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2002 Minnesota Health Demand Assessment

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    2002 Minnesota Health Demand Assessment 2002 Minnesota Health Demand Assessment Document Transcript

    • Minnesota Health Workforce Demand Assessment 2002 Since 1994, the Rural Health Resource Center’s Minnesota Center for Rural Health has completed a regular survey of the demand for physicians, advanced practice registered nurses, mental health providers and physician assistants in greater and urban underserved areas of Minnesota. In 2002 the survey was expanded to include hospitals and clinics in the seven county metropolitan area. This annual survey is conducted under contract with the Minnesota Department of Health Office of Rural Health and Primary Care. Demand as defined in this assessment indicates the number of providers that clinics, hospitals and community health centers are actively recruiting. Under this definition, demand is not intended to reflect appropriate, minimum or optimal levels of provider supply based on population needs. METHODOLOGY The 2002 survey assessed the fourth quarter demand by specialty and region, as well as the reasons for recruiting. The survey, originally developed in 1993, has not been substantially modified since 1994. A new question was added to the 2002 survey that asked whether the organization was interested in considering an international physician applicant with a J1 Visa. As a result of the survey distribution in the metropolitan area, 13 additional physician specialty categories were added due to the medical staff recruitment activity of large clinics and hospitals. A total of 467 surveys were distributed to healthcare employers in Minnesota, with 217 surveys mailed to greater Minnesota clinics, hospitals and mental health centers. In the seven county metropolitan area surveys were distributed to 24 hospitals and 226 randomly selected clinics. i The overall response rate was 45.7% (n=203) after 11 facilities were Figure 1. Facility Type of Demand Assessment Respondents 60% 50% Percent of Responses 40% 30% 20% 10% 0% C H H M H O lin os os en ea th ic p p ta l th er ita ita lH l/ C l Sy l in ea s lth te ic m C tr Produced by the Rural Health Resource Center, Minnesota Center for Rural Health under contract with the Office of Rural Health and Primary Care, Minnesota Department of Health. Page 1
    • deleted from the sample group because the recruiting information was reported by an affiliated facility and three were deleted due to duplication, resulting in a sample of 453. The response rate was 58.9% (n = 121) in greater Minnesota and 34.1% (n=86) in the metropolitan area. Clinics and hospitals responded at a similar rate in greater and metropolitan Minnesota. The most frequent type of facility reporting was clinics (Figure 1). PHYSICIAN DEMAND Recruitment As shown in Table 1, in greater Minnesota, 269.4 full-time equivalent (FTE) physicians were being recruited by respondents in 2002. Forty percent of the demand was for primary care specialists. An additional 161.8 medical, surgical and other specialists were being recruited in greater Minnesota. Rural respondents reported recruiting 221 full-time equivalent physicians, with 47% of the demand for primary care specialists. An additional 117.4 medical, surgical, and other specialists were being recruited in rural Minnesota. In the metropolitan area, 86 respondents were recruiting 116.2 full-time equivalent physicians with 45% of the physician demand reported for primary care specialties and 55% for medical, surgical and other specialties. The highest number being recruited was family practice with 45.6 full- time equivalent physicians in demand in greater Minnesota and 19.5 in the metropolitan area. This is a significant decrease compared to 2001 when 84.6 family practice physicians were being recruited in greater Minnesota. However, the number reported practicing increased in greater Minnesota from 767.8 in 2001 to 854.4 in 2002. The estimated demand for physicians in greater Minnesota if all 207 organizations responded totaled 460.32. The estimated total demand in rural Minnesota was 362.29. For the metropolitan area, the estimated demand for physicians if all 1,254 metro clinics were surveyed and all clinics and hospitals responded was 1,245.16 FTE. Table 1. 