Methodological Notes – Health Workforce Module

Updated: January 2019

Concepts and Definitions

The health workforce is made up of many different types of workers. The World Health Organization’s International Classification of Health Workers recognizes five broad categories: (1) health professionals, (2) health associate professionals, (3) personal care workers in health services, (4) health management and support personnel, and (5) other health service providers. http://www.who.int/hrh/statistics/Health_workers_classification.pdf. Health professionals vary substantially in their training, licensure and registration requirements, and how statistics on employment are collected.

The names of selected health professionals in the official languages of circumpolar countries are shown below:

English/French physician/médecin dentist/dentiste nurse/infirmière public health
nurse/infirmière de santé publique		 midwife/sage-femme
Danish læge tandlæge sygeplejerske sundhedsplejerske jordemoder
Finnish lääkäri hammaslääkäri sairaanhoitaja terveydenhoitaja kätilö
Icelandic læknir tannlæknir hjúkrunarfræðingur ljósmóðir
Norwegian lege tannlege sykepleier helsesøster jordmor
Swedish läkare tandläkare sjuksköterska distriktssköterska barnmorska
Russian vrach stomatolog medicinskaya sestra akusherka

OECD makes the distinction among the categories of “practising”, “professionally active”, and “licensed to practise”. This is summarized in the figure below.

Some countries do not distinguish “practising” and “professionally active” There are usually two ways to count workers, by a head count or the number of full-time equivalent (FTE). It is difficult to apply the FTE concept to self-employed professionals who do not have regular hours of work. The data presented in CircHOB are based on head counts. Some countries provide data from employment records, some conduct surveys, and some include only public sector employees.

Among the many types of health professionals, CircHOB selects physicians, dentists and nurses for monitoring. Physicians and dentists include interns/residents, defined as trainees who have graduated but are undergoing further clinical training under supervision. Both generalists and specialists are included. The United States is unique in including doctors of osteopathy (DO) as physicians. DOs are now indistinguishable in training and scope of practice from doctors of medicine (MDs), whereas outside the U.S. osteopathy tends to treat only musculoskeletal disorders. Dentists (or stomatologists) are not included under physicians, although in some countries (such as Russia) they are considered medical specialists.

OECD includes under “professional nurses” clinical nurses, district nurses, nurse-anesthetists, nurse-educators, nurse-practitioners, public health nurses, and specialist nurses. Excluded are midwives (unless they are also registered as nurses and working as nurses), nursing aides, associate professional nurses, practical and vocational nurses.

The measure used to compare the availability or supply of health professionals is density, expressed as the number of professionals per 100000 people in the population. Where possible, it is data on practicing professionals that are presented. Some countries do not distinguish between the “practising” and “professionally active” categories.

Data Sources and Limitations

United States

There is no single source of information on health human resources. For physicians, the source is the American Medical Association, accessible from the Area Resource File (ARF) distributed by the Health Resources and Services Administration of the Department of Health and Human Services. For dentists, pre-2009 data are from the American Dental Association’s publication Distribution of Dentists in the United States. From 2009 on, they are available from ARF.

Data on nurses are obtained from the Occupational Employment Statistics database of the Bureau of Labor Statistics. Only salaried employees of health care institutions are included. Before 2012 there was one code (291111) for all registered nurses (RN), including nurse-anesethetists (NA), nurse-midwives (NW) and nurse-practitioners (NP). From 2012 on, there are separate codes for NAs (291151), NWs (291161), NPs (291171), and all other RNs, including clinical nurse specialists (291141). These categories are aggregated to be comparable to previous years’ data.

Canada

Data on physicians are from the Canadian Institute of Health Information’s annual report Supply, Distribution and Migration of Canadian Physicians. Data on dentists are from Canada’s Health Care Providers, periodically updated. Data on nurses are from Regulated Nurses: Trends, published annually. For physicians, interns and residents data are included under Canada but not in the North. Northwest Territories and Nunavut data are combined for nurses, and for dentists prior to 2004. Only Registered Nurses (RN) employed in nursing (including administration and research) are included. Although CIHI includes separate data for nurse-practitioners, these individuals are also registered nurses.

Note that the CIHI data refer to professionals registered to practise in the territories, who may be engaged in part-time practice consisting of multiple short visits, which may explain the high rate of supply (especially for dentists).

Denmark, Greenland, Faroe Islands, and Iceland

Data for Denmark, Greenland and Faroe Islands are available from NOMESCO’s Social and Health Indicators database, supplemented by the annual report Health Statistics in the Nordic Countries.

Iceland

Iceland data are from OECD Health > Health care resources.

Norway

Data are from Statistics Norway’s Statbank Labour market and earnings > Employment > Health care personnel. Tables 3448 and 3491 cover national and regional data pre-2008 (discontinued), replaced by Tables 7939 and 7936 from 2008 onward. Health professionals refer to “persons with health care education employed in region”. Nurses include public health nurses and physicians include generalists and specialists.

Sweden

Swedish national and regional data are from the National Board of Health and Welfare database.

Finland

Finnish data are from SOTKAnet Services and resources > Personnel > Health services personnel Data for 2000-07 refer to only public sector employees employed by municipal health services (indicator no. 2621, 2647-49, 3325, no longer available). From 2010 onward data are available separately for public and private sectors.

Data are as reported in the publication Health Care in Russia.

Included under “dentists” are stomatologists (stomatologi) but not middle-level dentists (zubnye vrachi). The number of stomatologists, however, is deducted from the total number of physicians. Nurses (medicinskie sestry) and midwives (akusherki) are middle-level health staff.