occurred. By 1960 the total number of physicians will have increased to approxi- mately 237,000. Based on an estimated population of 182,500,000 persons, the 1960 ratio will be 129.9 physicians per 100,000 population. To maintain the 1955 rate of 131.4 physicians per 100,000 population requires an average annual net gain of 4,000 physicians. 420030 O—H7——+ In 1955, the United States had 133 physicians per 100,000 population, with the highest ratio in the Northeast and the lowest in the South . . . Wide regional variations continue in the supply of physicians in relation to population. The Northeast (New England and Middle Atlantic States) averaged 160 physicians per 100,000 population, while the South (South Atlantic, East South Central, and West South Central States) had a ratio of only 103. The Northeast and West regions have been consistently above the United States average. Ratios in the West and the South increased slightly between 1949 and 1955. TREND IN REGIONAL DISTRIBUTION OF PHYSICIANS Rate Per 100,000 Population 200 Northeast 150 West United States LLTa1 WNT] SIE 100 90 80 70 22 For the United States as a Wr. the physician-population ratio was lowest in 1929 and highest in 1949 . . . The American Medical Association publishes directories giving the location of physicians. These directories appeared at 2- or 3-year intervals from 1906 to 1942, with a lapse thereafter until 1950 and 1956. The latest published figure of the total number of physicians in the United States is 218,061 as of mid-1955, excluding the graduates of that year. This gives a rate of 133 physicians per 100,000 population. PHYSICIAN-POPULATION RATIOS BY REGION: 1921-55 Number of Physicians per 100,000 population As of July 1! Physicians in United . States United Northeast North South West States Central £1.11 Ep 145, 404 134 138 138 21 152 1923... 145, 966 130 135 134 116 150 TO25 .% io wives = 5 sovotin » 5spu 147,010 127 134 130 111 147 Y927 .% sivvosswnssses 149, 521 126 137 128 107 144 JO29 Li .umvssnnmssamy 152, 503 125 138 127 106 144 T9301 5 oinen in nmns nes 156, 406 126 141 128 104. 147 1934... ............ 161, 359 128 149 128 102 147 1936. ............... 165, 163 129 154 129 101 147 1938. ............... 169, 628 131 160 130 101 146 1940, . 5 ovis miss vans 175, 163 133 167 130 101 147 1942.5 oe ssmunsames 180, 496 135 172 132 105 138 1949. ............... 201,277 135 168 124 99 141 1955... lL 218, 061 133 160 117 103 142 1 Excludes the graduates of that year. Source: PHS Pub. No. 263, section 1, tables 1 and 2; and the American Medical Directory, 1956. 23 New York has the highest ratio of physicians to population; Mississippi has the lowest New York and Massachusetts rank highest among States in the ratio of physicians to population in 1955, with 193 and 174 physicians per 100,000 population, respectively. PHYSICIAN—POPULATION RATIOS IN EACH STATE Physicians per 100,000 population, 1955 0 I. 100 150 200 250 300 District of Columbia AMATI TTT a. I EY New York ETE SI SS Coa Massachusetts AON wr, CL SUNNY Connecticut AMMMIIIININ i ——= Ly California AAMT as SS RE Colorado —— a SSN Vermont ETS a TE Maryland SAN Lo ST = Minnesota yn ITT Si New Hampshire INNS Ly Loc Log linois i TE = Pennsylvania DD SOMA —. SOMMMIINNY TRY, Delaware IS a = IE SM Uth SAN Se == IETS TY; Florida IIHT So == SI S| Oregon Sn, Sn | Washington TTI New Jersey AWN LL ATT ! Rhode Island AMIE Li | Ohio TIES — ESS 5 : Missouri EEE EEE... Nebraska SS = ! Louisiana III TH TNT Michigan TITIES sass i Kansas AIH 55 ! Maine TTT ni La | Wisconsin Sm ’ lowa NAW > Nn TIT ! Arizona AMMEN | Oklahoma DAN Se SS _ ' Tennessee NY I Indiana ETT mo Texas MHI | Virginia wa MEME | Nevada NS TTT : Montana INN _- —_— | Georgia TIS Lo re og Idaho NAN TIS SY | Akonsas SN TTT TE i North Carolina EES — | Kentucky IIS SI ! Wyoming TET ' West Virginia EY ! New Mexico TTT RNy | South Dokoto ITTY i North Dakota TET ’ Alabama TTI RR a | South Carolina RAN a SSN Mississipi EE “Uaeas | | | States Only 10 States and the District of Columbia have higher physician- population ratios than the average for the United States as a whole . . . The States with physician-population ratios above the national average of 133 physicians per 100,000 population are: California, Colorado, Con- necticut, Illinois, Maryland, Massachusetts, Minnesota, New Hampshire, New York, and Vermont. The District of Columbia, with a rate of 291 physicians per 100,000 population, has a relatively larger supply of physicians than any State. However, the physicians located there also serve the population in nearby Maryland and Virginia. TOTAL NUMBER OF PHYSICIANS AND PHYSICIAN-POPULATION RATIOS FOR EACH REGION AND STATE: 1955 Number | Rate per Number | Rate per Region and State of phy- 100,000 Region and State of phy- 100,000 sicians population sicians population United States. |! 218,061 1133 || Minnesota. .......... 4, 440 140 a— Mississippi. .......... 1,562 74 Northeast. ........... 68, 438 160 || Missouri............. 4,902 119 North Central. ....... 56, 682 117 | Montana. .«.c.wvvsns 621 98 South: cs emesseveinn 51, 749 103 || Nebraska... :..c000nn 1,581 114 West....:omssnmsssas 32, 840 142 | Nevada. ............ 228 101 New Hampshire. . . ... 752 135 Alabama. ........... 2.32] 72 | New Jersey.......... 6,737 124 AXIZONA.. 5 5+ + wre 0 0 n 1,018 104 || New Mexico. ........ 632 79 Arkansas. ., .; «esx ve 1, 626 91 New York. .......on. 31, 146 193 California; . sv c3 5+ 20, 763 159 || North Carolina. ...... 3,913 91 Colorado... ..c.c 3:5. 2.385 154 || North Dakota........ 494 77 Connecticut. ......... 3,777 169 || Ohio. ............... 10, 873 121 Delaware... ......... 509 132 || Oklahoma. .......... 2,226 103 Dist. of Col. ; «ccs vn 2,483 201 | ‘Oregon. ..c.o0me sommes. 2,098 126 Florida. . + . «wos swms 4, 530 131 Pennsylvania. ........ 14, 727 132 Georgla.....veovs5us 3,391 94 || Rhode Island. ....... 1,036 123 Idaho. .............. 568 93 || South Carolina. ...... 1, 741 76 Illinois. . ........... 12, 529 134 || South Dakota. ....... 534 79 Indiana. ............ 4, 420 102 |} “Tennessee. , vv: «uw 3,535 103 Towa. :crivumarswnse 2,829 105 || Wexas. wucssmnssvwass 8, 750 102 Kansas... .:ovssaviis 2,254 109 li Utah... + scsssmenns 1,026 131 Kentucky............ 2,638 88 || Vermont . ........... 563 149 Louisiana. ........... 3.202 112 Virginia. . «oor vw wmv vee 3,652 102 Maine, ; sss ome nmmnsn 985 109 || Washington.......... 3,238 126 Maryland. .. «isvvse 3, 884 146 || West Virginia. ....... 1, 696 85 Massachusetts. . . .... 8, 715 174 || Wisconsin. .......... 3,926 106 Michigan... ......... 7,900 109 || Wyoming............ 263 86 ! Includes 8,352 physicians not allocated to States—those on active duty with regular Army, Navy, U. S. Public Health Service, Veterans Administration, and Indian Service. Source: Based on American Medical Directory, 1956. 