2002 Regional Physician Demand by Recruitment Activity Specialty Greater Rural Metro Minnesota Minnesota Minnesota* Primary Careii 107.6 103.6 52.0 Medical Specialtiesiii 35.0 23.0 30.0 Surgical Specialtiesiv 57.4 46.4 14.0 Other Specialtiesv 69.4 48.0 20.2 Total 269.4 221.0 116.2 * Survey sample included 226 randomly selected clinics and all 24 hospitals in the seven county metropolitan area. Survey respondents were asked to report the number of physicians recruited in the past year. Although 174 primary care physicians were recruited in greater Minnesota and 89 were recruited in the metropolitan area, each region lost a number of physicians due to retirement, relocation or death. Considering the total number practicing, a net gain of 6% in greater Minnesota and 4% in the metropolitan area was realized (Table 2). Vacancies Primary care physicians represented the greatest proportion of physicians practicing in all three regions (Table 3). Seventy percent of the practicing physicians reported were primary care in rural Minnesota and approximately 50% were primary care in the greater and metropolitan regions. The number of vacancies reported was lower than the number being recruited in the rural and metro regions, but higher Produced by the Rural Health Resource Center, Minnesota Center for Rural Health under contract with the Office of Rural Health and Primary Care, Minnesota Department of Health. Page 2
    • Table 2. Number of Primary Care Physicians Recruited vs. Number of Physicians Lost in 2002 Region Number of Number Number Number Lost Net Gain (%) Respondents Practicing Recruited Greater 121 1391.5 174.0 85.0 89.0 (6%) Rural 110 1122.6 139.0 79.7 59.3 (5%) Metro* 86 996.2 89.0 49.5 39.5 (4%) *Survey sample included 226 randomly selected clinics and all 24 hospitals in the seven county metropolitan area. in greater Minnesota. Physician recruitment differs from other healthcare employment in that recruiting may take several months and it may be conducted without an open vacancy in preparation for retirement or a physician leaving. Respondents in greater and rural Minnesota reported more vacancies due to newly created positions, especially among the “other specialties”. In the metro area, respondents indicated a higher number of vacancies were due to a physician leaving compared to vacancies from new positions. Table 3. Physician Practice and Vacancy by Region Specialty Number Number Number Number Number Number Practicing Vacancies Practicing Vacancies Practicing Vacancies Greater MN Greater MN Rural MN Rural MN Metro* MN Metro* MN Primary 1391.50 102.5 1122.6 89.5 996.2 30.2 Care Medical 324.2 45.0 62.2 14.0.0 236.4 14.0 Specialties Surgical 389.4 47.9 205.4 31.9 382.9 9.0 Specialties Other 705.60 96.9 219.10 40.5 440 8.0 Specialties Total 2810.7 292.3 1609.3 175.9 2055.5 61.2 * Survey sample included 226 randomly selected clinics and all 24 hospitals in the seven county metropolitan area. The vacancy rates (Figure 2) were determined with the number of vacancies as a portion of the number practicing added to the number of open positions (vacancies). In greater Minnesota the highest vacancy rate was in Orthpaedic Surgery and the lowest rates, less than 5%, were in Obstetrics/Gynecology and Family Practice. Rural Minnesota facilities had the highest vacancy rate in Diagnostic Radiology (47%). Cardiovascular Disease Specialists, Dermatology, and Orthopaedic Surgery also had high vacancy rates in rural Minnesota, while Family Practice had the lowest rate. In the metropolitan area, Gastroenterology had the highest vacancy rate while Psychiatry, Emergency Medicine and Radiology had vacancy rates of zero. The metropolitan area had the lowest vacancy rates overall and the highest rates overall were in rural Minnesota in non-primary care specialties. This reflects the number of new medical and surgical practices under development in rural Minnesota. Produced by the Rural Health Resource Center, Minnesota Center for Rural Health under contract with the Office of Rural Health and Primary Care, Minnesota Department of Health. Page 3
