Brief Health Workforce Trends in State Legislatures

Health workforce remains a priority across state legislatures. At least 45 states, Washington, D.C., and Puerto Rico enacted more than 580 bills in 2024 addressing the shortage and maldistribution of health care professionals, particularly in rural and underserved communities, in a variety of ways.

NCSL hosted its inaugural Health Workforce Peer Learning Group on Jan. 17, 2025, in Salt Lake City. The meeting brought together 20 state legislators to discuss health workforce priorities for 2025, as well as: 

• Federal updates.
• Data collection and analysis.
• Licensure portability. 
• Scope of practice. 
• Recruitment and retention. 

Federal Updates 

As health workforce challenges exist nationwide, the Health Resources and Services Administration maintains several programs to bolster health workforce occupations. 

Candice Chen of HRSA’s Bureau of Health Workforce highlighted federal investments in training grants, scholarships and loan repayment, graduate medical education and workforce analysis. Chen emphasized that there is no single policy that will address all workforce challenges and states must balance a variety of strategies.

Data Collection and Analysis 

Attendees took a deeper dive into how their states measure who is providing what services, to whom and where. Hannah Maxey of the Bowen Center for Health Workforce Research and Policy at Indiana University shared a variety of sources for workforce data. Maxey discussed Indiana’s experience standardizing data collection during licensure renewal processes, and the Bowen Center’s Cross Professional Minimum Data Set, which has been piloted in other states, including Utah.

Susan Skillman of the Center for Health Workforce Studies at the University of Washington shared questions states may ask using data, including practice location, specialty, vacancies and populations served. Skillman highlighted the Washington Health Workforce Sentinel Network, which surveys employers to identify signals of changes health workforce demand.

Licensure Portability  

To ensure patient safety and quality of care, states are responsible for licensing health care occupations. At least 42 states and the District of Columbia enacted 260 bills in 2024 on licensure and certification, including interstate licensure compacts (Kentucky and Rhode Island), temporary or provisional licenses (Hawaii and Michigan) and background check requirements (Florida and Pennsylvania). 

Many states are exploring licensure portability measures, or the ability for licensed health professions to practice across state lines. Mei Wa Kwong of the Center for Connected Health Policy highlighted the impact of compacts, reciprocity, registries and licensure exemptions on telehealth access.

Lisa Robin, of the Federation of State Medical Boards discussed how to promote quality, safe care for patients while creating alternative licensure pathways for international medical graduates.

Scope of Practice  

States set the scope of practice, balancing the need for quality, safe care and allowing professionals to practice to the full extent of their education and training. At least 34 states and the District of Columbia enacted 119 bills related to scope of practice for dental hygienists (Virginia), pharmacists (Arizona), physical therapists (Alabama), physician assistants (Utah) and social workers (Illinois). 

NCSL highlighted new 50-state and territory information on certified registered nurse anesthetist scope of practice, including physician relationship requirements for practice and prescriptive authority.