Perspectives on Minnesota’s Health Industry Workforce

1. Perspectives on Minnesota’s Health Industry Workforce Minnesota Rural Health Conference July 19, 2005 Duluth, MN Jay Fonkert Office of Rural Health and Primary Care MN Department of Health

2. Opinions expressed in this presentation are the sole responsibility of the author and do not represent opinions or positions of the Minnesota Department of Health or the State of Minnesota.

3. Workforce Analysis Program Office of Rural Health and Primary Care Annual surveys of licensed health professionals to better understand workforce demographics and disparities in health care access

4. Health care industry accounts for 11 percent of all private sector employee compensation in Minnesota. Health Services Other private nonfarm industries Source: Bureau of Economic Analysis, regional accounts, 2003

5. Ambulatory Care employees receive more than half of all health care compensation in Minnesota. Nursing and residential care facilities Ambulatory Care Hospitals Source: Bureau of Economic Analysis, regional accounts, 2003

6. Some counties with high dependence of health care employment Health care and social services employment as % of wage and salary employment Olmsted (Rochester) 37% Wilkin (Breckenridge) 25% Chisago 22% Grant 21% Mille Lacs 20% St. Louis (Duluth) 20% Statewide: 13% Source: U. S. Bureau of Economic Analysis, Regional accounts, 2002

7. Minnesota’s Healthcare Workforce Estimated active at MN sites, 2004

8. Minnesota’s Healthcare Workforce Estimated active at MN sites, 2004

9. Largest Minnesota health occupations Source: Minnesota Department of Employment and Economic Development, 2nd Quarter 2004.

10. Half of Minnesota health care workers work outside hospitals or physician offices. Hospitals All other sites Physician and dentist offices Nursing care facilities Source: U.S. Census Bureau, County Business Patterns, 2002.

11. Male – Female Composition of Workforce Physicians Physician assistants RNs LPNs RCPs Physical therapists Dentists Dental assistants Dental hygienists Source: MDH, Office of Rural Health and Primary Care, 2004 survey data.

12. Dentists, physicians and RNs are older than other practitioners. Median age of MN practitioners Physicians Physician assistants RNs Respiratory care practitioners Physical therapists Dentists Dental assistants Dental hygienists Source: MDH, Office of Rural Health and Primary Care, 2004 survey data.

13. Age composition of workforce… Physician assistants are significantly younger than physicians or RNs. < 45 yr. > 55 yr. Source: MDH, Office of Rural Health and Primary Care, 2004 survey data.

14. The retirement crunch may be more serious for dentists than for physicians. Dentists enter workforce at slightly younger age than physicians, but may stay in part-time practice a bit longer. Source: MDH, Office of Rural Health and Primary Care, 2004 survey data.

15. Retirement is more imminent for dentists in the most rural areas. DENTISTS BY AGE < 45 yrs. 55+ yrs.

16. Rural practitioners tend to be a year or two older than urban practitioners. Median age comparisons Source: MDH, Office of Rural Health and Primary Care, 2004 survey data.

17. Dentists are more geographically dispersed than physicians. Dentists Dentists Physicians Physicians Population: 41% rural RNs 26% LPNs 52% RCPs 19% Physical therapists 29% Dental assistants 34% Dental hygienists 33% Physician assistants 31% Source: MDH, Office of Rural Health and Primary Care, 2004 survey data.

18. Specialist physicians are more concentrated in urban areas than primary care physicians. Primary care physicians Other specialties Source: MDH, Office of Rural Health and Primary Care, 2004 survey data. Urban = Anoka, Carver, Dakota, Hennepin, Ramsey, Scott and Washington counties, plus Rochester, St. Cloud and Duluth.

19. Per 100,000 Population (2000) * Patient care physicians Source: HRSA , State Health workforce Profiles.

20. Per 100,000 Population (2000) * Patient care physicians Source: HRSA , State Health workforce Profiles.

21. Minnesota Workforce Mix Ratios 2000 data, HRSA Health Workforce Profiles

22. Minnesota is… • AVERAGE in number of PHYSICIANS. • ABOVE AVERAGE in number of RNs and Dentists. • MUCH ABOVE AVERAGE in number of LPNs and Dental hygienists.

23. Minnesota has… • high ratio of RNs to physicians • high ratio of RNs to LPNs What are the implications? What changes can be expected?

24. Primary Work Sites of MN LPNS MDH: ORHPC 2004 Licensing Survey

25. What kind of problem is it? Workforce Supply? Grow Workforce Weak Market Demand? Strengthen Markets Weak Demand = Low Need

26. Hospitals and clinics, doctors and dentists… Aren’t that much different from… Other professionals or firms. They set up business where there are enough paying customers to pay the bills.

27. DISTANCE = TIME = $ The Rural Health Care Access Challenge: Get the person to where the health care is or get the health care to where the person is… and find a way to pay for the care.

28. All occupations face shortages ISSUE: How will health care attract its needed share of a limited supply of workers? • Challenges: • Finding enough employees • … with appropriate education and skills Critical importance of K-12 Education: we will need young people prepared to acquire the KNOWLEDGE, SKILLS and ETHICS necessary for health careers.

29. As workers become scarce and expensive… Incentives to: 1. Use technology to reduce labor need. 2. Redesign way services are delivered to use labor more efficiently. 3. Use different mixes of occupations. Improve labor productivity

30. For more information: Workforce Analysis Program Office of Rural Health and Primary Care Minnesota Department of Health Jay Fonkert 651-282-5642 Jay.fonkert@state.mn.us

31. THE END Following slides are held in reserve.

32. Vacancy rates in nursing occupations have been quite high, but generally declined.

33. Vacancy rates in other health occupation vary widely, and sometimes are erratic.

34. Workforce stories “It’s physician specialists that help draw patients into your facility.” Hospital CEO, Marshall MN Pop: 12,788 Marshall Independent, March 1, 2005 COMMENT: Critical mass affects economic viability. Regional centers will be higher level health care centers.

35. Workforce stories “Going to a small town and having an abundance of patients that you are going to lose money on when you have $180,000 of debt doesn’t make it.” Rural MN Dentist Northwest Dentistry January-February, 2005 COMMENT: Providers need paying customers – whether they be private sector or government.

36. Workforce stories “When those ambulance people come up to your side… you want them to be the best.” Supporter of higher national EMT standards “These guys have jobs. They work at the Cenex store, they work at the butcher shop. They’re farmers trying to get their crops in.” Director of North Dakota EMS Association COMMENT: Higher professional standards, advanced training requirements and expensive technology tend to favor concentration of health care services in regional centers.

37. Health Care in the Minnesota Economy Share of personal income 9.3% Share of wages and salaries 10.0% Percent of employment 10.4% The health care industry creates jobs and buying power in communities with hospitals, clinics and care facilities. Source: Bureau of Economic Analysis, regional accounts, 2003. All data reported by place of work.

38. Minnesota Health Care Employment By type of business Offices of physicians and dentists 44,091 15% Outpatient care centers 32,513 11% Home health services 17,855 6% Other ambulatory care services 14,207 5% Hospitals 99,990 35% Nursing care facilities 42,940 15% Residential MR/MH/substance abuse fac. 22,495 8% Other residential facilities 15,371 5% Source: U.S. Census Bureau, County Business Patterns, 2002.