Health care delivery in the U.S. is the sum of many parts, all large and complex. With their imposing size and large payrolls, hospitals serve as a symbol of the sector.

According to the most recent data from the federal Center for Medicare & Medicaid, hospital activities represented 30% of all health-related expenditures nationally in 2022, the largest segment.

Physician and clinical services followed, claiming 20% of all expenditures. Retail prescription drugs amounted to 9%.

Rounding out the top five expenditure categories were: other personal & residential care services (6%), while two industries held down fifth place: dental services and nursing care facilities (both at 4%).

There is no reason to believe the distribution of expenditures is any different for health care delivery services provided in the greater Tri-Cities. Like the U.S., the health care sector here is big. Measured by workforce, it amounted to nearly 14% of the local economy, as seen in this Trends indicator.

Courtesy Benton-Franklin Trends

A pyramid structure

Despite buildings, equipment and sophisticated technologies, the heartbeat of the health care sector rests with its workforce. To understand its workforce is to understand the sector.

Imagine the health care workforce as a pyramid, a broad one. The layers of the pyramid are occupations, and are ordered by the length of time needed to prepare for the job.

At the tip of the pyramid are physicians and dentists.

According to the most recent (2022) data from Washington’s Employment Security Department ESD), these professionals composed slightly less than 3% of the health care workforce of the greater Tri-Cities. At its base are home health and personal care aides. Locally, they contributed nearly 35% to the health care workforce of the two counties in 2022.

Immediately below physicians and dentists are “mid-level” professions, such as pharmacists, nurse practitioners and physician assistants.

In 2022, they constituted slightly over 3% of all health care workers in the two counties. Immediately above home health and personal care aids are nursing and medical assistants. For the two counties, these made up nearly 11% of all local health care workers.

In need of nurses

The rub to the triangular shape to the health care workforce? Nurses.

By training, registered nurses fall immediately after the mid-levels. Yet, they vastly outnumber those professions and those that follow, such as technicians of various specialties (laboratory, radiological, surgical, pharmacy).

In 2022, the ESD survey put the number of nurses in the two counties at slightly over 2,400, or 16% of the entire workforce.

Nurses, then, outnumber local physicians by a factor of 5 to 6. Without nurses, health care delivery would grind to a halt.

Yet, they are in relatively short supply. Current openings tracked by ESD put nurses at the top of the list of occupations in the greater Tri-Cities that require at least a bachelor's degree.

ESD uses Burning Glass to scrape job posting sites to produce monthly a Top 20 list of occupations in highest demand. For most of 2023, openings for nurses landed the profession in first place, by far, followed by the core engineering specialties – mechanical, civil and electrical.

Another data product from Washington’s ESD offers occupational projections over the next few years for the two counties.

In light of current labor market conditions, it should come as no surprise that nurses land at or near the top for those occupations that require at least a bachelor’s degree.

For the 2021-26 period, ESD has recently projected annual openings for nurses to be 200 per year, an estimate exceeded only by elementary school teachers.

For the following five years, ESD’s forecast puts nurses in first place, with about 230 local openings expected per year.

If the local issuance of nurses were to come close to matching these numbers, there would be no cause for alarm. But this is hardly the case.

Data from the U.S. Department of Education on recent degrees granted make this clear. In the 2020-21 school year, bachelor’s degrees granted by Columbia Basin College in the health professions amounted to 51. This sum includes both nurses and dental hygienists.

Far more degrees in nursing have recently been granted by Washington State University, about 350 per academic year. But with campuses in Benton, Spokane and Yakima counties, this supply of new nurses is apportioned over many counties.

With forecasted annual openings over the next decade in Spokane County of about 600, the largest county in Eastern Washington can absorb all of WSU’s supply of new nurses and then some.

Of course, there are smaller academic programs throughout Eastern Washington, from Heritage, Walla Walla, Whitworth, and, soon, Eastern Washington universities. And like CBC, some community colleges will contribute to the flow of new nurses. But the sum still doesn’t match demand in the counties east of the Cascade.

As result, nurses appear near the top of “occupations in demand” here and elsewhere. That doesn’t seem likely to change anytime soon.

 D. Patrick Jones is the executive director for Eastern Washington University’s Institute for Public Policy & Economic Analysis. Benton-Franklin Trends, the institute’s project, uses local, state and federal data to measure the local economic, educational and civic life of Benton and Franklin counties.