    • Figure 2. Physician Vacancy Rates by Region Psychiatry Dermatology Diagnostic Radiology Orthopaedic Surgery Gastroenterology Cardiovascular Disease Pediatrics OB/GYN Metro Rural Internal Medicine Greater Family Practice 0% 10% 20% 30% 40% 50% Length of recruitment Facilities in greater Minnesota most frequently (40%) indicated having spent two to six months to successfully recruit Family Practice physicians (Figure 3). Thirty-two percent reported a 7-12 month wait and 22% reported a wait of 13-24 months. Rural facilities reported a similar pattern for Family Practice recruitment. In the metropolitan area, half of the respondents indicated that Family Practice recruitment required a 7–12 month wait and 33% reported 13-18 month wait. Successful recruitment of General Internists required 7-12 months for 42% of respondents in greater Minnesota and 33% for the rural and metropolitan areas (Figure 4). One-third of metropolitan respondents also reported a 13-18 month wait for General Internists. Successful recruitment of non primary care specialists required 2-6 months or 7- 12 months by half of the respondents in greater and rural facilities and 75% of the metropolitan facilities. A 25–36 month period for successful recruitment of non primary care specialists was reported by 18% of respondents in greater Minnesota and 14% in rural Minnesota. Produced by the Rural Health Resource Center, Minnesota Center for Rural Health under contract with the Office of Rural Health and Primary Care, Minnesota Department of Health. Page 4
    • Figure 3. Length of Time to Recruit Family Practice Physicians 55% 50% 45% Percent of Responses 40% 35% 30% Greater MN 25% Rural MN 20% Metro MN 15% 10% 5% 0% <=1 2-6 7-12 13-18 19-24 25-36 37+ month months months months months months months Figure 4. Length of Time to Recruit Internal Medicine Physicians 50% 45% 40% Percent of Responses 35% 30% 25% Greater MN 20% Rural MN 15% Metro MN 10% 5% 0% <=1 2-6 7-12 13-18 19-24 25-36 37+ month months months months months months months Produced by the Rural Health Resource Center, Minnesota Center for Rural Health under contract with the Office of Rural Health and Primary Care, Minnesota Department of Health. Page 5
    • Figure 5. Length of Time to Recruit Other Physician Specialties 45% 40% 35% Percent of Responses 30% 25% Greater MN 20% Rural MN Metro MN 15% 10% 5% 0% <=1 2-6 7-12 13-18 19-24 25-36 37+ month months months months months months months Reasons for Recruiting Of those facilities recruiting physicians statewide (n = 81), the top reasons for recruiting were an increase in the number of patients (68% of respondents), loss of physician on staff (62%) and to increase competitiveness in the service area (27%) (Figure 6). Figure 6. Reasons for Physician Vacancies Statewide Unknown New satellite clinic New service/specialty To increase competitiveness Loss of physician on staff Increase in # of patients Increase in service area 0% 5% 10% 15% 20% 25% 30% 35% Percent of Responses Reasons for Physicians Leaving a Practice The most common reason physicians left a practice in all three regions was a change in the physician’s personal or family needs (Figure 7). Greater and rural Minnesota reported losing a higher percentage of physicians due to retirement or not meeting financial expectations. Produced by the Rural Health Resource Center, Minnesota Center for Rural Health under contract with the Office of Rural Health and Primary Care, Minnesota Department of Health. Page 6
    • Figure 7. Top Five Reasons for Physicians Leaving 50% 45% Percent of Responses 40% 35% 30% Greater 25% Rural 20% Metro 15% 10% 5% 0% Physician or Retirement Financial Poor Academic family needs expectations realtionship appointment changed not met w/other providers J1 Visa Physicians As shown in Figure 8, 38% of greater Minnesota respondents reported that they would be willing to consider an international physician applicant with a J1 Visa compared to 22% in the metropolitan area. Thirty-five percent in greater Minnesota and 23% in the metropolitan area reported that they would not be willing to consider an international physician applicant. In the metropolitan area over 50% of the respondents indicated that recruitment of a J1 Visa applicant was not applicable to their facility. Figure 8. Organizations Willing to Hire a Physician with a J1 Visa Greater MN Metro MN 22% 27% 38% 55% Yes 23% No Not Applicable 35% Recruitment Costs Forty-one percent of respondents statewide reported that their estimated cost to recruit physicians over the last 12 months ranged from $0 to $5,000 (Figure 9). Thirteen percent reported spending $25,000 - $49,999 and 5% reported spending over $100,000. Produced by the Rural Health Resource Center, Minnesota Center for Rural Health under contract with the Office of Rural Health and Primary Care, Minnesota Department of Health. Page 7