25 Between 1921 and 1955 the physician-population ratio has declined in three-fourths of the States . . . The States with the largest decreases in physicians per population unit are Indiana, Iowa, and Missouri in the North Central region; Arkansas and Kentucky in the South; and Nevada and Wyoming in the West. In each of these States there were at least 40 fewer physicians per 100,000 population in 1955 than in 1921. On the other hand, Connecticut and New York in the Northeast region had large increases in their physician-population ratios. CHANGES IN PHYSICIAN-POPULATION RATIOS IN EACH STATE Difference between 1921 and 1955 rates of physicians per 100,000 population BR Decrease of 20 or more Decrease of | to 19 [] Increase 26 The Northeast region showed a gain in the number of physicians in relation to population between 1921 and 1955 . . . In this 34-year period, the number of physicians in the United States increased 50 percent while the population increased 51 percent. The Northeast, North Central, and South regions did not have population growths as great as the national average. However, in the Northeast region the number of physicians increased 64 percent while in the other two regions the increases were only 17 and 26 percent, respectively. The West had a 129-percent increase in physician supply but the popula- tion grew at a greater rate, 146 percent. PHYSICIANS PER 100,000 POPULATION IN EACH REGION AND STATE: 1921 AND 1955 1921 | 1955 1921 | 1955 Region and State rate | rate | Change Region and State rate | rate | Change United States. .| 134 133 —1 Minnesota. . ........ 108 140 +32 Mississippi. ......... 97 74 —23 Northeast. .......... 138 160 +22 MiIsBOUrd : se sv 5 wv 5 wo 173 119 —54 North Central. ...... 138 117 —21 Montana. ........... 112 98 —14 South. .ovianmarsn 121 103 —18 || Nebraska. .......... 150 114 —36 West. ....oiismssian 152 142 —10 || Nevada............. 185 101 —84 hn —— New Hampshire. . . .. 143 135 —8 Alabama............ 100 77 —23 i New Jersey...«...nws 99 124 +25 Arizona. ............ 108 104 —4 [| New Mexico......... 116 79 —37 Arkansas. ........... 138 91 —47 New York......::5+: 156 193 +37 California. .....5::+: 178 159 —19 || North Carolina. ..... 84 91 +7 Colorado. ........... 189 154 —-35 North Dakota. ...... 86 i) -—9 Connecticut. ........ 122 169 +47 || Ohio. ............... 137 121 —16 Delaware. .......... 121 132 +11 Oklahoma. ........:: 124 103 —21 Dist. of Col. .......... 379 | 291 —88 i Oregon. ..ivoassmes 143 126 - 7 Florida. . ..cocivmess 129 131 +2 Pennsylvania. ....... 128 132 +4 Georgia............. 115 94 —21 || Rhode Island. ....... 124 123 —1 Idaho. J. ... consmmnss 110 93 —17 || South Carolina. . .... 86 76 —10 Minois. ............. 155 134 -21 South Dakota. ...... 101 79 —22 Indiana. ............ 149 102 —47 || Tennessee. .......... 140 103 —37 lows: buss svisswasss 147 105 —42 [| Texas............... 128 102 —26 Kansas, .:ooinmmes ss 143 109 —34 || Utah. .............. 109 131 +22 Kentucky. .......... 136 88 —=48 I! Vermont. ..u..uoinssn 167 149 —18 Louisiana. .......... 108 112 +4 Virginia. .or oxen nvnn 106 102 —4 Maine... ccovmsviun 143 109 —34 || Washington. ........ 128 126 —2 Maryland... ......... 158 146 —12 || West Virginia........ 116 85 —31 Massachusetts. . ..... 151 174 +23 || Wisconsin. .......... 101 106 +5 Michigan... ........ 119 | 109 —10 || Wyoming........... 131 86 —45 Source: Based on physician counts shown in the American Medical Directories. 27 For both economic and professional reasons, physicians tend to con- centrate in urban communities . . . Metropolitan areas in general are characterized by high per capita income, readily available hospital facilities, and opportunities for fre- quent contact with hospital staffs and teaching centers. Marked declines appear in the physician-population ratios of progressively less urban county groups, especially for specialists and for physicians in hospital service. Isolated rural areas are also conspicuously low in the ratio of general practitioners to population. URBAN-RURAL DIFFERENCES IN PHYSICIAN SUPPLY Active Non -Federal Physicians Per 100,000 Population, 1949 0 50 100 150 I T I Greater SRE BERR NN Metropolitan os actitioners: Specialists Lesser Metropolitan Adjacent to ~ Metropolitan Isolated Semirural isolated Rural 28 Isolated counties contain 27% of the total population of the United States, but have only 17% of the active non-Federal physicians . . . In 1950 nearly three-fourths (73 percent) of the population was living in metropolitan counties or in counties contiguous to them. These persons are assumed to be served by or readily accessible to large urban medical centers. Persons in isolated counties are less likely to have the advantages of easy access to a metropolitan center, and their health services are for the most part limited to those which can be obtained locally. In relation to population there were twice as many active non-Federal physicians in 1919 in the metropolitan service areas as in the more isolated counties. To bring the isolated counties up to the metropolitan-adjacent rate— from 69 to 112 physicians in private practice per 100,000 population— would have required about 18,000 additional physicians. PHYSICIAN-POPULATION RATIOS BY COUNTY GROUP Active non-Federal physicians, 1919 ph 1930 | Rate per 100,000 population popu- | : y County group! lation | General | Hos- (thou- | Number Total | Special- practi- | pital sands) | { | ists | tioners | service, | other United States... ......... 150, 697 179, 041 119 37 64 | 18 Metropolitan-adjacent. . . . .. | 109,272 | 148, 498 | 137 | 45 | 67 | 25 Greater metropolitan... ..... 44, 946 | 77.262 | 173 59 | 79 35 Lesser metropolitan. ............ | 40,632 | 52,887 131 | 18 59 24 a 23.6914 18,319 | | 1 58 6 | | | Isolated... .... convo mniamusn | 41,425 30, 543 74 | 14 | 55 5 Isolated semirural . . ............ | 33,077 26.421 80 | 17 57 | 6 Isolated rural... .....c.coo.nn.. | o8.248 | 4122 50 2 | 48 (2) 1 Metropolitan counties are counties within standard metropolitan areas as defined by Bureau of the Census. A greater metgppolitan county is one containing any part of a standard metro- politan area of 1,000,000 population or more. Lesser metropolitan counties are all other metro- politan counties. Adjacent counties are counties that are not themselves metropolitan but are contiguous with metropolitan counties. All other counties are classified as isolated; semirural counties contain an incorporated place of 2,500 or more population, rural counties do not. 2 Less than 0.5. Source: PHS Pub. No. 263, section 1, table 35. 