---
title: "Healthcare Is Doing All the Hiring, and Licensing Boards Are Deciding Who Gets In"
description: "Health care generated 121% of US net job growth last year; the gatekeepers training its workers have other priorities"
author: "Nate Ledger"
published: 2026-09-26T20:46:12.584Z
modified: 2026-10-22T21:25:11Z
url: https://rews.cc/a/healthcare-is-doing-all-the-hiring-and-licensing-boards-are--0c7f88
language: en
tags: ["healthcare", "education", "jobs", "ai", "nursing", "us"]
publisher: "Rews (https://rews.cc)"
---

# Healthcare Is Doing All the Hiring, and Licensing Boards Are Deciding Who Gets In

*Health care generated 121% of US net job growth last year; the gatekeepers training its workers have other priorities*

By Nate Ledger · September 26, 2026 · https://rews.cc/a/healthcare-is-doing-all-the-hiring-and-licensing-boards-are--0c7f88

## In brief

- Health care generated 436,000 of 360,000 net US jobs added in 2025, or 121% of net job growth; other sectors lost 76,000
- BLS: health care and social assistance added 680,500 jobs from March 2025 to March 2026 while total payrolls barely moved
- The average hospital has 43 unfilled nursing positions; HHS projects shortages in every health care profession into the next decade
- US nursing schools turned away 93,176 qualified applications in 2025, citing shortages of faculty, clinical sites and preceptors
- Nurses hold 5 of 9 seats on California’s Board of Registered Nursing, with no representation from hospitals, providers or payors

Fifteen years ago, Marc Andreessen published the essay that gave a generation of investors their favorite sentence: software is eating the world. The claim was that software companies were “poised to take over large swathes of the economy,” and it has aged into something more modest than prophecy. Software companies now represent 15% of the S&P 500’s market cap, up from about 5% in 2011, which is real growth but not conquest. AI may eventually deliver some generous version of the prediction, but as the Forbes contributor Ryan Craig points out, in Andreessen’s business “being off by years, let alone decades, is the same as being wrong.” In the meantime, as [Forbes reported](https://forbes.com/sites/ryancraig/2026/09/25/healthcare-is-eating-the-world/), a different industry has quietly done the eating, and it did it the old-fashioned way: by hiring.

The numbers are stark enough to require a second reading. Last year the U.S. economy added 360,000 net jobs. Health care generated 436,000 of them, which is 121% of net job growth, which in turn means that every other sector of the American economy, taken together, shed 76,000 jobs. This is not a one-year accident. Health care has added jobs every month since January 2022 and accounts for nearly half of all net job growth since the pandemic, a run powered in large part by the aging of the country.

The exact denominator is a little slippery, because the official count of 2025 keeps moving. In February the Bureau of Labor Statistics’ annual benchmark revision pushed last year’s payroll employment down by 403,000 jobs, leaving just 181,000 for the whole year, which Laura Ullrich of [Indeed Hiring Lab](https://hiringlab.indeed.com/2026/02/11/january-2026-jobs-report/) called “an exceptionally weak year by almost any standard.” So the 360,000 figure is generous to the rest of the economy, if anything. Ullrich’s description of the labor market was a job market at “an almost complete standstill outside of the essential healthcare sector.” Whatever number you divide by, health care is the numerator.

The government’s own year-over-year figures make the point without any ratio games. From March 2025 to March 2026, according to the [BLS](https://www.bls.gov/opub/ted/2026/health-care-and-social-assistance-employment-increased-by-2-9-percent-or-680500-from-march-2025-to-march-2026.htm), employment in health care and social assistance rose 2.9%, or 680,500 jobs, while total nonfarm payrolls “changed little on net.” That category is a bit bigger than health care alone, since it folds in social assistance, but look at the competition. The next-best performer, leisure and hospitality, added 176,000. The federal government lost 330,000 jobs, transportation and warehousing lost 121,200, and information, which is roughly where the software-eating-the-world people work, lost 76,000. Health care and social assistance added nearly four times as many jobs as the runner-up, in a year when the total barely moved.