    • Figure 9. Estimated Amount Spent on Physician Recruitment in the Last 12 Months 45% 40% 35% Percent of Responses 30% 25% 20% 15% 10% 5% 0% Not Sure $0-$4,999 $5,000- $10,000- $25,000- $50,000- $75,000- $100,000+ $9,999 $24,999 $49,999 $74,999 $100,000 ADVANCED PRACTICE NURSES AND PHYSICIAN ASSISTANT DEMAND Recruitment Respondents in greater Minnesota reported active recruitment of 18.0 Nurse Practitioners, seven Physician Assistants, and one Certified Nurse Midwife (Table 4). Most of the openings were attributed to demand at rural facilities. Of the Nurse Practitioners being recruited in greater and rural Minnesota, the majority of the demand was for Family Nurse Practitioners specifically. In the metropolitan area, four Nurse Practitioners, one Physician Assistant and one Certified Nurse Midwife were being recruited. Table 4. 2002 Regional Advanced Practice Nurses and Physician Assistants Demand by Recruitment Activity Specialty Greater Rural Metro Minnesota Minnesota Minnesota* Nurse Practitioners 18.0 17.0 4.0 Physician Assistants 7.0 5.0 1.0 Certified Nurse Midwives 1.0 1.0 1.0 Total 26.0 23.0 6.0 *Survey sample included 226 randomly selected clinics and all 24 hospitals in the seven county metropolitan area. Over 70 Nurse Practitioners were recruited in greater Minnesota in the past year, 26.8 were recruited in rural Minnesota and 37.6 were recruited in the metropolitan area. The greater and rural regions had net gains of 17.5% and 15.3% in the total number of providers considering the number lost due to retirement, relocation or death and the number practicing. A similar number of Physician Assistants were recruited into the greater and metro regions in the past year. The metro region had the greatest gain in the total number of Physician Assistants. All of the reported recruitment of Certified Nurse Midwives occurred in the metropolitan area with six being recruited. Greater and rural Minnesota experienced a net loss in the number of Certified Nurse Midwives. Produced by the Rural Health Resource Center, Minnesota Center for Rural Health under contract with the Office of Rural Health and Primary Care, Minnesota Department of Health. Page 8
    • Table 5. Number of Nurse Practitioners, Physician Assistants and Certified Nurse Midwives Recruited vs. Number Lost in 2002 Providers Region Number of Number Number Number Net Gain Respondents Practicing Recruited Lost (%) Nurse Practitioners Greater 121 323.0 73.6 17.2 56.4 (17.5%) Rural 110 153.2 37.6 14.1 23.5 (15.3%) Metro* 86 310.2 26.8 10.0 16.8 (5.4%) Physician Assistants Greater 121 240.4 31.9 9.4 22.5 (9.4%) Rural 110 139.4 24.9 7.4 17.5 (12.5%) Metro* 86 89.0 32.0 15.0 17.0 (19.1%) Cert. Nurse Midwives Greater 121 13.2 0.0 1.0 -1.0 (-7.6%) Rural 110 9.2 0.0 1.0 -1.0 (-10.9%) Metro* 86 27.1 6.0 5.0 1.0 (3.7%) *Survey sample included 226 randomly selected clinics and all 24 hospitals in the seven county metropolitan area. Vacancies Nurse Practitioners represented the greatest proportion of advanced practice providers practicing in all three regions (Table 5), however in rural Minnesota the number of Physician Assistants was close to the number of Nurse Practitioners. Table 6. Advanced Practice Nurses and Physician Assistants Practice and Vacancy by Region Provider Number Number Number Number Number Number Type Practicing Vacancies Practicing Vacancies Practicing Vacancies Greater MN Greater MN Rural MN Rural MN Metro* MN Metro* MN Nurse 323.0 21.6 153.2 21.6 310.2 2.0 Practitioners Physician 240.0 7.1 139.4 5.1 89.0 0.0 Assistants Certified 13.2 1.0 9.2 1.0 27.1 1.0 Nurse Midwives Total 576.2 29.7 301.8 27.7 426.3 3.0 * Survey sample included 226 randomly selected clinics and all 24 hospitals in the seven county metropolitan area. Produced by the Rural Health Resource Center, Minnesota Center for Rural Health under contract with the Office of Rural Health and Primary Care, Minnesota Department of Health. Page 9