29 Less than three-fourths of the physicians in the United States are in private practice . . . According to the 1956 edition of the American Medical Directory, 70 percent of all physicians are in private practice. About 16 percent are in hospital service, 6 percent are in Federal service, and 3 percent are engaged in full-time research, teaching, administration, or professional activities other than private practice. About 5 percent of the physicians are reported as retired or as not practicing medicine in any form. This estimate is probably low in view of the fact that about 35,000 to 40,000 physicians are aged 65 or over. The proportion of all physicians who are in private practice has decreased from 75 percent in 1949 to 70 percent in 1955. PHYSICIANS BY TYPE OF PRACTICE Type of practice 1949 1955 Total number... ......... 201,277 218, 061 In private practice. . . .................... 150, 417 152, 305 In general Practice. . ....c.couvnnrmnrnnn ions ieeue arenas aren 72, 550 64,716 In general practice with some specialization. . .... .......... .... .. .. 22,976 20, 475 Practice limited to a specialty... .......................... .... . .. 54, 891 67,114 INOU 100 PUIVATE PIACIICC. 11s 525: + 5 5551505 54505 # 9 00m 50 4 oun = 0 0 20 nim 3 00 50, 860 65, 756 Hospital interns, residents, administrators. . ....... ...... .. .. ........ 24, 887 33,973 Federal Government service... ...................... ...... .. ...... 12.536 13,518 Full-time research, teaching, public health. .............. .. .. . . . 3.737 6, 636 Retired, not in practice. . ....................... 9, 700 11, 629 Source: American Medical Directory, 1950 and 1956 ed., table 3. Between 1940 and 1955 the total number of physicians increased 25 percent. Among those in private practice the net gain was only 7 per. cent, however. Full-time specialists in private practice nearly doubled in number, from 33,667 to 67,114; while general practitioners decreased 22 percent, from 109,255 to 85,191. 30 ‘The number of physicians practicing as full-time specialists has increased fivefold from 1923 to 1955 . . . In 1923 the 15,000 full-time specialists represented 11 percent of the 146,000 physicians. In 1955, when the total number of physicians had increased to 218,000, nearly 2 out of 5, or about 84,000, were full-time specialists. NUMBER OF FULL-TIME SPECIALISTS: 1923-55 Total Specialists Year . physicians Number Percent 1923. vn rismisammresmsss pees 145, 966 15, 408 11 VIZ... sco ruc wine se tik BiB EET 152, 503 22,166 15 1934... 161, 359 26, 156 17 VOU 1. 53h 3705 v5 To rn md 90 175,163 36, 880 21 VOD. omspmassmeasesmnsnme ssn 201, 277 62, 688 31 1955... cosamasamasamupavasens 218, 061 84, 441 39 Source: PHS Pub. No. 263, section 1, tables 1 and 8; and American Medical Directory, 1956, tables 3 and 4. INCREASING FULL-TIME MEDICAL SPECIALISTS Thousands of Physicians 300 All Physicians | 200 | x— ——— 100 — 80 = = eh Full-Time ~~ 60 Specialists — | pr > \ _~ Pr 40 > - —— — — - ~ ~ ~~ ~ _~ -— — 20 > +4 BR C@ Le »” 2 FFE 1935 EXE 1955 31 Internal medicine and surgery together account for two out of CRE time specialists in 1955 . . . In 1955, surgery, EENT, urology, and tuberculosis had smaller pro- portions of the full-time specialists than in 1923. Specialty fields with large relative increases are infernal medicine, obstetrics, pediatrics, orthopedics, and anesthesiology. Hospital administration and physical medicine, with no full-time specialists in 1923, together had less than 1 percent of the specialists in 1955. CHANGES IN FULL-TIME MEDICAL SPECIALISTS o 5,000 10,000 15,000 20,000 T Internal Medicine Surgery EENT Obstetrics, Gyn. Psychiatry, Neur. Pediatrics Radiology Orthopedics Urology Pathology, Bact. Anesthesiology 1923 BH 1] 1955 Dermatology, Syph. Public Health Pulmonary Diseases Hosp. Adm. Phys. Med. | | 32 More than half of the full-time specialists hold certificates from the approved examining boards in their medical specialty . . . The proportion of specialists who were diplomates of their respective boards in 1955 varied considerably by type of specialty, from a low of 23 percent for the hospital administrators to 83 percent for the roentgenologists. About 3,800 certificates were awarded in 1955 by the 19 approved examining boards. The total number of certificates issued by June 30, 1955 was 60,644 as compared with 56,801 in 1954. FULL-TIME SPECIALISTS BY TYPE OF SPECIALTY: 1923 AND 1955 1923 1955 Percent of 1955 spe- Specialty cialists who Number | Percent | Number | Percent | were diplo- mates WOR. cotiin bovoon fom stuom be sh 2 om ie 8 do 15, 408 100.0 | 84,441 100. 0 56 Internal medicine... ......... .......... 1,958 12.7 | 17,608 20.9 46 Surgery. cuss eramn ramus vamos sano mmne 3,336 21.7 | 15,442 18.3 45 Ophthalmology, otorhinolaryngology.......| 4,703 30.5 9, 664 11.4 67 Obstetrics, gynecology... ccovwirsnassnmss 696 4.5 7,198 8.5 52 Psychiatry, neurology.................... 945 6.1 7,048 8.3 61 Pediatrics. ....c vo vv oovvvmn mim nmin nw am ne 689 4.5 6,567 7.8 67 Radiology, roentgenology . ............... 588 3.8 4,249 5.0 88 Orthopedios: ou vuevmresd sie en somes smn 326 2.1 3,083 8.7 73 Wrology. . ... sis usssrmssamoeonisgavens suse 762 5.0 2,746 3.3 57 rn Pathology, bacteriology... ............... 317 2.1 2,514 3.0 74 7 Anesthesiology... ....................... 107 + 7 2,453 2.9 46 Dermatology, syphilology................ 361 2.3 2,020 2.4 62 Public health, «ss coos 5s wes cnind so mms os wane 315 2.0 1,680 2.0 49 Pulmonary diseases. ...:coervmss mes smoss 305 2.0 1,429 1.7 26 Physical medicine. . ..... PERSE amass mas Alwar pa fene wma ny 374 .4 62 Hospital administration... ................|........[........ 366 1 23 ! Includes allergy, cardiovascular disease, and gastroenterology. 2 Includes neurological surgery, plastic surgery, proctology, and industrial practice. Sourci: PHS Pub. No. 263. section 1, table 8; and American Medical Directory, 1956, vs table 4. A physician's income varies with age and type of practice . . . General practitioners had their highest incomes at ages 35 to 50, while specialists reached their peak about ten years later, at ages 45 to 60. In 1949 the average net income of nonsalaried general practitioners was about $8,800 as contrasted with $15,000 for full-time specialists. Certain groups of specialists had even higher incomes. Those with the highest average net incomes were in the following specialties: neuro- logical surgery, obstetrics and gynecology, orthopedics, pathology and bacteriology, roentgenology-radiology, surgery, urology. VARIATION IN PHYSICIANS' INCOMES WITH AGE AND SPECIALIZATION GENERAL PRACTITIONERS AGE FULL - TIME SPECIALISTS Under 35 EERE $20,000 15,000 0 0 5,000 10,000 15,000 $20,000 Mean Net Income of Physicians in Nonsalaried Practice, 1949 Source: U. S. Department of Commerce, Office of Business Economics. Mail question- naire survey. (See PHS Pub. No. 263, section 1, tables 45 and 46, and Building America’s Health, vol. 4, p. 248.) 