**One sector did the hiring** US employment change by industry, March 2025 to March 2026, jobs

|  | Change in employment (jobs) |
| --- | --- |
| Health care and social assistance | 680,500 |
| Leisure and hospitality | 176,000 |
| Local government | 135,000 |
| Construction | 57,000 |
| Other services | 35,000 |
| Private educational services | -16,700 |
| Mining and logging | -17,000 |
| Retail trade | -29,600 |
| Professional and business services | -40,000 |
| State government | -47,000 |
| Financial activities | -67,000 |
| Manufacturing | -75,000 |
| Information | -76,000 |
| Transportation and warehousing | -121,200 |
| Federal government | -330,000 |

Source: [US Bureau of Labor Statistics](https://www.bls.gov/opub/ted/2026/health-care-and-social-assistance-employment-increased-by-2-9-percent-or-680500-from-march-2025-to-march-2026.htm). Seasonally adjusted; preliminary. Two industries with changes under 10,000 omitted: utilities (+4,600) and wholesale trade (-7,400).

And it keeps going. In the [September jobs report](https://www.bls.gov/news.release/empsit.htm), released on Oct. 2, total payrolls rose by 29,000 and health care by 17,000. Over the prior 12 months the whole economy averaged 45,000 new jobs a month and health care averaged 33,000. Divide one by the other and health care accounted for about 73% of job growth over the past year, which by recent standards counts as health care having an off year. September was softer still: the 17,000 was below the sector’s average, and nursing and residential care facilities lost 9,000 jobs, while ambulatory services added 13,000 and hospitals 12,000.

The Department of Labor projects millions more new health care jobs in the next few years. In its [2025–2035 projections](https://www.bls.gov/news.release/ecopro.nr0.htm), the BLS expects the whole economy to add 5.9 million jobs, and health care and social assistance to add more than 2.2 million of them, about 37.0% of the total. Healthcare support occupations are projected to grow 13.3% and healthcare practitioners 8.0%, the two fastest-growing occupational groups, together accounting for almost a third of new jobs. Nurse practitioners are projected to grow faster than any other detailed occupation, at 41.0%. And unlike the software boom, this one is geographically indiscriminate: health care providers are dominant employers in essentially every market in the country, not just Silicon Valley and the big cities.

## Short of everyone

The demand side of the story is even bigger. Nearly every major health care profession faces a talent shortage. The U.S. is short tens of thousands of doctors, particularly in lower-paid primary care and in rural areas, and short hundreds of thousands of nurses and allied health professionals. There are also shortages of hundreds of thousands of psychiatrists, therapists and counselors. The Department of Health and Human Services projects significant shortfalls in every single health care profession into the next decade.

![A stethoscope lifts several briefcases with red cords against a teal background, while three more briefcases sit below.](https://rews.cc/img/46f6628a82a556470069c2e579ab65c93fbdf67a.webp)

The specific projections are big even at their gentlest. The Association of American Medical Colleges [projects a shortage](https://www.aamc.org/news/press-releases/new-aamc-report-shows-continuing-projected-physician-shortage) of between 13,500 and 86,000 physicians by 2036, including between 20,200 and 40,400 primary care doctors. For nurses, the American Association of Colleges of Nursing cites HHS’s Health Resources and Services Administration projecting a shortage of 267,330 full-time registered nurses by 2028. HRSA’s earlier projections, [as summarized by the AONL](https://www.aonl.org/news/HRSA-predicts-nursing-shortage-through-2037), put the 2027 shortfall at 24% of needed nurses in nonmetro areas against 7% in metro ones, which is the rural doctor problem again, with nurses.

At the hospital level, the average hospital has 43 open, unfilled nursing positions. The AACN’s nursing shortage fact sheet cites a 2026 NSI survey putting the acute-care RN vacancy rate at 8.6%, down from 9.6% in 2024, with hospital RN turnover of 17.6% and 56 to 102 days to recruit an experienced nurse. A vacancy that takes two to three months to fill, at a hospital that loses about a sixth of its nurses a year, is a vacancy that never really closes.

Here is where the story stops being a labor-market story and becomes an incentives story. When one sector of the economy is generating all the net job growth and projecting shortages in every occupation, you would expect the pipeline into that sector to be widening as fast as physically possible. And in part, it is. Students are flooding into health sciences programs; undergraduate enrollment in health care programs is up about 15% since the medical drama *The Pitt* premiered, and the most popular show on television is, once again, about health care. The AACN reports that nursing schools received 821,491 applications in 2025, and entry-level bachelor’s enrollment rose 7.6% to 283,303. Health care is also the one field that even the AI pessimists consider safe from automation, at least for now.