    • In greater Minnesota, the highest vacancy rates were found for Psychiatric Nurse Practitioners and Obstetric Nurse Practitioners while Adult, Geriatric and Pediatric Nurse Practitioners had vacancy rates of zero (Figure 10). Rural Minnesota facilities also had the highest vacancy rates for Obstetric Nurse Practitioners and Psychiatric Nurse Practitioners. All nurse practitioner specialties, Physician Assistants and Certified Nurse Midwives had vacancy rates less than 5%. Figure 10. Advanced Practice Nursing and Physician Assistant Vacancy Rates by Region 50% 45% 40% Percent of Responses 35% 30% 25% Greater 20% Rural 15% Metro 10% 5% 0% Adu Fam Ger OB Phy Ce rt Ped Psy iatr N s icia lt N P chia iatri . i ly N Ps Nur ic N c /N e tr ic n As s Ps se Ps NPs M id ona sist a wiv e ta l nts NPs s Length of Time to Recruit Of the greater Minnesota facilities that had successfully recruited Nurse Practitioners in the past year, 2– 6 months were required by 50% and less than one month was required for 30% of respondents (Figure 11). Rural facilities reported a similar length of time to successfully recruit Nurse Practitioners. Metropolitan facilities required 7-12 months to successfully recruit Nurse Practitioners. Successful recruitment of Physician Assistants required 2-6 months for 50% of the greater and rural facilities and less than one month for 25% of the facilities in each region (Figure 12). In the metropolitan area, 80% of respondents waited 2–6 months to successfully recruit a Physician Assistant and 18% recruited in less than one month. None of the metropolitan facilities indicated that recruitment of a Physician Assistant required more than six months. For the facilities that had recruited a Certified Nurse Midwife in the past year in greater and rural Minnesota, an equal percentage reported less than one month, 2–6 months, and 25–36 months (Figure 13). Sixty percent of metropolitan respondents indicated a 2-6 month wait for a Certified Nurse Midwife. Produced by the Rural Health Resource Center, Minnesota Center for Rural Health under contract with the Office of Rural Health and Primary Care, Minnesota Department of Health. Page 10
    • Figure 11. Length of Time to Recruit Nurse Practitioners 80% 70% 60% Percent of responses 50% 40% Greater MN Rural MN 30% Metro MN 20% 10% 0% <=1 2-6 7-12 13-18 19-24 25-36 37+ month months months months months months months Figure 12. Length of Time to Recruit Physician Assistants 80% 70% 60% Percent of responses 50% Greater MN 40% Rural MN Metro MN 30% 20% 10% 0% <=1 2-6 7-12 13-18 19-24 25-36 37+ month months months months months months months Produced by the Rural Health Resource Center, Minnesota Center for Rural Health under contract with the Office of Rural Health and Primary Care, Minnesota Department of Health. Page 11
    • Figure 13. Length of Time to Recruit Certified Nurse Midwives 60% 50% Percent of responses 40% Greater MN 30% Rural MN Metro MN 20% 10% 0% <=1 2-6 7-12 13-18 19-24 25-36 37+ month months months months months months months Reasons for Recruiting Of the 66 facilities recruiting Nurse Practitioners, Physician Assistants, Certified Nurse Midwives and Mental Health Providers statewide the top reasons for recruiting were an increase in the number of patients (38% of respondents) or the loss of a provider on staff (38%) (Figure 14). Figure 14. Reasons for Nurse Practitioner, Physician Assistant, Certified Nurse Midwife, Clinical Psychologist and Social Worker Vacancies Statewide Unknown Add'l Physicians to Consult New Satellite Clinic Loss of Provider on Staff New Service/Specialty Increase in # of patients Increase in service area 0% 5% 10% 15% 20% 25% 30% 35% 40% Percent of Responses Produced by the Rural Health Resource Center, Minnesota Center for Rural Health under contract with the Office of Rural Health and Primary Care, Minnesota Department of Health. Page 12