34 Region and size of community also affect the physician's income . . . Physicians in private practice in the Far West had the highest average net income and those in New England had the lowest income in 1949. For specialists the highest average income was in the North Central States, while the general practitioner earned most in the Far West and in the Southwestern States. The size of the physician’s net earnings also reflects the size of the com- munity in which he practices. Physicians in the smallest communities (under 2,500) and in the largest cities (over a million) had the lowest average net incomes in 1949. Specialists in cities with 250,000 to 500,000 persons had the highest incomes; for general practitioners the highest was in cities with 10,000 to 25,000 persons. PHYSICIANS’ INCOMES RELATED TO PLACE OF PRACTICE GENERAL PRACTITIONERS = FULL - TIME SPECIALISTS IA TT] West North Central gig TNO] UIA SY Mountain Central re 00 New England $16 000 12,000 8,000 4,000 0 0 4,000 8,000 12,000 $16,000 Mean Net Income of Physicians in Private Practice, 1949 Source: U. S. Department of Commerce, Office of Business Economics. Mail questionnaire survey. (See Building America’s Health, vol. 4, pp. 246-247 and 249.) 35 In 1955, graduates of dental schools in the United States numbered nearly 3,100 . . . In mid-1955 the number of dentists, including the June graduates of that year, totaled 97,529. Of these, about 13 percent were 65 years of age or older. The annual number of deaths among those in the profession is approxi- mately 1,600. About half of the new graduates are needed to replace those who die each year. GAINS AND LOSSES TO THE DENTAL PROFESSION IN 1955 Graduates of U.S. Dental Schools 3,100 Deaths Among Those in Profession 1,600 Net Gain 1,500 36 . 1f the number of denfal school graduates follows the expected trend, the supply of practitioners will not keep pace with population growth . . . The number of applicants to dental schools has decreased slightly since 1946. There are still nearly twice as many applicants as can be ac- commodated in the 43 schools in operation in the United States, however. In 1954, about 5,800 persons applied for admission and 57 percent were admitted, a ratio of 1.8 applicants per freshman. The ratio of dentists to total population has probably declined from 62.0 per 100,000 population in 1947 to 59.4 in 1955, when account is taken of the progressive improvement in the completeness of the Ameri- can Dental Directories. In 1960 the number of graduates of United States dental schools is ex- pected to be about 3,360. The total number of dentists in the continen- tal United States will have increased to approximately 104,400. Based on an estimated population of 179,358,000 persons in that year, the 1960 ratio will be 58.2 dentists per 100,000 population. To maintain the 1955 rate of 59.4 dentists per 100,000 requires an average annual net gain of 1,850 dentists, instead of 1,420 per year that may be expected on the basis of present school enrollments and the number of deaths that may be anticipated. The American Dental Association has stated that “nearly two new schools, or the equivalent in expansion of existing schools, will be required each year between 1957 and 1971” in order to reestablish the dentist-population ratio at the 1955 level. Source: PHS Pub. No. 263, section 7, pp. 3, 37, and 38, and J. A. D. A. 52:484-488, April 1956. 37 The number of dentists in relation to population is highest in the Northeast region and lowest in the South . . . For the country as a whole and for each geographic region the number of dentists per 100,000 population increased substantially in each of the two decades after 1910. During the depression years the trend changed and ratios were lower in 1940 than in 1930. In this decade, however, the ratio for the Northeastern States changed but little. Between 1940 and 1950 the downward trend continued in both the North Central and the Western States. In the Northeastern States and in the South the ratios in 1950 were essentially the same as in 1940. Throughout the four decades the dentist manpower in the South was markedly less than in any other region of the country. TREND IN REGIONAL DISTRIBUTION OF DENTISTS Rate Per 100,000 Population 100 T 90 80 70 Northeast 60 West North Central VINCE GIT 50 40 30 ro enn ses see [ST 1 20 1920 1930 E10} 38 For the United States as a whole, the dentist-population ratio has declined from 58 dentists per 100,000 population in 1930 to a rate of 50 in 1950. . . During the last two decades the increase in dentist manpower has not kept pace with the expansion of population. Trends in dentist- population ratios are available from the decennial censuses showing the number of dentists in the labor force in relation to population. DENTIST-POPULATION RATIOS BY REGION: 1910-50 Number of Dentists per 100,000 population Census date dentists in United States United Northeast North South West States Central 1900. . J: vsiemmazs ons 39,997 43 50 49 27 67 19200. . J. cv cme ns Gita 56, 152 53 63 59 31 79 1930. ............... 71.055 58 69 65 33 82 1940... ............. 70,417 53 67 62 29 68 1950... ............. 75,025 50 67 54 29 55 Source: Based on census findings; see PHS Pub. No. 263, section 7, table 13. The latest published figure for the total number of dentists in the United States is 97,529 as of mid-1955, including the June graduates of that year. This gives a ratio of 59.4 dentists per 100,000 population. The somewhat higher level of this figure, in contrast with the ratio for 1950 based upon census data, is attributable to the American Dental Directories having a greater inclusion of inactive and nonpracticing dentists. It seems unlikely that any improvement in the dentist-population ratio took place between 1950 and 1955. 39 New York has the highest ratio of dentists to population; South Carolina has the lowest . . . The top ranking States are in the northern part of the country, scattered from the east to the west coast. DENTIST-POPULATION RATIOS IN EACH STATE Dentists per 100,000 population, 1955 0 20 40 60 80 100 District of Columbia : New York Connecticut Minnesota Oregon Massachusetts Washington Nebraska Wisconsin Hlinois New Jersey California lowa Utah Pennsylvania Rhode Island Missouri Colorado Montana New Hampshire Wyoming Maine Michigan Ohio Florida Indiana Kansas Nevada Idaho Vermont South Dakota North Dakota Maryland Oklahoma Tennessee Delaware Louisiana Kentucky Virginia West Virginia Arizona Texas North Carolina Alabama Georgia Arkansas Mississippi New Mexico South Carolina 40 Only one-third of the States TH higher dentist-population ratios than the average for the country as a whole . . . New York ranks highest among the States, with 86 dentists per 100,000 population. The District of Columbia, with a rate of 91, has a relatively larger supply of dentists than any State, but that metropolis furnishes dentist service to the population living in adjoining States. TOTAL NUMBER OF DENTISTS AND DENTIST-POPULATION RATIOS FOR EACH REGION AND STATE: 1955 Number Rate per Number Rate per Region and State of 100,000 Region and State of 100,000 dentists | population dentists | population United States. .