TOP 10 Countries by Nurse-to-Physician Ratio (2025)
Nurse-to-Physician Ratios in 2025: where nursing teams are deepest
The nurse-to-physician ratio is a compact way to describe how responsibilities are shared inside a health system. It tells us how many nurses are available to support each doctor – for example, a ratio of 3:1 means three practising nurses for every one practising physician. Across OECD countries, the average is about 2.5 nurses per doctor, but the range is wide: from roughly one nurse per doctor in some systems to more than four in the best-staffed countries.
Why the nurse-to-physician ratio matters
A higher ratio typically reflects a model where nurses take on a broad clinical role: monitoring chronic conditions, coordinating care, providing patient education and running vaccination or screening programmes. When the ratio is too low, doctors end up doing tasks nurses could handle just as safely and often more efficiently – from routine injections to discharge planning. That can drive up costs and burnout without improving outcomes.
At the same time, there is no single “magic number” that works for every country. Systems with strong primary care and digital tools can operate safely with fewer hospital nurses per doctor, while ageing populations with high rates of chronic disease need more nursing capacity in hospitals, home care and long-term care to keep people out of acute beds.
The Top 10 below highlights health systems that have invested heavily in nursing relative to medical staff, using the latest OECD and WHO workforce data as a proxy for the 2025 landscape.
Table 1. TOP 10 countries by nurse-to-physician ratio (latest data, ~2021–2023)
Each row shows approximate densities of practising nurses and physicians per 1,000 population and the resulting nurse-to-physician ratio. Values are rounded and based on the latest available data before 2025; the ranking is therefore indicative but robust.
| Rank | Country | Nurses per 1,000 (approx.) | Physicians per 1,000 (approx.) | Nurses per doctor (ratio) |
|---|---|---|---|---|
| 1 | Japan | 11.8 | 2.5 | 4.7 : 1 |
| 2 | United States | 12.9 | 2.8 | 4.6 : 1 |
| 3 | Ireland | 13.5 | 3.0 | 4.5 : 1 |
| 4 | Finland | 15.0 | 3.4 | 4.4 : 1 |
| 5 | New Zealand | 14.2 | 3.3 | 4.3 : 1 |
| 6 | Denmark | 13.9 | 3.3 | 4.2 : 1 |
| 7 | Switzerland | 17.6 | 4.3 | 4.1 : 1 |
| 8 | Iceland | 16.0 | 4.0 | 4.0 : 1 |
| 9 | Norway | 18.7 | 4.8 | 3.9 : 1 |
| 10 | Luxembourg | 11.1 | 3.0 | 3.7 : 1 |
Note: Values are stylised and compiled from WHO, World Bank and OECD workforce indicators (nurses and midwives per 1,000 people; physicians per 1,000 people). Rankings and ratios can shift slightly as new data arrive, but these systems consistently sit at the top of the distribution.
What is the “golden middle” for nurses per doctor?
Table 2. Comparing the Top 10 to a 3:1 benchmark
Workforce planners often talk about a “golden middle” of around three nurses per doctor. Below that level, nurses struggle to cover basic tasks and doctors spend a lot of time on work that does not require their full training. Far above that level, a system may rely heavily on nurses to fill gaps created by physician shortages or rigid scope-of-practice rules.
The Top 10 group sits mostly in the 4:1 range, which is significantly above the OECD average but still compatible with high-income health systems that rely strongly on multidisciplinary teams.
| Band | Typical ratio | Examples and implications |
|---|---|---|
| Low or tight mix | Below 2 : 1 | Health systems where each doctor works with one nurse or less often report high overtime, difficulty covering night shifts and limited time for patient education. Chronic-care management is harder to scale, and doctors may become the default contact point for non-urgent tasks. |
| “Golden middle” | Around 3 : 1 | Common in many OECD countries with relatively balanced teams. Nurses can take on a broad clinical role, while doctors focus on diagnosis, complex decision-making and emergencies. When combined with good digital tools and primary care, this band can deliver strong access and quality with sustainable workloads. |
| High nursing intensity | 4 : 1 and above | Seen in the Top 10 countries such as Japan, Finland, Switzerland and the United States. These systems rely on large nursing workforces to staff hospitals, long-term care facilities and community services, but they also need robust retention and training policies to avoid chronic shortages and turnover. |
These bands are indicative and should not be used as rigid targets. The right ratio depends on disease burden, technology, urban–rural mix and how responsibilities are shared with other professionals such as pharmacists, midwives and community health workers.
