Texas’ health care and social assistance sector has grown 123% in the past 30 years, adding more than one million jobs – but it hasn’t kept pace with the state’s growing demand.
State officials outlined the state of Texas’ health care workforce during a House Committee on Public Health hearing last week. Despite being Texas’ largest and fastest growing industry, the health care industry’s need for workers continues to “outpace supply” across the state, officials said.
Mariana Vega, director of labor market information at the Texas Workforce Commission, said the health care sector has grown faster than all other industries combined, driven largely by “population expansion.”
“Texas continues to lead the nation in population growth, adding hundreds of thousands of new residents each year,” Vega said. “As a result, demand for health care services continues to grow across all regions of the state.”
Texas’ population growth significantly slowed last year, but it still had the largest increase in the county. In North Texas alone, the population is expected to reach nine million people over the next year.
In addition to a growing population, Kristen Benton, Texas Board of Nursing’s executive director, said the population is also aging.
“As we get older, we have more demand for health care,” she said.
How bad are workforce shortages?
Nearly 1.4 million Texans are employed in health care occupations. But, Vega said in many regions in the state only about 30 to 50% of health care employers' needs are being met, while in other regions as little as 25% of the need is met.
“Texas is facing a growing imbalance between health care workforce supply and demand,” she said. “This gap is clearly reflected in real-time job demand.”
Health care workforce shortages are seen in both the high skill and “entry level” ends of the industry, affecting dozens of occupations statewide, according to Vega.
Registered nursing positions, or RNs, are one of the most in-demand jobs in Texas, accounting for more than 158,000 postings statewide. Home health and personal care aids also ranked among the highest in demand with more than 43,000 job postings.
At the same time, Vega said the health care and social assistance sector is projected to add more jobs than any other industry in Texas – nearly 294,000 by 2032.
While workforce shortages are a concern for the entire industry, state officials and health care leaders in Texas focused heavily on the shortage of nurses and doctors in Texas.
Texas nurses most in demand
Dr. Manda Hall, who oversees the community health improvement division at the Texas Department of State Health Services, said there are more than 345,000 nurses practicing in Texas across licensure levels.
“Texas has the third greatest number of nurses with active licenses in the country, only behind California and New York,” she said.
Based on licensure data, the number of RNs registered in Texas has increased by almost 25% over the past decade. At the same time, Hall said the data shows the number of advanced practice registered nurses, or APRNs, has more than doubled.
Despite the growing workforce, Hall said the projected shortage of both RNs and APRNs is expected to increase over the next decade.
A significant factor in Texas’ nursing shortage is the availability of training, according to Benton with the Texas Board of Nursing. But, the state is working to approve more programs to increase training capacity.
Texas had about 220 approved nursing programs at the end of fiscal year 2025, with most being APRN or RN programs.
“We are busy,” Benton said. “We get a lot of proposals for education programs, which is a good thing.”
Over the past five years, Benton said the state has approved more than 25 programs. The Texas Board of Nursing is in the process of reviewing 11 more programs, according to Benton. She said she anticipates several going to the board next month for approval.
Benton notes that not every program is able to offer admission to all qualified applicants.
“The number one reason…is the lack of clinical space for clinician education training,” she said. “The second is lack of qualified faculty available to teach.”
The Texas Board of Nursing, as well as the Texas Workforce Commission, have been working to address the workforce shortages and the barriers to training, including a program making it easier for bedside nurses to become educators.
Texas’ physician shortage grows
The state projects shortages in general internal medicine, geriatrics, pediatrics and psychiatry to increase significantly in the next several years.
Despite a 25% increase in primary care physicians between 2016 and 2025, Hall said unmet demand for primary care physicians is projected to increase from 36% in 2022 to 41% by 2036.
In addition, the number of communities without primary care is growing – from 32 counties in 2020 to 40 counties last year.
Similar to the nursing workforce, availability of training and education is a significant factor contributing to the shortage of physicians.
Dr. Wynn Rosser, commissioner of higher education and CEO of the Texas Higher Education Coordinating Board, said in the current state budget, graduate medical education received more than 30% more funding than the previous budget.
He said that’s helped to increase the number of first year medical slots available in Texas.
“This continued investment demonstrates Texas's commitment to strengthening physician training capacity and meeting health care needs of our growing population,” Rosser said.
Despite the growth, Dr. Adrian Billings, a physician from West Texas and Texas Medical Association representative said, said rural residents and physicians need more medical professionals to serve in rural areas – which he said requires some action from state lawmakers and education leaders.
“We must admit more rural students into medical schools, and we have to enable more rural medicine exposure to trainees if we want to improve access to care for rural Texas,” Billings said.
Rural students who want to pursue a career in health care are often at a disadvantage, according to Billings.
Rural schools often lack access to programs that Billings said can be strong predictors of success, like advanced placement or international baccalaureate courses. He also said the need to travel to larger urban areas can present a social challenge for rural students.
“Rural students come with this incredible asset of what we want in health care providers,” he said. “They’re diverse and they’re rooted in the community that helped raise them, but it’s really the academics.”
Billings said investing in rural students could be critical in addressing the workforce need, since he said studies show rural residents are most likely to return to their rural community or serve a similarly sized community.
Family physicians only make up about 15% of the physician workforce nationwide, but provide more than 40% of care in rural areas.
Several studies, including a recent study published in Health Affairs, show that most family physicians end up practicing where they are training in their residency program.
Billings said that’s why it’s critical to focus on adding more residency training programs in rural areas.
“Rural training tracks and residency programs where future physicians are training in rural, under-resourced settings, help prepare physicians for practice in those settings,” he said. “We should continue building pathways specifically to produce future rural physicians.”
Abigail Ruhman is KERA’s health reporter. Got a tip? Email Abigail at aruhman@kera.org.
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