Central Minnesota Area Health Education Center

Central Minnesota Health Professional Workforce and Community Health Analysis

August 2007

Prepared by:

Rural Health Resource Center Minnesota Center for Rural Health 600 E. Superior Street, Suite 404 Duluth, MN 55802 218-727-9390 www.ruralcenter.org/mcrh

Table of Contents

Introduction…………………………………………………………………………1-2

Section 1. Current Supply of Health Care Professionals in Central MN A. Physicians in Central MN…………………………………………...... 3 Figure 1. 2006 Active Physicians Breakdown in Central MN ……………………..3 Table 1. 2006 Active, Licensed Physicians by County in Central MN……………4 Table 2. 2006 Active, Licensed Primary Care Physicians by County in Central MN………………………………………………...5 Table 3. 2006 Active Specialty Physicians by County in Central MN…………….6 Figure 2. 2006 Physician Practice Settings in Central MN…………………………7 B. Advanced Nursing in Central MN Table 4. 2004-2006 Active Advanced Nursing Professions by County in Central MN……………………………………………………………..8 Table 5. 2004-2006 Active Nurse Practitioner Specialties by County in Central MN……………………………………………………………..9 Figure 3. 2004-2006 Active Nurse Practitioners by Practice Setting in Central MN………………………………………………………………10 C. Occupational Therapists in Central MN Table 6. 2006 Active Occupational Therapists by County in Central MN………..11 D. Pharmacists in Central MN Table 7. 2005 Active Pharmacists by County in Central MN…………………….12 E. Dentists in Central MN Table 8. 2005 Active Dentists by County in Central MN……………………….. 13 Figure 4. 2002-2004 Dental Practice Settings in Central MN……………………..14 F. Dental Hygienists in Central MN Table 9. 2005 Active Dental Hygienists by County in Central MN……………...15 G. Physician Assistants in Central MN Table 10. 2006 Active Physician Assistants by County in Central MN…………...16 H. Veterinarians in Central MN Table 11. 2006 Active Veterinarians by County in Central MN…………………..17 I. Physical Therapists in Central MN Table 12. 2006 Active Physical Therapists by County in Central MN……………18 J. Occupational Therapists in Central MN Table 13. 2006 Active Occupational Therapists by County in Central MN………19 K. Potential Supply of Health Care Professionals in Central MN…….20 Table 14. Health Care Professionals in Central MN Compared to the State of MN Overall…………………………………………………………………..20 Section 2. Health Professional Compensation Table 15. Physician Compensation, Midwest vs. St. Cloud, MN………………...21 Table 16. Advanced Practice Nursing Compensation…………………………….22 Table 17. Other Health Professions Compensation……………………………….23 Section 3. Potential Supply of Health Care Professionals in Central MN…….24 Table 18. Number of Health Care Professional Graduates in Central MN Health Professional Programs, 2007…………………………………………...24 Table 19. Central MN Graduate Medical Education………………………………25 L. Projected Supply of Health Care Professionals in Central MN……26

Table 20. Number of Health Care Providers Age 55 and Older in Central MN…..26 Figure 9. Percent of Health Care Processionals Age 55 and Older in Central MN 27 Section 4. Current Demand for Health Care Professionals in Central MN…..28 Table 21. Central MN Physician-to-Population Ratios……………………………28 M. Other Health Care Professional Demand in Central MN…………..29 Table 22. Central MN Care Professional-to-Population Ratios……………………29 Table 23. U.S. and MN Health Care Professional-to-Population Ratios………….30 N. Health Care Professional Vacancies in the Region………………….30 Table 24. Health Care Professional Vacancy Rates in Northwest MN……………30 O. Minnesota Health Care Professional Shortage Areas……………….31 Figure 10. Health Professional Shortage Areas Map: Primary Care……………….32 Figure 11. MN Rational Service Areas – Mental Health HPSA Designations Map 33 Figure 12. Health Professional Shortage Areas Map: Dental Designations………..34 Figure 13. Medically Underserved Areas (MUAs) and Medically Underserved Populations (MUPs)…………………………………………………….35 Section 5. Projected Demand for Health Care Professionals in Central MN….36 Table 25. MN* Population Projections by Region………………………………...36 Table 26. Central MN Populations by County……………………………………. .37 Table 27. Ration of Health Care Professionals per 100,000 Individuals 2000-2020 in Central MN………………………………………………………………38 Section 6. Community Health Analysis for Central MN………………………..39 P. MN Public Health Goals……………………………………………….39 Table 28. MN Public Health Improvement Goals – 2004………………………….41 Table 29. Regional Public Health Priorities by County, 2005-2009……………….43 Q. Behavioral Risk Factors in Central MN………………………………44 Table 30. MN Behavioral Risk Factors of Adults – County Synthetic Estimates and State Estimates, 2005…………………………………………………….45 R. Infant Mortality in Central MN……………………………………….46 Table 31. Minnesota Infant Mortality by State and County………………………..46 S. Unintentional Injury, Homicide and Suicide Fatalities in MN………47 Table 32. Number of Fatal Unintentional Injuries, Homicides and Suicides in MN by County, 2005……………………………………………………………..47 T. Cancer Deaths in MN………………………………………………….48 Table 33. Number and Percent of Cancer Deaths by Type of Cancer Site and Sex in Minnesota by State and County, 2001-2003**………………………….48 Table 34. Number and Percent of Cancer Deaths by Type of Cancer Site and Sex in Minnesota by State and County, 2001-2003**………………………….49 Table 35. Number and Percent of Cancer Deaths by Type of Cancer Site and Sex in Minnesota by State and County, 2001-2003**………………………….50 Table 36. State of Minnesota Leading Causes of Death by Age Group, 2005……..51 Table 37. Central Minnesota – Leading Causes of Death by Age Group, 2005…...52 U. Health Care Facilities in Central MN………………………………..53 Table 38. Regional Health Care Facilities, 2007…………………………………..53 V. Health Care Utilization in Central MN……………….……………...55 Table 39. Health Care Utilization* - Minnesota county Synthetic Estimates and State Estimates, 2002……………………………………………………….….55 Section 7. K – 12 and Community College Inventory of Health Professional Career Activities in Central MN………………………………………56 Figure 14. Target Population for Health Careers Information and Courses in Central