    • Reasons for Leaving The most common reasons Nurse Practitioners, Physician Assistants, Certified Nurse Midwives, Clinical Psychologists or Social Workers left a practice in greater and rural Minnesota were the provider’s personal or family needs changed (Figure 15). Less than 10% of respondents reported that providers left due to retirement, financial expectations not met or poor relationship with other provider in greater and rural Minnesota. In the metropolitan area the top response was “unknown” followed by the provider’s personal or family needs changed. Figure 15. Top Five Reasons for Advanced Practice Nurses, Physician Assistants and Mental Health Providers Leaving a Practice 50% 45% 40% Percent of Responses 35% 30% 25% Greater 20% Rural 15% Metro 10% 5% 0% Provider's Retirement Financial Poor Unknown personal or expectations realtionship family needs not met w/other changed providers Estimated Recruitment Expense Sixty-seven percent of respondents statewide reported $4,999 as their estimated cost to recruit Nurse Practitioners, Physician Assistants, Certified Nurse Midwives, Clinical Psychologists or Social Workers statewide over the last 12 months. Eight percent reported spending $5,000 - $9,999, and four percent reported spending over $49,999 on advanced practice provider recruitment over the last 12 months. Produced by the Rural Health Resource Center, Minnesota Center for Rural Health under contract with the Office of Rural Health and Primary Care, Minnesota Department of Health. Page 13
    • Figure 16. Estimated Amount Spent on Advanced Practice Provider Recruitment in the last 12 months in Minnesota 70% 60% 50% Percent of responses 40% 30% 20% 10% 0% $0 No $5 $1 $2 $5 $7 $1 -$ ,0 0, 5, 0, 5, 00 t Su 4, 00 00 00 00 00 ,0 99 re -$ 0- 0- 0- 0- 00 9 9, $2 $4 $7 $1 + 99 4, 9, 4, 00 9 99 99 99 ,0 9 9 9 00 MENTAL HEALTH PROVIDERS Recruitment Among community mental health centers in greater Minnesota, 17 Clinical Psychologists and 24 Social Workers were in demand as shown in Table 7. In rural Minnesota, 16 Clinical Psychologists and 13 Social Workers were being recruited by respondents. The demand in the metropolitan area was low among the clinics and hospitals responding. Table 7. 2002 Regional Mental Health Provider Demand by Recruitment Activity Provider Type Greater Minnesota Rural Minnesota Metro Minnesota * Clinical 17.0 16.0 1.5 Psychologists Social Workers 24.0 13.0 2.0 * Survey sample included 226 randomly selected clinics and all 24 hospitals in the seven county metropolitan area. Survey respondents reported that a similar number of Clinical Psychologists and Social Workers, approximately 24, were successfully recruited in greater Minnesota during the past year (Table 8). Sixteen providers were lost in both greater and rural Minnesota regions. In metro Minnesota, the number of providers lost due to relocation, retirement or death surpassed the number recruited, resulting in a net loss of Clinical Psychologists. Considering the total number of Clinical Psychologists practicing, a net loss was also reported in rural Minnesota and a slight gain reported in the metro area. Produced by the Rural Health Resource Center, Minnesota Center for Rural Health under contract with the Office of Rural Health and Primary Care, Minnesota Department of Health. Page 14
    • Table 8. Number of Mental Health Providers Recruited vs. Number of Providers Lost in 2002 Provider Type Region Number of Number Number Number Net Gain (%) Respondents Practicing Recruited Lost Clinical Psychologists Greater 121 90.4 23.4 16.5 6.9 (7.6%) Rural 110 84.4 22.4 16.5 5.9 (7.0%) Metro* 86 49.7 0.0 1.8 -1.8 (-3.6%) Social Workers Greater 121 145.8 24.8 16.8 8.0 (5.5%) Rural 110 88.8 13.8 15.8 -2.0(-2.2%) Metro* 86 61.3 2.2 2.0 .2 (.3%) * Survey sample included 226 randomly selected clinics and all 24 hospitals in the seven county metropolitan area. Vacancies Social workers represented the greatest proportion of mental health providers practicing in all three regions (Table 9). However, rural facilities reported a similar number of each provider type. The number of vacancies for Clinical Psychologists and Social Workers was similar between regions. Table 8. Mental Health Provider Practice and Vacancy by Region Provider Number Number Number Number Number Number Practicing Vacancies Practicing Vacancies Practicing Vacancies Greater MN Greater MN Rural MN Rural MN Metro* MN Metro* MN Clinical 90.4 15.0 84.4 14.0 49.7 2.5 Psychologists Social 145.8 17.5 88.8 11.5 61.3 2.0 Workers Total 236.2 32.5 173.2 25.5 111/0 4.5 * Survey sample included 226 randomly selected clinics and all 24 hospitals in the seven county metropolitan area. The vacancy rates, defined as the number of vacancies as a portion of the number practicing added to the number of open positions, were similar between greater and rural Minnesota for Clinical Psychologists and Social Workers (Figure 17). Both provider types had vacancy rates over 10% in greater and rural Minnesota. Metropolitan area facilities reported vacancy rates under 5% for mental health providers. Produced by the Rural Health Resource Center, Minnesota Center for Rural Health under contract with the Office of Rural Health and Primary Care, Minnesota Department of Health. Page 15
