Perspectives on Minnesotas Health Industry Workforce Jay Fonkert Office of Rural Health and Primary Care MN Department of Health Minnesota Rural Health.

Perspectives on Minnesota’s Health Industry Workforce

Jay Fonkert

Office of Rural Health and Primary Care

MN Department of Health

Minnesota Rural Health Conference

July 19, 2005

Duluth, MN

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

11%

89%

Health Services

Other private nonfarm industries

Source: Bureau of Economic Analysis, regional accounts, 2003

Health care industry accounts for 11 percent of all private sector employee compensation in Minnesota.

54%

30%

16%

Ambulatory Care employees receive more than half of all health care compensation in Minnesota.

Ambulatory Care

Hospitals

Nursing and residential care facilities

Source: Bureau of Economic Analysis, regional accounts, 2003

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

Source: U. S. Bureau of Economic Analysis, Regional accounts, 2002

Statewide: 13%

Minnesota’s Healthcare WorkforceEstimated active at MN sites, 2004

0 10000 20000 30000 40000 50000 60000

Physicians

PhysicianAssistants

RNs

LPNs

Minnesota’s Healthcare WorkforceEstimated active at MN sites, 2004

0 1000 2000 3000 4000 5000

Dentists

Dental hygienists

Dental assistants

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.

34%

15%15%

36%

Physician and dentist offices

Hospitals

Nursing care facilities

All other sites

Source: U.S. Census Bureau, County Business Patterns, 2002.

Half of Minnesota health care workers work outside hospitals or physician offices.

Male – Female Composition of Workforce

Source: MDH, Office of Rural Health and Primary Care, 2004 survey data.

81%

24%

37%

40%

72%

99%

100%

19%

76%

63%

97%

94%

60%

28%

6%

3%

0%

1%

0% 20% 40% 60% 80% 100%

Male Female

Physicians

Physician assistants

RNs

LPNs

RCPs

Physical therapists

Dentists

Dental assistants

Dental hygienists

Physicians

41

37

49

39

44

47

39

47

Physician assistants

RNs

Respiratory care practitioners

Physical therapists

Dentists

Dental assistants

Dental hygienists

Median age of MN practitioners

Source: MDH, Office of Rural Health and Primary Care, 2004 survey data.

Dentists, physicians and RNs are older than other practitioners.

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%

< 45 yr. > 55 yr.

Age composition of workforce…

Physician assistants are significantly younger than physicians or RNs.

Source: MDH, Office of Rural Health and Primary Care, 2004 survey data.

0%

5%

10%

15%

20%

25%

30%

35%

40%

under35

35-44 45-54 55-64 65+

age

Dentists

Physicians

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.

Retirement is more imminent for dentists in the most rural areas.

Metropolitan statistical area (MSA) counties (21)

36% 29%

Micropolitan area counties (20)

34% 34%

Rural counties (46) 19% 40%

55+ yrs.< 45 yrs.

DENTISTS BY AGE

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.

Physicians Dentists

Rural20%

Urban80%

Rural34%

Urban66%

Physicians Dentists

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.

Urban73%

Rural27%

Urban87%

Rural13%

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.

MN U.S. MN:US

Physicians 194* 198* .98

Physician assistants 14 14 1.00

RNs 943 793 1.19

LPNs 342 241 1.42

Dentists 71 64 1.11

* Patient care physicians

Per 100,000 Population (2000)

Source: HRSA , State Health workforce Profiles.

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

Per 100,000 Population (2000)

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

Dentists: Dental Assistants .76 .72

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?

Nursing homes34%

Clinic-provider offices25%

Hospitals20%

Other21%

Primary Work Sites of MN LPNS

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

Workforce Analysis Program

Office of Rural Health and Primary Care

Minnesota Department of Health

Jay [email protected]

For more information:

THE END

Following slides are held in reserve.

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

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

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Dental assistants

Medical assistants

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%

Source: Bureau of Economic Analysis, regional accounts, 2003. All data reported by place of work.

The health care industry creates jobs and buying power in communities with hospitals, clinics and care facilities.

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.