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Minnesota’s Healthcare Workforce Shortage

A growing crisis

By Teri Fritsma, PhD

Then COVID hit, and a bad situation got worse. Within months, media and industry reports of burnout, turnover and pandemic-provoked health care workforce shortages entered the public discourse. What started as isolated anecdotes quickly turned into widespread reports of severe staffing shortages. Exacerbating this problem was that the COVID-related workforce effects were happening in a broader context of turnover, layoffs and retirements in the economy at large.

We may now be moving into a “new normal” with respect to the virus itself, but its effects on the workforce are still unfolding. COVID has touched nearly every sector of the health care workforce, and the worst of the fallout is likely still to come.

This article summarizes findings from the Minnesota Department of Health’s (MDH) Healthcare Workforce Survey. We investigate turnover and workforce exits among much of Minnesota’s licensed health care workforce, including physicians, physician assistants, nurses, respiratory therapists and licensed mental health providers.

One-third of rural physicians… say they plan to leave their professions within the next five years.

Minnesota Department of Health’s Workforce Study

The Minnesota State Legislature mandates that MDH survey licensed health care providers at the time they renew their licenses. The resulting intelligence and analyses often serve as input to state workforce policy. MDH has been conducting this survey on an ongoing basis for more than a decade, and since nearly all providers who renew their license take the survey, our response rates approach 100%. The result is a very rich and robust data source with which to study the full impact of COVID across all professions and regions. In what follows, we compare data from the calendar year of 2019 (pre-COVID) to responses from October 15, 2021 through March 15, 2022. In this way we are able to isolate, as much as possible, the effects of COVID on nearly the entire licensed health care workforce. (Our survey does not cover direct care providers such as Certified Nursing Assistants, Home Health Aides and Personal Care Assistants. Some of the worst shortages are in this segment of the workforce, so the full effects of COVID on the health care workforce are almost certainly understated here.

Major Findings 

Number of license holders. Being licensed to practice in a health profession does not guarantee that a person is actually practicing. However, the number of license holders is effectively a count of the full potential labor supply. During the height of COVID in 2020 and 2021, that number continued to increase modestly. In June 2020, there were a total of 237,995 license holders in health care. By December 2021, that number had risen to 245,056, an indication that—in the aggregate, at least—new licensees continue to offset retirements and other license lapses. The only profession to experience a net reduction in the number of active license holders was licensed practical nursing, and that decline is part of a longer trend, as more nurses opt for the higher-level registered nursing license. This represents a bit of good news, but the devil is in the details, as we will see.

Figure 1. Percentage of licensed providers who plan to leave their profession within the next five years by profession and year.

Job vacancies. Job vacancy rates—defined as the number of open-for-hire positions for every 100 jobs in an occupation—are a leading indicator of workforce shortages. They tell a story about the current level of hiring demand. Based on data from the Department of Employment and Economic Development, we know that vacancy rates in most health care occupations were notably higher in 2021 than they were in 2019. The following occupations all saw vacancy rates, regardless of region or work setting:

• Registered nursing.
• Licensed practical nursing.
• Mental health and substance abuse counseling.
• Physical therapy.
• Respiratory therapy.
• Pharmacy.

This broad view supports the anecdotes: Minnesota’s health care employers are struggling to find the workers they need, and COVID has exacerbated the situation. Perhaps most alarming is the sharp rise in vacancies for mental health and substance abuse counselors: for every 100 jobs in this profession, 26 are currently open. This is the highest vacancy rate of all licensed health care professions (compared to, for example, 8% for respiratory therapists and 7% for registered nurses). The increase perhaps reflects the so-called “second wave” or “second pandemic”, the mental health pandemic resulting from anxiety, stress, depression and other disorders brought about by the COVID-19 pandemic.

Plans to leave the workforce. Across nearly all professions for which MDH collects survey data, an increased share of providers report that they plan to leave the workforce within the next five years, as shown in Figure 1. Any such increase is concerning, because, as noted, the state is already facing a shortage of providers in critical occupations. However, in some cases, the increases are alarming. Statewide, more than 25% of respiratory therapists; 22% of licensed practical nurses; 20% of physicians; and 19% of registered nurses report that they plan to leave their profession within the next five years. With the exception of licensed alcohol and drug counselors, the proportion of providers who report planning to leave has increased in all professions since 2019.

Health care employers have to focus on retention..

Figure 2. Percenage of planned exits that are due to burnout or job dissatisfaction.

Burnout is driving a larger share of workforce exits. The most commonly cited reason for leaving the health care workforce is always retirement. However, the share of providers who say they will leave to retire in the next five years has decreased, and the share citing burnout has increased across all licensed health professions. See Figure 2. Among providers who report that they plan to leave their profession within the next five years, physician assistants (PAs), followed by respiratory therapists (RTs), are the two professions most likely to cite burnout or job dissatisfaction as the reason. PAs and especially RTs regularly work in acute care settings, such as hospitals and urgent care facilities. So while this finding may not be surprising, it is a clear example of the devastating effects of COVID on of the workforce.

As concerning as the workforce losses are for the state as a whole, it is important to take special notice of our rural communities. Per capita, rural areas have far fewer providers than do urban areas. Even before COVID hit, we saw a variety of serious patient- and system-level effects as the direct result of these shortages:

• Long wait times to see providers.
• Long travel distances to access care, particularly specialty care.
• A shortage of beds.
• Hospital and clinic service line closings.

COVID has not improved this situation. Regardless of profession, rural providers are all more likely to report that they plan to leave their profession within the next five years. Indeed, if the self-reports are correct, Minnesota could lose nearly one-fifth of its rural workforce to retirement, burnout or other reasons. Most alarmingly, one-third of rural physicians and one-fifth of rural physician assistants say they plan to leave their professions within the next five years, leaving ever-widening gaps in care that would be extremely challenging to fill.

What can be done? What is being done? 

The data presented here paint a fairly alarming picture. With populations growing and baby boomers aging, health care services are needed more than ever. Workers are already in scarce supply, and the next five years very likely will usher in a wave of retirements and premature exits that cannot be fully replaced by the current level of new entrants into the workforce. We are right to search for a fix. However, very likely there isn’t a single fix. This multifaceted issue needs a multisectoral solution that involves all aspects of workforce development, recruitment and retention.

Our first charge must be to stop the leaks; health care employers have to focus on retention. Given the cost and the length of training required for many of these positions, we cannot rely exclusively on training new providers to address the immediate problem. Health care workers need more than appreciation; employers must do more to address burnout. Jobs should be as safe, flexible, lucrative and family-friendly as possible.

Second, we have to continue to grow the supply. Health professional education programs need to expand education and clinical training opportunities, particularly in rural and small town areas of the state so their graduates are rural practice-ready.

Third, workforce recruitment and retention efforts need to reach across all levels of the workforce—focusing solely on the nursing or physician shortage will have impact, but alone will not solve the health care workforce crisis. The stress and shortages that have created the current crisis affect all aspects of the workforce. Targeted solutions are needed for other critical members of the health care team, such as physician assistants and respiratory therapists, who are also exhibiting high levels of burnout and planning early exits.

Finally, the state must engage all sectors and policy levers at its disposal to grow and nurture the health care workforce pipeline. Loan forgiveness for health care providers, scholarships, stipends and career exploration initiatives for new and dislocated workers and programs aimed at increasing the diversity of the workforce are all good places to start.

Teri Fritsma, PhD, is the lead health care workforce analyst at the Minnesota Department of Health. Prior to this position she was a labor market analyst for both DEED and the Minnesota State Colleges and Universities system.