| !97,529 159 Minnesota. .......... 2,304 73 Mississippi. .......... 563 27 Northeast. . ......... 30, 689 72 Missouri. ............ 2,445 59 North Central... : 27.836 58 Montana; «sum 5000 345 55 South. nd ivicizramass 17,518 35 Nebraska............ 944 68 West... ............. 14, 196 61 Nevada. ............ 110 49 een ——————— || New Hampshire... .. 292 52 Alabama. : oc. cumiessn 857 28 || New Jersey..... «wus 3,565 66 ATIZONRS . 500 v2 5 oi v0 334 34 New Mexico. ........ 217 27 Arkansas. .o.vsunus pn 491 27 New York. ; cums ues 13, 883 86 California. . ......: 004 © 8,393 64 North Carolina. ...... 1,224 29 Colorado. ........... 885 57 || North Dakota........ 284 44 Connecticut. ......... 1.638 73 Ohio................ 4,472 50 Delaware. ........... 149 89 || Oklahoma. .......... 868 40 Dist. of Col... ....... 772 91 Oregon. ..cccnmeramans 1,217 73 Florida.) sos manssmes 1,687 19 || Pennsylvania... ... .. 6,680 60 Georgia. ............ 1,027 28 || Rhode Island... ... .. 508 60 Idaho... ..... .... .... 29] 48 || South Carolina..... .. 460 20 IMlinois. ............. 6, 180 66 South Dakota. ....... 303 45 Indiana. co ivom nus 2,106 49 Tennessee. . ......... 1,358 40 lowa.. diiiseussnmans 1,668 62 Texas. .....-::0:5:60 2, 880 34 Kansas.............. 1.009 49 Utah. .............. 487 62 Kentucky. .......... 1,046 35 Vermont. ........... 178 47 Louisiana. ........... 1,097 37 Virginia. . ccovomsinme 1,241 35 Maine, o.ocosasunsss 449 50 Washington. ....... .. 1,762 69 Maryland, . ...oue53s 1,089 41 West Virginia. ..... .. 709 35 Massachusetts. . . .... 3,496 70 Wisconsin. . ......... 2,509 68 Michigan... ........ 3.612 50 Wyoming... «cu. eum» 155 51 1 Includes 7,290 in the Federal dental services not allocated to States. SOURCE: American Dental Association. Distribution of Dentists in the United States by State, Region, District, and County. Chicago, The Association, 1956. 41 Between 1920 and 1950 the dentist-population ratio has declined in three- fourths of the States . . . The States with the largest decreases in dentists per population unit are in the West. California, Nevada, and Oregon each had at least 30 fewer dentists per 100,000 population in 1950 than in 1920. The largest increase, a net gain of 12 dentists per 100,000 population during the three decades, was in New Jersey. Three other States in the Northeast region also had increases in their dentist-population ratios: Connecticut, New York, and Pennsylvania. CHANGES IN DENTIST-POPULATION RATIOS IN EACH STATE Y, le Ly NN (1) RN DN ) Difference between 1920 and 1950 rates of dentists per 100,000 population EBB Decrease of 15 or more NX Decrease of | to [4 [CJ Increase or no change 42 The Northeast region increased its dentist supply slightly in relation to population between 1920 and 1950 . . . For the country as a whole, the dentist-population ratio declined reflect- ing the fact that, although the number of dentists increased 34 percent, total population grew 42 percent. This same pattern prevailed in the South. In the Northeast region, on the other hand, the dentist count increased 42 percent and the population only 34 so that the ratio im- proved over the period. The reduction from 59 to 54 in the ratio for the North Central States reflects the smallest dentist gain (19 percent) registered in any region and a population gain of 30 percent. The ratio in the West showed the greatest reduction; even though the dentist count increased 54 percent, it failed to keep pace with the tremendous popula- tion growth of 117 percent. DENTISTS PER 100,000 POPULATION IN EACH REGION AND STATE: 1920 AND 1950 Region and State 1920 / 1950 Change Region and State 1920 | 1930 Change rate rate rate rate United States. 53 50 —-3 Minnesota. .......... 66 69 +3 i Mississippi. .......... 22 21 = Northeast. .......... 63 67 +4 || Missouri. ............ 63 53 —10 North Central... .... 59 | 54 —5 || Montana... .... ... 56 | 47 | —9 South............. .. 31 29 —2 || Nebraska. ........... 64 61 -3 West................ 79 55 —24 || Nevada............. 80 50 —30 ————|———— || New Hampshire. ..... 55 40 —15 Alabama............ 26 20 —6 || New Jersey.......... 52 64 +12 Arizona. ............ 37 29 —8 || New Mexico......... 23 24 +1 Arkansas. ........... 20 22 +2 New York........... 74 83 +9 California. .......... 95 60 —35 North Carolina. ...... 23 24 +1 Colorado. ......... .. 72 51 —21 North Dakota. ....... 41 40 —1 Connecticut... ....... 60 68 +8 || Ob¥oi umm: swe immees 52 47 —5 Delaware. ........... 38 36 —2 Oklahoma........... 32 32 0 Dist. of Col. ......... 98 60 —38 || Oregon.............. 98 62 —36 Florida.......... .... 45 36 —9 Pennsylvania. ....... 49 54 +5 Georgia... ......... 33 25 —8 || Rhode Island. ....... 53 52 i] Idaho. .....cu.:5:0.. 59 37 —22 || South Carolina. ...... 22 18 | —4 NHNols...oinmivsvmes 69 65 —4 || South Dakota........ 47 44 | —-3 Indiana............. 51 44 —7 || Tennessee. .......... 31 28 —3 Towa... .............. 66 55 —11 || Texas............... 31 31 0 Kansas.............. 58 49 —9 || Utah................ 66 54 —12 Kentucky... ...:0:0:0 32 27 =5. || Vermont. .:.oussumes 47 38 =) Louisiana. ........... 34 34 O || Vieginia.....o vi: 29 30 +1 Maine. .............. 60 40 —20 Washington. ......... 79 58 —21 Maryland. .......... 49 43 —6 || West Virginia........ 37 31 —6 Massachusetts. . .. . .. 82 64 —18 || Wisconsin. .......... 61 64 +3 Michigan...........: 49 45 —4 || Wyoming............. 55 38 —17 SouRcE: Based on census findings; see PHS Pub. No. 263, section 7, table 13. Dentists, like other professional persons, tend to establish practice in large urban population centers . . . The ratio of dentists to population is greatest for metropolitan areas with the largest population totals. The 14 areas that had 1 million or more inhabitants in 1950 averaged 82 dentists per 100,000 population, with the following variation: Minneapolis-St. Paul 103, New York- Northeastern New Jersey 99, San Francisco-Oakland 89, Chicago 85, Cleveland 83, Boston-Lowell-Lawrence 78, Los Angeles 77, St. Louis 73, Philadelphia 71, Buffalo 69, Washington 67, Pittsburgh 66, Detroit 59, and Baltimore 46. The 148 metropolitan areas with populations of less than a million each grouped together as lesser metropolitan have a ratio of 57 dentists per 100,000 population. URBAN-RURAL DIFFERENCES IN DENTIST SUPPLY Non-Federal dentists (1952) per 100,000 population (1950) 0 20 40 60 80 I I ! I T I Greater Metropolitan Lesser Metropolitan Adjacent to Metropolitan