    • Figure 17. Mental Health Provider Vacancy Rates 25% 20% 15% Greater Rural 10% Metro 5% 0% Clinical Psychologists Social Workers Length of Recruitment In greater Minnesota, facilities that had successfully recruited mental health providers in the past 12 months most often reported a 2–6 month wait (47%) while an additional 30% reported less than one month to recruit. Rural Minnesota facilities reported a similar length of time to successfully recruit mental health providers. A small number of mental health providers were recruited into the metro area; however, 7–12 months was the most frequent waiting period reported (Figure 18). Figure 18. Length of Time to Recruit Mental Health Providers 60% 50% Percent of Responses 40% Greater MN 30% Rural MN Metro MN 20% 10% 0% <=1 2-6 7-12 13-18 19-24 25-36 37+ month months months months months months months Produced by the Rural Health Resource Center, Minnesota Center for Rural Health under contract with the Office of Rural Health and Primary Care, Minnesota Department of Health. Page 16
    • SUMMARY The Minnesota Health Workforce Demand Assessment began in 1994 as one of the key objectives of the Robert Wood Johnson Foundation Primary Care Practice Sights Grant Program in Minnesota. At that time, the focus of the Demand Assessment was measuring recruitment activity of primary care providers in rural and underserved urban areas. Following the end of the Grant Program in 1997, the Minnesota Department of Health, Office of Rural Health and Primary Care continued to fund the Demand Assessment and it now encompasses 36 physician specialties, mental health providers and includes the seven county metropolitan area as well as greater Minnesota. When reviewing the data generated by this survey, it is important to remember that “demand” does not equate with “need”. “Demand” denotes the total number of providers being recruited by clinics, hospitals and community mental health centers and the number of vacancies, regardless of the viability of individual offerings, the size of the population, access issues such as insurance, language or transportation, or the overlap of service areas. The 2002 Minnesota Health Workforce Demand Assessment found that 40% of all respondents were actively recruiting physicians, 9% were recruiting Nurse Practitioners, 10% were recruiting Clinical Psychologists, 7% were recruiting Social Workers, 5% were recruiting Physician Assistants and 2% were recruiting Certified Nurse Midwives (Figure 19). Figure 19. Percent of Respondents Recruiting Providers in 2002 40% 35% Percent of Responses 30% 25% 20% 15% 10% 5% 0% Ph Ps N Ph C So er ur yc ys ys ci se tN al ho ic ic ur ia Pr ia W lg ns n se ac or is As ts ke t it M st io rs id s ne w iv rs es Primary care physician specialties represented at least 40% of the demand in each region. This assessment indicated a decreased demand for Family Physicians in greater Minnesota as compared to past years while Internal Medicine and Pediatrics had slight increases in demand (Figure 20). Family Practice had the greatest number of openings in each region. The number of Family Physicians practicing in Minnesota increased 11% from 2001 to 2002. Overall, each region reported a net gain in the total number of physicians recruited versus lost compared to the number practicing. Several non-primary care specialty Produced by the Rural Health Resource Center, Minnesota Center for Rural Health under contract with the Office of Rural Health and Primary Care, Minnesota Department of Health. Page 17
    • vacancy rates in greater and rural Minnesota were over 10% as compared to rates under 5% for the metropolitan areas. Figure 20. Demand for Primary Care Physicians in Greater Minnesota by Year 200 180 160 Number Being Recruited 140 120 100 80 60 40 20 0 1995 1996 1997 1998 1999 2001 2002 Family Practice Internal Medicine Obstetrics/Gynecology Pediatrics Figure 21. Demand for Advanced Practice Nurses, Certified Nurse Midwives and Physician Assistants in Greater Minnesota by Year 70 60 Number Being Recruited 50 40 30 20 10 0 1995 1996 1997 1998 1999 2001 2002 Certified Nurse Midwives Physician Assistants Nurse Practitioners Produced by the Rural Health Resource Center, Minnesota Center for Rural Health under contract with the Office of Rural Health and Primary Care, Minnesota Department of Health. Page 18