MN………………………………………………………………………56 Table 40. Health Career Information/Courses Offered by K-12 Schools in Central MN……………………………………………………………………….57 Table 41. Health Care Professionals Courses Offered by Organizations in Central MN……………………………………………………………………….58 Summary………………………………………………………………………….59-60 References……………………………………………………………………………61

Appendix A. Health Professional Shortage Areas (HPSA)…………….………..62 Primary Care…………………………………………………………………………62 Mental Health………………………………………………………………………...63 Dental………………………………………………………………………………...64

Appendix B. Medically Underserved Areas (MUA)……………………….…....65

Appendix C. Leading Causes of Death in Central MN………………………….66 Big Stone County – Leading Causes of Death by Age Group, 2005………………..66 Clay County – Leading Causes of Death by Age Group, 2005……………………..67 Crow Wing County – Leading Causes of Death by Age Group, 2005……………...68 Douglas County – Leading Causes of Death by Age Group, 2005………………....69 Grant County – Leading Causes of Death by Age Group, 2005……………………70 Morrison County – Leading Causes of Death by Age Group, 2005………………..71 Otter Tail County – Leading Causes of Death by Age Group, 2005……………….72 Pope County – Leading Causes of Death by Age Group, 2005…………………….73 Stearns County – Leading Causes of Death by Age Group, 2005………………….74 Todd County – Leading Causes of Death by Age Group, 2005……………………75 Traverse County – Leading Causes of Death by Age Group, 2005………………...76 Wadena County – Leading Causes of Death by Age Group, 2005………………....77 Wilkin County – Leading Causes of Death by Age Group, 2005…………………..78

Appendix D. K-12 Health Careers Information and Courses Survey for Central MN…………………………..……………………………..79

Introduction

In May 2007, the Central Minnesota Area Health Education Center (AHEC) contracted with the Rural Health Resource Center to conduct a comprehensive Health Professional Workforce and Community Health Analysis for Central Minnesota. AHEC is a national program to improve the accessibility and quality of primary health care. The Central Minnesota AHEC promotes rural health education opportunities and addresses health care workforce challenges unique to the region. The central region of Minnesota as defined by AHEC, includes the counties of: Big Stone, Clay, Crow Wing, Douglas, Grant, Morrison, Otter Tail, Pope, Stearns, Stevens, Todd, Traverse, Wadena and Wilkin.

The total population of the Central Minnesota AHEC region was 443,995 in 2000. The population of the 14 counties located in the Central Minnesota AHEC region follows: • Big Stone 5,820 • Clay 51,229 • Crow Wing 55,099 • Douglas 32,821 • Grant 6,289 • Morrison 31,712 • Otter Tail 57,159 • Pope 11,236 • Stearns 133,166 • Stevens 10,053 • Todd 24,426 • Traverse 4,134 • Wadena 13,713 • Wilkin 7,138

Focusing on health professional shortage areas and medically underserved populations, AHEC’s develop and support community-based education for medical, dental, nursing, pharmacy, allied health and other health profession students; recruit under-represented and disadvantaged persons into health care careers; conduct health promotion and disease prevention activities; assist communities in recruiting and retaining health professionals; and provide continuing education for health care professionals.