The bar chart below visualises the gap between the OECD “golden middle” and the leading countries, all of which operate with roughly four or more nurses per practising doctor.
Ratios are rounded to one decimal place and based on the same data as Table 1. They represent practising workforce densities, not training capacity or total licensed staff.
Do higher nurse-to-physician ratios translate into better outcomes?
Intuitively, having more nurses per doctor should make it easier to monitor patients, prevent complications and keep hospital stays short. Cross-country data generally support this intuition: countries with high nurse-to-physician ratios tend to report better healthy life expectancy and lower rates of avoidable hospitalisation. But the relationship is far from mechanical, and several notable outliers remind us that workforce indicators are only one piece of the puzzle.
Scatter plot: nurse-to-physician ratio vs healthy life expectancy
The stylised scatter plot below links each Top 10 country’s nurse-to-physician ratio to its approximate healthy life expectancy at birth (HALE). The pattern suggests that once countries pass the 3:1 threshold, additional gains are gradual rather than dramatic and can be overshadowed by other factors such as smoking, obesity, income inequality or traffic injuries.
HALE values are rounded and indicative, based on WHO and OECD life expectancy estimates. They illustrate the broad relationship rather than provide precise country rankings.
How planners should use (and not misuse) this indicator
For ministries of health and hospital managers, the nurse-to-physician ratio is most useful as a warning light and a conversation starter. A ratio below 2:1 in an ageing population virtually guarantees pressure points in hospitals and long-term care. A very high ratio may reflect deliberate investment in advanced nursing roles – or, alternatively, difficulty recruiting and retaining doctors.
In practice, expert reviews of high-performing systems highlight a handful of common themes:
- Task-sharing is explicit, not accidental. Countries near the top of the ranking tend to specify which tasks nurses can perform independently, from managing stable chronic diseases to adjusting medication doses within agreed protocols.
- Training follows the model of care. Expanding the scope of nursing practice only works if undergraduate and postgraduate curricula equip nurses with the skills to take on more complex clinical judgement and coordination tasks.
- Workforce planning spans sectors. Ratios in acute hospitals mean little if community nursing, home-care services and long-term care facilities face chronic understaffing, forcing avoidable admissions.
- Data are updated regularly. Because migration, retirement waves and policy reforms can change workforce numbers quickly, relying on snapshots that are five or ten years old can lead to wrong conclusions about “too many” or “too few” nurses.
When used together with indicators for bed capacity, primary-care strength and financial protection, the nurse-to-physician ratio becomes a powerful tool for stress-testing health-system resilience and designing realistic workforce strategies up to 2030 and beyond.
Primary data sources and methodological notes
- World Health Organization – Global Health Workforce Statistics and National Health Workforce Accounts (NHWA), indicator “Density of nursing and midwifery personnel (per 10,000 population)” and “Density of medical doctors (per 10,000 population)”. Open WHO workforce data
- World Bank World Development Indicators – “Nurses and midwives (per 1,000 people)” and “Physicians (per 1,000 people)” series, latest available values up to 2022 used as a proxy for 2025 rankings. Nurses and midwives per 1,000 | Physicians per 1,000
- OECD – Health at a Glance 2023/2025, chapters on nurses, doctors and health workforce, including comparative figures on the ratio of nurses per doctor across OECD members. Access OECD Health data
- Our World in Data – processed WHO/OECD workforce indicators and life expectancy/HALE series, used to align country values and cross-check trends. Nurses per 1,000 dataset
- National and regional workforce studies (e.g. New Zealand and European Union reports) providing additional context on high nurse-to-physician ratios and projected shortages. OECD health workforce hub
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