isolated Semirural EE Dentists Reported as Graduated 1935-1952 goloted All Dentists ura 44 Nonmetropolitan counties are conspicuously low in the ratio of dentists to population . . . The counties adjacent to metropolitan counties, although they may be sparsely populated, are nonetheless relatively close to the dentist supply in the large urban centers. In these adjacent counties the ratio is 39 dentists per 100,000 population. In the isolated counties, those farther removed from the metropolitan areas, the ratios are still lower. The same tendency for metropolitan counties to rank very high in contrast to more isolated areas is also evident in the ratios reflecting their share of recent graduates of dental schools, with progressively declining ratios of the younger dentists in the more rural areas. DENTIST-POPULATION RATIOS BY COUNTY GROUP Non-Federal dentists, 1952 1950 Rate per 100,000 County group! Deflation Pagers population (1950) ands) Number | graduated 1935-52 1935-52 Total graduates United States... .............. 150, 697 84,214 36 56 20 Greater metropolitan... ............. 44,946 36, 834 35 82 29 Lesser metropolitan. . ......... .. .... 40, 632 23,336 37 57 2] Adjacent... ...... 23, 694 9, 327 35 39 14 Isolated semirural . .............. .... 33,177 12, 737 34 38 13 Tsnlated rural, «coc vnvcnmnisamus mos 8,248 1,980 29 24 7 I Metropolitan counties are counties within standard metropolitan areas as defined by Bureau of the Census. A greater metropolitan county is one containing any part of a standard metropolitan area of 1,000,000 population or more. Lesser metropolitan counties are all other metropolitan counties. Adjacent counties are counties that are not themselves metropolitan but are contiguous with metropolitan counties. All other counties are classified as isolated; semirural counties contain an incorporated place of 2,500 or more population, rural counties do not. Source: PHS Pub. No. 263, section 7, pp. 20-23. 45 Dentists in the United States tend to establish their practice within the area where they. received their training . . . Each geographic division of the country draws the majority of its dentists from graduates of schools located within its borders, with the exception of the Mountain States. In the East and West North Central groups of States nearly 9 out of 10 dentists located there in 1952 had attended school in the geographic division. In four other divisions— Middle Atlantic, South Atlantic, East South Central, and West South Central-—where the proportion of dentists trained within the area was not quite so high, the rest of the dentists were drawn from schools located in one or another of the adjoining geographic divisions. NON-FEDERAL DENTISTS LOCATED IN 1952 IN THE SAME GEO- GRAPHIC DIVISION IN WHICH THEY ATTENDED DENTAL SCHOOL Non-Federal dentists in area I Trained in dental Geographic division Total school in same area number Number Percent United States... o.coisomesnmvzanmiss 78, 025 59,757 7 NEW EBglanill. . ... ..cos ovis + oimon nm imine ores non 5,485 3,073 56 Middle Atlantic. . ......................... 20,922 17,174 82 East North Central. ......cocovvcinins.avniis 17,296 15,251 88 West North Central... ..................... 8, 442 1.352 87 South Aanbie, : «svn iismisadisindssmensa 6, 686 4, 840 72 Fast South Central. . .....oo vem nsmme ss mses 3.127 2,052 66 West South Central. ....................... 4,481 2,494 56 Mountain. ..............ciiiiiinnnnnnn. 2,279 408 18 Paciie; oouvyisvvrsenrssmpssemssnmesssmass 9.307 7. 113 76 Source: Public Health Reports 70: 1237-1241, December 1955. In two other divisions the spread is wider. In New England where 56 percent of the dentists were trained locally, 18 percent had attended a dental school in one of the South Atlantic States and 16 percent came from a school in the Middle Atlantic area. While 76 percent of the dentists in the Pacific area were trained there, the others were mainly drawn from schools in the North Central States. The Mountain States have an exceptional pattern because they lacked dental training facilities for the past 20 years or more. Only 18 percent of the dentists in this area were trained locally; another 18 percent came from States in the Pacific division. Approximately 32 and 25 percent, respectively, were drawn from schools in the West and East North Central States. 46 Dentists practicing as specialists number fewer than 3,000, or less than 3 percent of the total . . . The American Dental Association recognizes seven fields of dentistry as specialties, namely, dental public health, oral pathology, oral surgery, orthodontics, pedodontics, periodontics, and prosthodontics. For each there is a specialty examining board which is incorporated under the sponsorship of some national specialty organization. The 1955 American Dental Directory lists as specialists all dentists who meet one or more of the following qualifications: (a) diplomates of approved specialty boards, (b) members of recognized national specialty societies, and (c) individuals licensed as specialists by their State boards of dental examiners. Orthodontists, as a group, represent approximately one-half of all specialists, while about one-fourth of the specialists are oral surgeons. Public health dentists and oral pathologists, both recently added to the list of recognized specialties, each account for less than 1 percent of all specialists. DENTAL SPECIALISTS: 1954 Diplomates of boards Suecial Total Specialy number Number Percent All specialties. ..uiousscvisonssamivismuissn 2,829 1,128 40. 0 Dental publichealth. . ............ccvvnvervmnnna. 24 24 100. 0 Oral pathology. ...................... A 24 24 100. 0 Oral surgery. ..... ow a a 3 8 ka 778 282 36. 2 Orthodontics. . . ... rE EME EW EERE WEEE Re EEE 1, 442 408 28.3 Pedodontis. .: svw eso mess sues owes sms £5 oe Ee 130 55 42.3 Periodontics. . . . . . 5. 383 08 che Boe 0 i BH #8 Ser a2 me Berrale oh 220 173 78.6 Prosthodontics. . .. . ................ Ce 211 162 76. 8 Source: PHS I'ut. No. 263, section 7. pp. 40-41. 47 Student enrollments in schools leading to a degree in basic professional nursing have increased since 1947 . . . The nearly 15,000 students enrolled in basic degree programs in 1955 are twice the number enrolled in 1946. They comprise 14 percent of the 107,752 student nurses enrolled in State-approved schools of nursing on January 1, 1955. In 1946 they were about 6 percent of the total. TREND IN STUDENT PROFESSIONAL NURSES Number of Students Enrolled in Programs 200,000 | | | | | | 100,000 SS - i + a } + eels ’ lm 90,000 ii... : 80,000 es Ts, 70,000 —— eee en | _Y 60,000 “- EE. Bt WR +] 50,000 - —-.;,.» cs en _—t—— 40,000 30,000 ——t— fe FS 0 20,000 —t mre 10,000 9,000 8,000 7,000 6,000 5,000 7 4,000 i RRS th NG Advanced Programs Se——— ooo bree a... ees 2,000 i Ri. 1500 L | i | I 1946 1948 1950 1952 1954 1956 In contrast, enrollments in nursing diploma programs have remained almost at the same level . . . Students enrolled in diploma programs constitute 86 percent of the enrollments in schools of basic professional nursing. Enrollments have remained steady after a decline from the peak figures at the time of the Cadet Nurse Corps. Enrollment in advanced nursing programs, which prepare nurses for positions in teaching, administration, and supervision, has dropped sharply in recent years. NUMBER OF STUDENTS ENROLLED IN PROFESSIONAL NURSING PROGRAMS: 1946-55 Basie professional programs Advanced Year programs Total Diploma Degree 1946. ........................ 