The current and future status of health care employment in Central Minnesota was determined by gathering information and conducting an analysis to make projections in demand based on current employment, distribution, vacancy rates, shortage designations, population and changes in the health care workforce due to retirement, educational capacity and population growth. The gap between supply and demand was analyzed by population-to-practitioner ratios and evaluated over time from 2000 to 2020. The compensation of health care professions was also analyzed. The professions included in this analysis include: • Clinical Laboratory Scientists • Dentists • Dental Hygienists • Occupational Therapists • Nurses (certified nurse midwives and nurse practitioners)

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• Pharmacists • Physical Therapists • Physicians • Physician Assistants • Veterinarians

Community-based education or service learning is an AHEC goal. In order to target health professional projects relevant to the public health needs in Central Minnesota, this analysis reviewed the public health priorities in the 14 counties. By identifying current risk factors and mortality data, AHEC leaders and students may plan for health promotion programs that address the most pressing issues and concerns. The study also describes health care access and primary care utilization.

Finally, a primary focus of the Central Minnesota AHEC is providing opportunities for students (K-12) to learn about health care careers. This study inventoried the health care career activities in Central Minnesota schools and hospitals to assist students and educators in obtaining health careers information and experience. In addition, the analysis of the results will help identify gaps in health care careers activities that the AHEC can address through program development.

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Section 1. Current Supply of Health Care Professionals in Central MN

The Center utilized the 2006 Health Workforce Databases of the Minnesota Department of Health, Office of Rural Health and Primary Care to document the active, licensed physicians, certified nurse midwives (CNMs), nurse practitioners (NPs), physical therapists and occupational therapists in Central Minnesota. The databases through the Office of Rural Health and Primary Care include fields for specialty and practice setting; however, not all professionals provide data for these fields. The professional licensing board databases were the source of data for dentists, dental hygienists, pharmacists and veterinarians.

Physicians in Central MN Thirty percent (n=261) of physicians in Central Minnesota were licensed and practicing in the primary care specialties. For purposes of this study, the primary care physician specialties include: family practice, general practice, internal medicine, pediatrics, medicine/pediatrics and obstetrics/gynecology. Specialty care physicians comprised a total of 168 (35%) physicians. Over one-third of the physicians do not have specialty data in the licensure database.

Figure 1.

2006 Active Physicians in Central MN

30% % Primary Care 35% % Specialty

No Answer 35%

Source: 2006 Physician Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health.

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In 2006, a total of 791 physicians were licensed and practicing in Central Minnesota (Table 1). Of these primary care physicians, the greatest number (n=128) were practicing in Stearns County. Of the specialty care physicians, 84 (50%) were practicing in Stearns County. For purposes of this study, other specialty care physicians include: cardiology, child psychiatry, dermatology, emergency medicine, otolaryngology, gastroenterology, general surgery, neurosurgery, oncology, ophthalmology, orthopaedic surgery, psychiatry, radiology and urology.

Table 1. 2006 Active, Licensed Physicians by County in Central MN Primary Care Specialty Care *Other Unlisted Total # of County Physicians Physicians Specialties Specialty Physicians Big Stone 3 0 0 4 7 Clay 8 3 0 4 15 Crow Wing 24 31 3 69 127 Douglas 26 19 2 16 63 Grant 0 0 0 1 1 Morrison 12 6 1 10 29 Otter Tail 28 17 8 11 64 Pope 6 0 0 3 9 Stearns 128 84 49 162 423 Stevens 4 4 0 6 14 Todd 15 1 0 2 18 Traverse 1 1 0 2 4 Wadena 5 2 1 5 13 Wilkin 1 0 1 2 4 Total 261 168 65 297 791**

* = Other specialties not included in Central AHEC Study ** 100% Response based on licensure database.

Source: 2006 Physician Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health.

In rural areas, the smaller number of people per square mile limits the feasibility of many other specialty care physicians to maintain a practice. Also, there may be limitations in technology and supportive health professionals to provide procedures.

Family medicine was the most prevalent specialty type of physician in Central Minnesota (Table 2). Stearns County had the greatest number of family medicine physicians reported in the region (n=67). Douglas and Otter Tail Counties followed with 18 and 17 family medicine physicians respectively. Big Stone and Pope Counties had no other specialties besides family medicine physicians and Grant County had only one physician and the specialty was not reported.

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Table 2.

