Published Jan. 6, 2021


Health care workers across the United States have been stretched thin for months as the COVID-19 pandemic has gripped the nation. A winter surge in cases due to colder weather and holiday gatherings, a mutated strain of the virus, shortages due to infections among staff and the responsibility of administering millions of vaccines are straining many health care workers beyond their capacity.

To determine which states’ health care workers are most feeling the pinch, we analyzed data from the Centers for Disease Control and Prevention and the Health Resources & Services Administration to compare COVID-19 case rates with the number of available nurses, paramedics, doctors, pharmacists and psychologists in those areas. 

Key Findings

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Table showing the 20 states with the most overworked health care workers due to COVID-19

According to our findings, Iowa is home to the most overworked health care workers in the nation amid the COVID-19 pandemic

The ratio of COVID-19 cases to health care workers in Iowa since January 2020 is reflected in the table below.

Iowa Frontline Workers During the COVID-19 Pandemic
Health Care Service Provider Number of Workers in Iowa COVID-19 Cases Per Worker Since January 2020
All M.D. 7,529 35.4













The states with the most overworked health care professionals tend to cluster in the Midwest and the South. Along with Iowa, the five states with the most overworked health care workers were Nevada, Alabama, Idaho and Nebraska. 

“Care is about more than a room with a hospital bed. It’s about medical professionals taking care of patients. If you don’t have the staff to do that, people are going to die.” – John Henderson, Chief Executive of the Texas Organization of Rural & Community Hospitals1

Most Overworked Nurses

Nurses are truly on the front lines of the pandemic. They’re often administering tests and typically serve as the first point-of-contact for a COVID-19 patient. And many nurses may now be tasked with administering the COVID-19 vaccine. 

Even during non-pandemic times, nurses are accustomed to working long days and nights, but the coronavirus has staffs stretching ever thinner. 

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Graphic showing the states with the most overworked nurses during COVID-19

Utah has seen 10.9 COVID-19 cases for every nurse since January 2020. While Utah’s COVID-19 case count of more than 283,000 is only the 28th-highest in the U.S., the state has fewer than 23,000 registered nurses (RNs). The intensive care unit at the University of Utah Hospital has had to resort to 36-hour shifts at times, with a nurse-to-patient ratio reaching four times the recommended limit.

At the other end of the spectrum is a state like Pennsylvania. While Pennsylvania has seen more than twice as many COVID-19 cases as Utah, it has more than six times as many RNs, for a rate of just 4.5 cases per nurse since the beginning of the pandemic. 

“I am concerned about burnout and the mental health of the nurses and care providers working today who are living more loss and trauma in a week or month than they may have seen in their entire career.” – April Hansen, RN, MSN, Executive Vice President of Workforce Solutions and Clinical Services at Aya Healthcare2

Most Overworked EMTs and Paramedics

EMTs and paramedics may be called if a person with COVID-19 experiences breathing difficulty and has no other transportation to an emergency room. 

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Graphic showing the states with the most overworked EMTs and paramedics during COVID-19

Nebraska and Iowa have each experienced more than 200 COVID-19 cases for every EMT or paramedic. Ambulance crews in California were recently told not to transport patients who had little chance of survival. And that’s in a state where the rate of 104.9 cases-per-paramedic isn’t even among the 10 worst in the country.

“We’re running out of ambulances, and our response to 911 calls is getting longer and longer.” – Cathy Chidester, RN, MSN, Director of the Los Angeles County Emergency Medical Services Agency3

Most Overworked Medical Doctors

Many people with COVID-19 develop severe symptoms and complications that require more intensive medical attention. Pneumonia, respiratory failure, septic shock and cardiac injuries are just a few of the potentially fatal complications that can place a COVID-19 patient on a ventilator or in the intensive care unit. 

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Graphic showing the states with the most overworked MDs during COVID-19

The doctors who care for patients with these severe complications are just as overworked as many other health care workers, with nearly 41 COVID-19 cases for every doctor in North Dakota.

One doctor in Texas worked at least 268 consecutive days, and Texas doctors aren’t even among the most overworked doctors in the nation, according to our data.

“It’s getting to the point where the doctor’s offices can’t see everybody. We are 60 patients behind that haven’t been seen yet, and in order to get our staff home and rest, we have to cut patients off, otherwise we will be there all night long.” – Dr. Darren Waters, President at Greater Mobile Urgent Care4

Most Overworked Pharmacists

Only one drug, remdesivir, has been approved by the Food and Drug Administration for the treatment of COVID-19, and only in certain situations. But COVID-19 patients are sometimes prescribed a round of antibiotics, steroids or other medications upon their discharge. 

The increased demand for prescription orders has squeezed the capacity for pharmacists. CVS and Walgreens responded by implementing signing bonuses during a recent hiring frenzy that included bringing on retirees and the recently unemployed.

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Graphic showing the states with the most overworked pharmacists during COVID-19

In Nevada, there’s been an average of 131 COVID-19 cases for every pharmacist. That ratio is nearly 25% higher than that of Idaho, the state with the second-highest total. 

Pharmacists were the only type of health care workers in Iowa who weren’t among the 10 most overworked in the nation. Iowa has had 69.9 COVID-19 cases for every pharmacist in the state. 

Most Overworked Psychologists

A potentially overlooked type of health care worker on the front lines of the pandemic are psychologists, who are providing treatment not just to sick patients but also to the overstressed doctors and nurses treating them. 

Even people who have not been directly affected by the novel coronavirus are seeking help. The American Psychological Association (APA) reports that 74% of psychologists who treat patients with anxiety and depression have seen an increased demand for those services since the start of the pandemic. 

“These data underscore what we already feared,” said APA’s Chief Executive Officer Arthur C. Evans Jr., PhD, in a release announcing the findings. “The coronavirus pandemic is taking a heavy emotional toll on many Americans.” 

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Graphic showing the states with the most overworked psychologists during COVID-19

Iowa psychologists are the most overworked in the nation, with a rate of more than 327 COVID-19 cases per professional.  ​


The COVID-19 pandemic has pushed the U.S. health care system to the brink and caused shortages and burnout among multiple types of health care employees. Capacity levels are not consistent across every state as some areas of the country experience far worse case-to-employee ratios than others. 

Methodology and Data Notes

We compared the total number of COVID-19 cases there have been since January 2020 in each state to the total number of each type of health care worker per state. We used the following sources for our data:


1 Goldhill, Olivia. (Nov. 19, 2020). ‘People are going to die’: Hospitals in half the states are facing a massive staffing shortage as Covid-19 surges.

2 McLemon, Lianna Matt. (Nov. 30, 2020). COVID-related nursing shortages hit hospitals nationwide. Center for Infectious Disease Research and Policy.

3 City News Service. (Jan. 2, 2021). ‘We’re running out of ambulances’; county reports 15,701 new COVID-19 cases as surge continues. Long Beach Post News.

4 Easterwood, Gabby. (Dec. 30, 2020). ‘We are running on fumes:’ Mobile doctors finding exhaustion with the new surge in covid cases. WKRG News 5.

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