Methodological Notes – Health Workforce Module

Updated: January 2012

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. 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 languages of circumpolar countries are shown below:

Canada physician/médecin dentist/dentiste nurse/infirmière public health
nurse/infirmière de santé publique
midwife/sage-femme
Denmark læge tandlæge sygeplejerske sundhedsplejerske jordemoder
Finland lääkäri hammaslääkäri sairaanhoitaja terveydenhoitaja kätilö
Iceland læknir tannlæknir hjúkrunarfræðingur ljósmóðir
Norway lege tannlege sykepleier helsesøster jordmor
Sweden läkare tandläkare sjuksköterska distriktssköterska barnmorska
USA physician dentist nurse public health nurse midwife
Russia vrach stomatolog medicinskaya sestra akusherka

Since 2010 OECD has made the distinction among the categories of “practising”, “professionally active”, and “licensed to practise”. This is summarized in the figure below.

In earlier editions of Health Data, the distinction was made only between “practising” and “licensed to practise”. Some countries are not able to distinguish “practising” and “professionally active” – these are either left blank, or they provide identical numbers for the two categories. 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. All data presented here are based on head counts. Some countries provide data from employment records, some conduct surveys, and some include only public sector employees.

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 as 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.

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 distributed by the Health Resources and Services Administration of the Department of Health and Human Services. After 2003, both federal and non-federal physicians are counted. For dentists the source is the American Dental Association’s publication Distribution of Dentists for 1998-2006, and annually thereafter [the document is accessible only to members or by purchasing it].

Data on nurses are obtained from the Occupational Employment Statistics database of the Bureau of Labor Statistics. However, only salaried employees of health care institutions are included.

Canada

Data on physicians are from the Canadian Institute of Health Information’s annual report on supply, distribution and migration of physicians; data on dentists from Canada’s Health Care Providers, 2000-2009 Reference Guide; and data on nurses from Regulated Nurse: Canadian Trends, 2005 to 2009. 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

Comparative data are from NOMESCO’s Health Statistics in the Nordic Countries and the Social and Health Indicators database.

Iceland

Iceland does not report hospital bed data to either OECD or NOMESCO. However, the total number of bed-days per year is published by the Directorate of Health (Landlæknisembættiđ). By dividing this by 365, the total number of beds can be determined, assuming full occupancy.

Norway

Data are from Statistics Norway’s Statbank tables on labour force participations. Health professionals refer to “persons aged 16-66 with health care education employed in region”. Nurses include public health nurses. Regional data for 2008 and 2009 refer to individuals aged 15-74; all other years refer to individuals aged 16-66. National data refer to individuals aged 16-66 for all years.

Sweden

Swedish national and regional data are from the National Board of Health and Welfare (Socialstyrelsen) database. Nurses include public health nurses. Health care personnel data can only be found in the Swedish version of the website.

Finland

Finnish data are from SOTKAnet, which includes only public sector employees employed by municipal health services. Only dentists employed in primary care are included. Nurses include public health nurses. Oulu data are obtained by combining the makunta of Kainuu and Pohjois-Pohjama.

Data are as reported in 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 who, together with various health care technicians and assistants, are referred to as supporting medical personnel. No data are reported from Taymyr, Evenkia, Koryak AO after 2007.