128, 828 121, 654 7,174 Mm 1947... 106, 900 101, 425 5,475 M 1948... 91, 643 85,597 6,046 " VORY. . vicamvnpnnmpssmmensnags 88,817 82,182 6,635 ™ VO500: 3 cca ooim es nmin ss ums nd iss 97,903 89,420 8,183 0) NOSE. : cers mous ma Rs mm es Bess 102, 509 93,325 9, 184 6, 492 195. . ivi chp msn hh nnn a 101, 809 90, 888 10,921 5,840 1953. 2 102,019 89,308 12,711 4,689 BOSE... «vein mu non aman 2 103,019 88, 365 14, 654 3,638 JOBS. ; icv vvmv sums amen mass 2107,572 92.583 14, 989 3, 460 ! Data not available. 2 Includes Hawaii and Puerto Rico. Source: 1955-1956 Facts About Nursing, p. 75 and National League for Nursing, Research and Statistics Service. Nursing students are drawn largely from girl high school graduates, the numbers of which have been estimated at 772,900 for the school year 1955~<56 and at 919,800 for 1959-60. The increase in the number of these girl graduates between 1950 and 1960 is expected to be more than 48 percent. Since about 6 to 7 percent of the graduates usually enroll in nursing schools, a gradual increase in admissions is anticipated. Whether enrollments will continue to increase at a rate sufficient to insure a nurse supply that might approach demand depends upon many factors. 49 In 1955, the United States had 258 graduate professional nurses per 100,000 population, with highest ratios in Northeast and West . . . The supply of nurses in relation to population varies widely among the several regions. The Northeast region and the West have been con- sistently above the United States average, with the Northeast in first place in 1940 and in 1950. Between 1910 and 1950 the nurse-population ratios in the North Central region and in the South have increased fivefold, although both regions continue to stay below the average for the country as a whole. The ratio in the Northeast States has quadrupled; in the West, tripled. TREND IN REGIONAL DISTRIBUTION OF NURSES. Rate Per 100,000 Population 500 400 (TIAL HL 5 —: ~ oo West United States North Central 200 LTH] 100 |—— 90 80 70 60 — 50 a0 fp 30 20 EE i re ree 1910 R-rdo) 1930 1940 50 For the United States as a whole, the nurse-population ratio has increased more than fourfold since 1910 . . . The American Nurses’ Association publishes a statistical summary called Facts About Nursing. The 1956-1957 edition published a new estimate of the total number of graduate nurses in the United States at the end of 1955. This estimate of 430,000 has been compiled from several sources by a committee representing the American Nurses’ Association, the Na- tional League for Nursing, the American Hospital Association, and the United States Public Health Service. Trend data on active graduate nurses are based on the findings of the decennial censuses. NURSE-POPULATION RATIOS BY REGION: 1910-55 Number of Nurses per 100,000 population Year nurses in United . . States United | North- | North South West States east Central AND... oni niin 50,476 55 75 47 34 104 1920. ............. 103, 879 98 133 87 60 166 1930. . cov vvv inns 214, 292 175 239 159 104 262 1940. ; vcs vivsvrmssse 284, 159 216 304 193 134 299 YO50 0. 2 05 8x umn # 374, 584 249 321 233 174 318 1955. , vv rms ws ms 430, 000 258 om 0) (M O ! Data not available. Sourci: 1910-50 data based on census findings; see PHS Pub. No. 263, sec- tion 2, tables 1 and 2. 1955 figure (as of 1-1-56) published in the 1956-1957 edition of Facts About Nursing, chapter 1, section A, table 1. Massachusetts has the highest ratio of graduate professional nurses to TN EHTEL Arkansas has the lowest . . . In 1950, Massachusetts and Connecticut ranked highest among the States in the ratio of graduate professional nurses to population, with 417 and 406 active graduate nurses per 100,000 population, respectively. NURSE-POPULATION RATIOS IN EACH STATE Active graduate nurses per 100,000 population, 1950 0 100 200 300 400 Massachusetts District of Columbia Connecticut New Hampshire Vermont California New York Washington Nevada Colorado Delaware Maine Arizona Minnesota Oregon New Jersey Rhode Island Maryland Pennsylvania Florida Montana Hlinois Michigan Ohio Wyoming Wisconsin lowa Kansas Idaho Utah Nebraska Virginia South Dakota Missouri Indiana New Mexico Texas North Dakota Louisiana North Carolina West Virginia Oklahoma Tennessee South Carolina | | | | | | | | | | | | 1 | | | | | | | | | | | | | | | | | | | | | | | 1 | | | Georgia Alabama Kentucky Mississippi United Arkansas = L __| States 1 4 52 Some States have 3 to 4 times as many nurses in relation to population as other States . . . The wide variation in the ratio of active graduate nurses to population among the States is shown by the following distribution: 2 States with more than 400 nurses per 100,000 population; 9 States with rates of 300-399; 21 States with rates of 200-299; 15 States with rates of 100-199; and 1 State with fewer than 100 nurses per 100,000 population. TOTAL NUMBER OF NURSES AND NURSE-POPULATION RATIOS FOR EACH REGION AND STATE: 1950 Rate per Rate per Region and State Number 100,000 Region and State Number 100,000 of nurses popula- of nurses popula- tion tion United States. .| 374,584 249 Minnesota. ........... 8,601 288 ———| =| Mississippi. .......... 2.247 103 Northeast. ..........| 126,573 321 Missouri. . ........... 7.834 198 North Central... .... 103, 440 IIR Montana... .. worcae 1,534 260 Sottth.. . dv vss 5. ons mw 82, 289 174 || Nebraska: i. sovovsnn 2,718 205 West. ooooviennns 62,282 318} Nevada. ...:i.vnvvsus 507 317 ———} {i New Hampshire....... 2,017 378 Alabama... ......... 4, 053 132 New Jersey... ........ 13, 766 285 ANVZONG J, ov sogamuss 2,201 293 || New Mexico. ......... 1,268 186 Arkansas. ........... 1,866 98 li New York... w.cvumev- 19, 241 332 California. ........... 37,040 350 || North Carolina. ...... 6, 806 168 Colorado. . .......... 4,161 314 || North Dakota. ....... 1,077 174 Connecticut... ....... 8,155 406 || Ohio... ............. 18, 853 237 Delaware. ........... 982 309 || Oklahoma... ...... .. 3,685 165 Dist. of Col. .: 50:00 3,318 414 || Oregon....scomisamennn 4,353 286 Florida... cni i330 7,208 260 || Pennsylvania. ....... 21.337 262 Georgia. ............ 