![Five students with backpacks climb a staircase rising from an open book toward a giant yellow shirt against a blue background.](https://rews.cc/img/2933339b8897b8c07698a49d197a77b103aa5579.webp)

Colleges and universities, a sector that is not adding jobs and very much needs the students, have announced hundreds of new programs in medicine, nursing, behavioral health and allied health, including 10 new medical schools this year alone. For higher education this is close to ideal: programs that answer a market signal, with clear pathways to good jobs, enrollment growth, and curricula that mix classroom instruction with real clinical work.

## Who teaches the nurses

But two bottlenecks stand between the market signal and the supply response, and neither is the market’s fault. The first is faculty. Almost nobody wants to teach this stuff, because teaching it means taking a pay cut. The median salary for a master’s-level nurse is $132,000; for a master’s-level nursing professor it is $83,000. That $49,000 gap is what a nurse gives up each year to train the next generation of nurses, which explains rather a lot about the shortage of nursing professors. The AACN’s faculty fact sheet puts the average master’s-prepared professor’s pay at $82,762 and counts 1,588 full-time faculty vacancies, a national vacancy rate of 7.2%. About 80.9% of those openings require or prefer a doctorate.

That last number is where the problem starts eating its own tail. The jobs that need filling mostly want PhDs and other doctorates, and enrollment in nursing PhD programs fell for the 11th consecutive year in 2025, to 4,077 students, down 20.8% from 5,145 in 2013. Meanwhile graduate nursing programs turned away nearly 17,000 qualified applications last year, partly for lack of faculty. So: there aren’t enough professors, so programs that train future professors turn people away, so there will be fewer professors. You could not design this better if you were trying to.

Compounding it is the preceptor gap: there aren’t enough working professionals willing to supervise student clinical placements, and some universities have responded by quietly shifting the burden of arranging those placements onto the students themselves. Craig’s prescription for colleges is unglamorous: if they want to ride the health care wave, they need to pay health care faculty more and put real budget behind clinical placements. Which is a fine answer to the first bottleneck. It doesn’t touch the second.

**Where the nursing pipeline narrows** The checkpoints between student demand and a filled hospital vacancy, as described by Forbes

| From | To | How |
| --- | --- | --- |
| Students apply *(Enrollment up about 15%)* | Faculty to teach *($49,000 pay cut to teach)* | needs |
| Faculty to teach *($49,000 pay cut to teach)* | Clinical placements *(Preceptor gap)* | needs |
| Clinical placements *(Preceptor gap)* | State board approval *(Programs, sites, faculty hires)* | each site approved |
| State board approval *(Programs, sites, faculty hires)* | Licensed graduates | capacity set |
| Licensed graduates | Hospital vacancies *(43 per hospital on average)* | fill |

![Where the nursing pipeline narrows. The checkpoints between student demand and a filled hospital vacancy, as described by Forbes](https://rews.cc/img/810bd92fd04c783678d9ad862931570f7e2443ae.webp)

Based on [Forbes](https://forbes.com/sites/ryancraig/2026/09/25/healthcare-is-eating-the-world/)

## Turned away at the door

The second bottleneck is bigger, and it is structural. Health care is the hottest employment sector in America and also, not coincidentally, one of the hardest to enter, because entry runs through licensure. Nearly 100,000 qualified nursing applicants were turned away last year. These were people who met the standards; they were turned away because licensure-driven capacity constraints meant there was no room for them.

The AACN’s count is a little more precise and a little more careful. U.S. nursing schools turned away 93,176 qualified applications in 2025, and the association stresses that these are applications rather than applicants, since one person can apply to several schools and some of those rejected may have enrolled elsewhere. Of the total, 75,255 were for entry-level bachelor’s programs, 9,859 for doctor of nursing practice programs, 6,496 for master’s programs, 1,066 for RN-to-BSN programs and 500 for PhDs. The schools’ stated reasons are insufficient clinical placement sites, faculty, preceptors and classroom space, plus budget cuts. Put the 93,176 next to the 821,491 applications, and roughly one in nine qualified applications ended in a no for want of room.