    • The demand for Nurse Practitioners and Physician Assistants decreased in 2002 compared to 2001 (Figure 21). The majority of the recruitment for these providers was for Family Nurse Practitioners specifically. As in past years, there was minimal recruitment for Certified Nurse Midwives. Nurse Practitioners and Physician Assistants had positive gains in the total number practicing with significant numbers recruited in the past year. Certified Nurse Midwives actually experienced a net loss in the number of providers. In greater and rural Minnesota, Family, Obstetric and Psychiatric Nurse Practitioner specialties as well as Certified Nurse Midwives had vacancy rates over 5%. Mental health providers have only recently been included in the Minnesota Health Workforce Demand Assessment. Comparing 2001 to 2002, the number of Social Workers being recruited increased from 16.5 to 24.0 and the number of Clinical Psychologists in demand rose to 17.0 from 8.0. Both provider types had small net gains or losses in the number of providers practicing in Minnesota. The vacancy rates for mental health providers were over 10% in rural and greater Minnesota. With the increasing demand for specialty healthcare services due to a growing and aging population and advances in technology, the demand for specific non-primary care physicians remains higher than available providers in greater and rural Minnesota as seen by the high vacancy rates. Moreover, a continued supply of primary care providers will be necessary to meet both short and long range health care demands in Minnesota. The demand for all types of mental health providers including Psychiatrists, Psychiatric Nurse Practitioners, Social Workers and Clinical Psychologists is significant and has increased from 2001 in greater and rural Minnesota. Several initiatives designed to improve recruitment of primary care providers in Minnesota have contributed to the increase in placement over the past ten years. These include the Minnesota Department of Health’s Office of Rural Health and Primary Care programs, such as Loan Forgiveness, the J1 Visa Waiver Physician Recruitment and the Collaborative Rural Nurse Practitioner Program, in addition to other state programs. Loan Forgiveness Programs are currently offered for mental health providers and Psychiatrists are eligible for the J1 Visa Waiver Program. These incentives, as well as the new Area Health Education Center Grant received by the University of Minnesota, help facilitate the education of rural mental health professionals and may impact the vacancies in Minnesota. i Definitions of Regions: Metropolitan area includes Anoka, Carver, Dakota, Hennepin, Ramsey, Scott and Washington counties. Greater Minnesota excludes the counties of Anoka, Carver, Dakota, Hennepin, Ramsey, Scott and Washington. Rural Minnesota excludes the cities of Duluth and Rochester and the counties of Anoka, Carver, Dakota, Hennepin, Ramsey, Scott and Washington. Urban underserved includes federally funded community health centers located in the metropolitan area. ii Primary Care: Family Practice, Internal Medicine, Internal Medicine/Pediatrics Obstetrics/Gynecology and Pediatrics. iii Medical Specialties: Allergy, Cardiovascular Disease, Dermatology, Gastroenterology, Hematology/Oncology, Hospitalist (IM), Hospitalist (FP), Pediatric Cardiovascular Disease and Pulmonology. iv Surgical Specialties: Cardiovascular Surgery, Colon & Rectal Surgery, General Surgery, Neurological Surgery, Ophthalmology, Orthopaedic Surgery, Otolaryngology, Plastic Surgery, and General Surgery. v Other Specialties: Anesthesiology, Child Psychiatry, Diagnostic Radiology, Emergency Medicine (BC), Emergency Medicine (FP or IM), Neurology, Occupational Medicine, Pathology, Physical Medicine & Rehabilitation, Psychiatry, Radiation Oncology, Radiology and other Produced by the Rural Health Resource Center, Minnesota Center for Rural Health under contract with the Office of Rural Health and Primary Care, Minnesota Department of Health. Page 19