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
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.
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
Health care industry accounts for 11 percent of all
private sector employee compensation in Minnesota.
11%
Health Services
89%
Other private nonfarm industries
Source: Bureau of Economic Analysis, regional accounts, 2003
Ambulatory Care employees receive more than half
of all health care compensation in Minnesota.
16%
Nursing and residential care
facilities
54%
30%
Hospitals
Source: Bureau of Economic Analysis, regional accounts, 2003
Ambulatory Care
Some counties with high dependence of
health care employment
Olmsted (Rochester)
37%
Wilkin (Breckenridge)
25%
Chisago
22%
Grant
21%
Mille Lacs
20%
St. Louis (Duluth)
20%
Health care and social
services employment as
% of wage and salary
employment
Statewide: 13%
Source: U. S. Bureau of
Economic Analysis, Regional
accounts, 2002
Minnesota’s Healthcare Workforce
Estimated active at MN sites, 2004
LPNs
RNs
Physician
Assistants
Physicians
0
10000
20000
30000
40000
50000
60000
Minnesota’s Healthcare Workforce
Estimated active at MN sites, 2004
Dental assistants
Dental hygienists
Dentists
0
1000
2000
3000
4000
5000
Largest Minnesota health occupations
Registered nurses
50,420 $20.09
Nursing assistants, orderlies and attendants
30,110
$9.36
Home health workers
18,250
$9.00
Licensed practical and vocational nurses
16,710 $13.91
Pharmacy technicians
6,130 $12.40
Medical assistants
5,200 $12.99
Dental assistants
4,370 $15.00
Dental hygienists
4,250 $28.00
Source: Minnesota Department of Employment and Economic Development, 2nd Quarter 2004.
Half of Minnesota health care workers work
outside hospitals or physician offices.
All other sites
34% Hospitals
36%
15%
Nursing care facilities
15%
Physician and dentist offices
Source: U.S. Census Bureau, County Business Patterns, 2002.
Male – Female Composition of Workforce
Physicians
72%
Physician assistants
28%
40%
RNs
6%
LPNs
3%
60%
94%
97%
RCPs
37%
Physical therapists
63%
24%
76%
81%
Dentists
0%
Dental assistants
Dental hygienists
0%
19%
100%
1%
99%
20%
40%
Male
60%
Female
Source: MDH, Office of Rural Health and Primary Care, 2004 survey data.
80%
100%
Dentists, physicians and RNs are older than
other practitioners.
Median age of MN practitioners
47
Physicians
Physician assistants
39
47
RNs
Respiratory care
practitioners
Physical therapists
44
39
Dentists
Dental assistants
Dental hygienists
Source: MDH, Office of Rural Health and Primary Care, 2004 survey data.
49
37
41
Age composition of workforce…
Physician assistants are significantly younger than
physicians or RNs.
< 45 yr.
> 55 yr.
Physicians
41%
25%
Physician assistants
63%
11%
RNs
43%
19%
Respiratory care practitioners
52%
10%
Physical therapists
65%
11%
Dentists
34%
31%
Dental assistants
74%
5%
Dental hygienists
61%
7%
Source: MDH, Office of Rural Health and Primary Care, 2004 survey data.
The retirement crunch may be more
serious for dentists than for physicians.
40%
35%
30%
25%
Dentists
20%
Physicians
15%
10%
5%
0%
under
35
35-44
45-54
55-64
65+
Dentists enter
workforce at
slightly younger
age than
physicians, but
may stay in parttime practice a bit
longer.
age
Source: MDH, Office of Rural Health and Primary Care, 2004 survey data.
Retirement is more imminent for dentists in
the most rural areas.
DENTISTS BY AGE
< 45 yrs. 55+ yrs.
Metropolitan statistical
area (MSA) counties (21)
36%
29%
Micropolitan area
counties (20)
34%
34%
Rural counties (46)
19%
40%
Rural practitioners tend to be a year or two
older than urban practitioners.
URBAN
RURAL
Physicians
47
40
Physician assistants
38
43
RNs
46
48
Respiratory care
practitioners
44
45
Physical therapists
41
38
Dentists
48
51
Dental assistants
36
39
Dental hygienists
42
40
Median age
comparisons
Source: MDH, Office of Rural
Health and Primary Care,
2004 survey data.
Dentists are more geographically dispersed
than physicians.
Dentists
Dentists
Physicians
Physicians
Rural
20%
Urban
80%
Rural
34%
Urban
66%
Population: 41% rural
RNs
26%
Physical therapists
29%
LPNs
52%
Dental assistants
34%
RCPs
19%
Dental hygienists
33%
Physician assistants
31%
Source: MDH, Office of Rural Health and Primary Care, 2004 survey data.
Specialist physicians are more concentrated
in urban areas than primary care physicians.
Rural
13%
Rural
27%
Urban
73%
Primary care physicians
Urban
87%
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.
Per 100,000 Population (2000)
MN
Physicians
U.S.
MN:US
194*
198*
.98
14
14
1.00
RNs
943
793
1.19
LPNs
342
241
1.42
71
64
1.11
Physician assistants
Dentists
* Patient care physicians
Source: HRSA , State Health workforce Profiles.
Per 100,000 Population (2000)
MN
U.S.
MN:US
Dentists
71
64
1.11
Dental hygienists
69
50
1.38
Dental assistants
94
89
1.06
Respiratory care spec.
26
29
.90
Physical therapists
55
43
1.28
* Patient care physicians
Source: HRSA , State Health workforce Profiles.
Minnesota Workforce Mix Ratios
MN
U.S.
RNs: LPNs
2.80
3.24
RNs: Physicians
4.92
3.95
Dentists: Hygienists
1.03
1.27
.76
.72
Dentists: Dental Assistants
2000 data, HRSA Health Workforce Profiles
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.
Minnesota has…

high ratio of RNs to physicians
• high ratio of RNs to LPNs
What are the implications?
What changes can be
expected?
Primary Work Sites of MN LPNS
Other
21%
Hospitals
20%
Nursing homes
34%
Clinic-provider
offices
25%
MDH: ORHPC 2004 Licensing Survey
What kind of problem is it?
Workforce Supply?
Grow Workforce
Weak Market Demand?
Strengthen Markets
Weak Demand = Low Need
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.
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.
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.
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
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
THE
END
Following slides are held in reserve.
Vacancy rates in nursing occupations have
been quite high, but generally declined.
14
12
percent
10
8
6
4
2
0
00
01
01
02
02
03
03
04
04
4Q 2Q
4Q 2Q
4Q 2Q 4Q
2Q 4Q
RNs
LPNs
Nursing aides
Vacancy rates in other health occupation
vary widely, and sometimes are erratic.
12.0%
8.0%
Pharmacists
6.0%
Dental assistants
Medical assistants
4.0%
2.0%
4Q04
2Q04
4Q03
2Q03
4Q02
2Q02
4Q01
2Q01
0.0%
4Q00
percent
10.0%
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.
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.
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.
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.
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.