**Qualified, and turned away** Qualified applications not accepted by US nursing schools in 2025, by program

|  | Qualified applications turned away (applications) |
| --- | --- |
| Entry-level BSN | 75,255 |
| Doctor of Nursing Practice | 9,859 |
| Master's | 6,496 |
| RN to BSN | 1,066 |
| PhD | 500 |

Source: [American Association of Colleges of Nursing](https://www.aacnnursing.org/news-data/all-news/article/schools-of-nursing-see-enrollment-increases-across-most-program-levels-signaling-strong-interest-in-nursing-careers-1480). Counts applications, not individual applicants. Total: 93,176. Survey of 998 schools, 89.5% response rate.

You might notice that the AACN’s list of reasons sounds like a resource problem, and Craig calls it a licensure problem. I think these are closer together than they look. Launching or expanding a health care program requires approval from state boards and accreditors that measure the inputs that are easy to count, which correlate only questionably with patient outcomes. If the board decides which clinical sites count and which faculty hires are acceptable, then “not enough clinical sites” and “not enough faculty” are partly descriptions of the market and partly descriptions of the rulebook.

## The California case

California’s Board of Registered Nursing is the case study. Its authority covers not just approval of new programs and enrollment expansion but every clinical placement site and the hiring of every faculty member. Deferrals on program decisions are routine and the process can take years. The board disfavors non-acute clinical settings, which is an awkward preference given that most health care is actually delivered in non-acute settings.

The board describes itself as a state agency created “to protect the public by regulating the practice of registered nurses,” and says it has approved more than 140 prelicensure nursing programs. It has a defense on the numbers, too. According to the state Senate’s 2026 sunset-review background paper, the board reports that since 2022 it has approved 62 enrollment increases, denied 3 (one of which was later deferred and approved), deferred 3 to a future meeting and reduced 8, granting less than the school asked. By its own tally, then, the board mostly says yes. That is less of a rebuttal than it seems: a count of decisions tells you how requests fared once they were filed, not how long they took or how many were never filed because a school looked at the clinical-site rules and gave up. Nobody publishes that last number, which is sort of the problem.

Now look at who sits on it. By statute, nurses hold 5 of the 9 seats: two nurses in direct patient care, one advanced practice nurse, one nurse administrator and one nurse educator. The governor appoints seven members, and the Legislature appoints two of the four public members. The public members currently include a teachers union official, an attorney, a retired tech executive and a retired therapist. There is no representation from hospitals, from providers or from payors, which is to say, no one whose job or balance sheet depends on there being enough nurses.

![A large hand pinches an hourglass filled with orange human figures, restricting their passage into the lower chamber against a blue background.](https://rews.cc/img/618c9e6c66386ad7b11689bf007f10eeb48477a9.webp)

A board majority composed of incumbent practitioners has a perfectly understandable economic interest in restricting the supply of new entrants, because scarcity of labor is what supports wages in that labor. Nobody around the table has a comparable incentive to close the talent gap, to help more young Americans start health care careers, or to rescue colleges from falling enrollment. The arrangement defends itself in the language of patient protection, which is real as far as it goes. But a public harmed by shortages, through less care and more expensive care, is also a public that licensing policy is supposed to protect, and the walls and moats around a profession are a cost to that public, too.

## Who could fix it

The political economy of fixing this is unpromising in a familiar way. The beneficiaries of the status quo are concentrated, organized and already sitting on the board. The people harmed by it are diffuse and will never hold a meeting about it: patients paying more, would-be nurses turned away, hospitals with 43 vacancies. Guilds like state nursing boards are not about to reform themselves. The Forbes piece suggests that colleges and universities, with enormous enrollment riding on future health care programs, may be the institutions best positioned to push states toward occupational licensure reform. They have their own conflicts, since they benefit from some of the degree requirements the boards impose, but deregulation would let them grow programs to meet, or at least approach, actual demand.

It is a funny coalition to bet on. Universities are the institutions that lose money on every nursing professor they fail to hire at $83,000, and that send students off to find their own clinical placements. Their pitch to the legislature would amount to: please let us have more of the thing we are already struggling to staff. Still, of everyone with a stake in more nurses, they are the only ones with lobbyists, a budget line and a reason to show up.

That leaves a strange equilibrium. The sector carrying the entire U.S. jobs market on its back is rationed by committees whose membership is legally tilted toward the people the rationing enriches. Software, it turned out, was easy to let into everything. Health care is doing the eating anyway, one licensed seat at a time.