Minnesota is on course for a health care workforce shortage never before seen in our state’s history. A reported reduction in some job vacancies in 2004 and 2005 has led to speculation that health care workforce shortages are over. This is not true; in fact, it’s worsening.
Minnesota’s health care community is on a demographically induced collision course defined by an increase in retirees and fewer workers coupled with a growing demand for healthcare services. These in-demand services will be across-the-board, affecting almost all employment sectors in the healthcare field and all Minnesota communities.
What will this mean for rural Minnesota?
Rural Minnesota presents unique challenges for health care access. There is an ever-increasing shortage of medical personnel in rural areas, as well as transportation and distance barriers to care and an increasing economic destabilization of rural healthcare services. Since the mid-twentieth century, physicians have favored urban and suburban practices over rural areas.
“Many physicians often need lucrative practices to repay high education debts, and they have been trained to use costly new technologies in diagnoses and treatment,” said Dr. Timothy Andersen, Owatonna Physician for Fairview Health Services.
Rural practices typically generate lower incomes for the physician and have fewer and older technology resources than urban and suburban locations.
“Modern medical school graduates are rarely well prepared to practice in rural environments. Consequently, rural communities suffer chronic physician shortages,” Andersen added.
What is causing the workforce shortage problem?
Advances in medical technology, increasing costs, and market forces contribute to the economic destabilization of many rural health care systems. Small rural health care providers, especially hospitals, cannot afford the equipment and personnel necessary to treat the entire array of modern disease and injury. Coronary bypass surgery, artery repair, advanced trauma care, and other complex procedures require specialized medical teams, equipment, and facilities. Such resources are economically viable only in hospitals and surgical centers with high volumes of patients. Consequently, rural Minnesotans must travel great distances to access more costly and complex levels of care.
Over the last few years state cuts have been imposed on public healthcare programs and rates for long-term care services have been frozen. Without rate increases, most nursing homes have found it impossible to pay wages that are comparable to the other job opportunities causing a high turnover and vacancy rate. Additionally, cuts to Medical Assistance programs will cost hospitals approximately $67.9 million and create 34,000 more uninsured people in Minnesota. As the demand for healthcare professionals rises these restrictions will handicap the state’s hospitals and long-term care providers in their ability to recruit and compensate the practitioners needed for their patients.
Decreased Access to Care
As the gap between supply and demand of health care professional services increases, Minnesotans will experience longer waiting periods and limited resources for patient care. When healthcare providers believe they do not have the services, they must limit access.
Today, both urban and rural hospitals increasingly divert ambulances because of patient capacity issues. Additionally, hospitals have difficulty discharging patients due to lack of resources.
The financial crisis in long-term care is especially real in greater Minnesota. Twenty nursing homes have closed their doors in the past five years. The impact is felt not just by Minnesota residents who must find new nursing homes, but also in the communities that lose jobs and economic vitality.
With current estimates predicting that the number of minorities in Minnesota alone will double by the year 2020, the need for medical professionals who are committed to serving Minnesota’s underserved population is great. Medical students from poor, rural or ethnic backgrounds-those who might be most apt to work and connect with minority patients – frequently are not afforded the best opportunities in medical education due to financial constraints.
Mayo Medical School recently partnered with the University of Minnesota in a remarkable initiative known as the Minnesota Future Doctors program. Currently in its early stages the program is aimed at creating a pipeline of future physicians for Minnesota by providing resources and financial support to medical students from less privileged backgrounds that want to serve the underserved.
“People in underserved communities are sometimes not aware of the health care services that are available to them,” said Thuy Nguyen-Tran, University of Minnesota student and Minnesota Future Doctors participant. “Many of these people are new to Minnesota’s healthcare system and policies. There are also large percentages of these patients without insurance. When they know the costs are going to be high, they will decide to not seek the care that is needed.”
Meanwhile, by making more health care services available to rural and minority communities across the state, preventative care can prevent emergency room visits and expensive operations that drive health care costs up for everyone. Physician shortages are most visible in primary prevention, diagnosis, and treatment. Public health systems and an array of alternative primary care providers often fill in the gaps. Nurse practitioners, physician assistants, or home-health nurses may provide primary care. Practice locations include publicly or charitably subsidized comprehensive primary-care centers or categorical service clinics (e.g., prenatal care, family planning, immunizations) situated in central locations, mobile clinics, and in patient’s homes.
“Physicians serve as ambassadors to medicine and people in their communities. They are information givers that can help eliminate healthcare disparities that are facing rural and minority communities,” Nguyen-Tran said.
Avoid Higher Health Care Costs and Limited Access to Quality Care
To avoid future crises in health care costs and access issues, Minnesota must prepare now to meet growing demands for health care services and take steps to build a high-functioning workforce to deliver those services.
There are no quick or easy solutions to this multi-faceted problem that has been building for years. The many partnerships identifying health care workforce development strategies are critical steps but if state policymakers continue to sidestep the problem, rural Minnesota, in particular, will find itself several key jobs short of adequate health care coverage.