5,016 146 || Rhode Island... .... .. 2,178 275 Idaho. .............. 1,286 218 || South Carolina... .... 3,193 151 Ilinois. . ............ 21,872 251 South Dakota... ..... 1,305 200 Indiana. ..oio0:0:00- 7.727 196 || Tennessee. ........... 5.129 156 lows. . booeonmusiwuany 5,770 D0 Il TORAB 52500 sss ws wom 14, 109 183 Kansas. ............. 4, 170 219: 0 Mwah. ..vsemanpmessame 1,437 209 Kentucky. .......... 3,818 130 || Vermont. ........ .... 1.375 364 Louisiana... ......... 4, 639 173 || Virginia... .......... 6, 662 201 Mage. dos nusvomosan 2.755 301 Washington... ....... 7,817 329 Maryland. .... ..... 6,200 265 || West Virginia. ........ 3.338 167 Massachusetts. . . .. .. 19, 549 ANT I} Wisconsin, ..v.ocomwans 7.930 231 Michigan... ..... .... 15.583 245 {| Wyoming. . .......... 678 233 Source: Based on census findings; see PHS Pub. No. 263, section 2, tables 1 and 2. Between 1920 and 1950 the nurse-population ratio has increased in all States . . . In sharp contrast to physicians and dentists, the ratio of graduate professional nurses to population has increased all across the country. One-fourth of the States had an increase of 170 or more nurses per 100,000 population in the 30-year period. The largest gains occurred in Connecticut, Delaware, Massachusetts, New Hampshire, and Ver- mont, where the increases exceeded 200 nurses per 100,000 population. CHANGES IN NURSE-POPULATION RATIOS IN EACH STATE Difference between 1920 ond 1950 rates of nurses per 100,000 population BR Increase under 120 ANN] Increase 120-136 Increase 137-169 [J Increase 170 and over 54 The Northeast region had the largest gain in the number of nurses in relation to population; the South had the smallest gain . . . A change in the nurse supply reflects both the increase in the number of nurses and the population growth during the period. Between 1920 and 1950 the number of nurses in each region tripled or quadrupled, with increases ranging from 220 percent in the Northeast to 321 percent in the West. The Nation as a whole increased its number of nurses by 261 percent. In these same three decades the total population increased 42 percent for the Nation and for the South; 30 and 33 percent for the North Central and Northeast regions; and 117 percent for the West. NURSES PER 100,000 POPULATION IN EACH REGION AND STATE: 1920 AND 1950 Region and State 1020: / 1030 Increase Region and State 1020: 1950 Increase rate | rate rate | rate United States. . 938 249 151 Minnesota. ......... $12 288 176 || || Mississippi. ......... 30 103 73 Northeast... ...... .. 133 321 188 [| Missouri. ........... 78 198 120 North Central... .... 87 233 146 || Montana............| 124 260 136 South. .............. 60 174 114 Nebraska. .......... 85 205 120 Weslo sou munsnuessens 166 318 152 Nevada............. 133 317 184 ———|———]————|| New Hampshire. .... 126 378 252 Alabama. ........... 44 132 88 New Jersey.......... 102 285 183 Arizona... ........ .. 121 293 172 New Mexico......... 83 186 103 Arkansas. ........... 26 98 72 | New York...........| 168 332 164 Califormia co nxn wes 212 350 138 || North Carolina. . .... 56 168 112 Colorado. . .cocivsmas 156 314 158 || North Dakota. ...... 68 174 106 Connecticut... ...... 143 406 263 || Ohio................ 83 237 154 Delaware. ......... .. 61 309 248 || Oklahoma... .... .... 45 165 120 District of Columbia.| 333 414 81 Oregon; sosvsrmass- 139 286 147 Florida. .... .. ...... 91 260 169 || Pennsylvania. .. .... 95 262 167 Georgia... ........... 60 146 86 || Rhode Island... .. .. 104 275 171 Idaho... .......... .. . 113 218 105 || South Carolina. . .... 62 151 89 Ilinois. ............. 110 251 141 South Dakota. ...... 65 200 135 Indiana... ..... .. .. 64 196 132 || Tennessee. .......... 53 156 103 lowa. .... .. ........ 88 220 132 | Texas. ....5000me5580 52 183 131 Kansas, . soocvvmeias 68 219 151 Utah. .......... .... 60 209 149 Kentucky... ..... .. 51 130 79 || Vermont... ........ 140 364 224 Louisiana. . ......... 51 173 122 || Virginia... «ovo 76 201 125 Maine... .... ..... 122 301 179 Washington. ........ 194 329 135 Maryland. ........... 134 | 265 131 || West Virginia. ....... 19 167 118 Massachusetts... . . .. 156 417 261 Wisconsin... ........ 90 231 141 Michigan. ......... .. 79 245 166 [| Wyoming. ........ .. 50 | 233 183 Source: Based on census findings: see PHS Pub. No. 263, section 2, table 2. The nurse supply in hospitals almost doubled between 1943 and 1955 . . . Six out of 10 graduate professional nurses are now employed in hospitals in the United States. This field of practice has shown the greatest gain, from 129,000 in 1943 to 256,000 at the end of 1955. During this 13-year period, the number of graduate professional nurses in public health has increased 35 percent; those in industry, 55 percent; and those on private duty, 64 percent. INCREASING NUMBERS OF NURSES IN SELECTED FIELDS 500,000 v 400,000 ie ee 300,000 A Hospitals -— 200,000 = ie op qum—] -_— | -_— -_— | a a | | | 100000 b——+———— — — | - | _— 90,000 = - tr Private Duty eee ee 80,000 en —te femme ; \ I | . 70,000 es a - Sl ———————— 60,000 EE . 50,000 ———a ibe . 40,000 1 - = simon — - Public Health | | 30,000 st i Sm — fo 20,000 Ee I —] ar Industr - y _—- -—" | \_— J | | po —— 10,000 l L | 1 J | l 1943 1945 1947 1949 1951 1953 1955 56 Professional nurses work in many different fields with hospitals em- ploying 60 percent of the total number . . . The latest data available on graduate professional nurses are as of Jan- uary 1, 1956, published in the 1956-1957 edition of Facts About Nursing. The number of nurses in each field of practice is estimated as follows: Allfields. .........ccovviiininsnss 430, 000 Hospitals: «so sus ruins swans swrms vooms nme 256, 000 Osteopathic hospitals... ................... 1, 000 Nursing homes. .......................... 7,000 Other institutions. . .. ..................... 2, 000 Private duty. ccs coins smans sues van smo 72,000 OBRGE. . ovr oasis 69 $B ms EE 68 Bs gREES 2 36, 000 Public health... .......................... 27, 000 Industry.......... 17, 000 Nursing education. . . .. coon run cn van swe ons 10, 000 Other fields. . . ...... 2,000 The trend in the number of professional nurses in selected fields of prac- tice is given below. PROFESSIONAL NURSES EMPLOYED IN SPECIFIED FIELDS OF PRACTICE: 1943-55 Year Hospitals bulla Industry Private health ? duty 1943... 129, 000 20, 000 11, 000 44, 000 VAS. vii os sass AT En EER Was enw 145, 000 20, 000 14, 000 [©] 1D... cnc pms BABIES BASLE 199, 000 23, 000 11, 000 65, 000 JOB). . cov vn mn mm na man nino 216, 000 25, 000 12, 000 70, 000 1955. . 256, 000 27, 000 17, 000 72, 000 I Data not available. Source: PHS Pub. No. 263, section 2, table 31: and the 1956-1957 edition of Facts About Nursing, chapter 1, section A, table I. U. S. GOVERNMENT PRINTING OFFICE: 1957 O—420535 C02937L387