2006 Active, Licensed Primary Care Physicians by County in Central MN

No County FP IM OBG PD MPD Specialty Listed Big 3 0 0 0 0 4 Stone Clay 4 4 0 0 0 4

Crow 19 4 1 0 0 69 Wing Douglas 18 4 2 1 0 16 Grant 0 0 0 0 0 1

Morrison 11 1 0 0 0 10 Otter 17 7 2 2 0 11 Tail Pope 6 0 0 0 0 3

Stearns 67 20 0 0 2 162 Stevens 3 1 0 0 0 6 Todd 13 0 0 1 1 2

Traverse 1 0 0 0 0 2 Wadena 5 1 0 0 0 5 Wilkin 1 0 1 0 0 2

Total 168 42 6 4 3 297

Source: 2006 Physician Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health.

FP – Family Practice IM – Internal Medicine OBG – Obstetrics/Gynecology PD – Pediatrics MPD – Medicine/Pediatrics

Orthopaedic surgery, general surgery and psychiatry were the most prevalent physician specialties outside of primary care (Table 3). Only Stearns County had child psychiatry and dermatology specialties. None of the counties had a gastroenterologist reported. The licensure database; however, did not report the specialties for 30% of the physicians.

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Table 3. 2006 Active Specialty Physicians by County in Central MN

County CD CHP D EM ENT GE GS NS ON OPM ORS P R U Other No Specialty Listed

Big Stone 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 4 Clay 0 0 0 0 0 0 0 0 0 0 0 3 0 0 0 4 Crow 3 69 0 2 0 1 1 0 3 0 1 3 8 4 6 2 Wing Douglas 0 0 0 0 1 0 4 0 0 3 7 1 3 0 2 16 Grant 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 Morrison 0 0 0 0 0 0 1 0 0 0 4 1 0 0 1 10 Otter Tail 0 0 0 1 1 0 2 0 1 1 2 5 3 1 8 11 Pope 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 Stearns 4 2 3 13 4 0 6 4 2 5 13 6 17 5 49 162 Stevens 0 0 0 0 0 0 1 0 0 0 2 0 1 0 0 6 Todd 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 2 Traverse 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 2 Wadena 0 0 0 0 0 0 1 0 0 0 0 0 1 0 1 5 Wilkin 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 Total 4 4 3 15 7 0 20 4 4 12 36 20 31 8 65 297

Source: 2006 Physician Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health.

CD- Cardiology NS - Neurosurgery CHP- Child Psychiatry ON - Oncology D- Dermatology OPM – Ophthalmology EM- Emergency Medicine ORS –Orthopaedic Surgery ENT- Otolaryngology P - Psychiatry GE – Gastroenterology R - Radiolgoy GS – General Surgery U - Urology

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Of the physicians practicing in central Minnesota that reported practice setting, the majority were in a clinic setting, 73%, followed by 14.5% in a hospital setting and 5% in the emergency department. One physician in Central Minnesota reported practicing in a medical school and treatment facility each (Figure 2).

Figure 2. 2006 Physician Practice Settings in Central MN

Clinic

Hosptial Medical School Emergency Room Lab Practice Setting Outpatient Surgery Teaching Hospital Treatment Facility Other No Setting Listed

0 50 100 150 200 250 300 350 400 450 500

Number of Physicians

Source: 2006 Physician Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health

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Certified Nurse Midwives and Nurse Practitioners Of the advanced practice nurses selected for this analysis, nurse practitioners and certified nurse midwives, nurse practitioners were the most prevalent in the region (Table 4). The largest counties, Stearns and Douglas had the highest number of nurse practitioners. Only three counties did not have nurse practitioners, Grant, Wadena and Wilkin. Three counties reported certified nurse midwives practicing in central Minnesota, Douglas, Stearns and Todd. Certified nurse midwives and nurse practitioners are mastered prepared registered nurses.

Table 4. 2004- 2006 Active Advanced Nursing Professions by County in Central MN

*Certified Nurse County Nurse Practitioners Total Midwives Big Stone 0 2 2 Clay 0 4 4 Crow Wing 0 8 8 Douglas 1 1 2 Grant 0 0 0 Morrison 0 1 1 Otter Tail 0 3 3 Pope 0 1 1 Stearns 1 23 24 Stevens 0 2 2 Todd 1 1 2 Traverse 0 2 2 Wadena 0 0 0 Wilkin 0 0 Total 3 48 51

Source: Minnesota Registered Nurse Licensure Database, Minnesota Department of Health, Office of Rural Health and Primary Care.

*All three CNMs practice in a clinic setting. *100% based on licensure response.

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Nurse Practitioners in Central MN Nurse practitioners self report their specialty type and approximately 26 of the 48 NPs selected more than one specialty type, with some selecting as many as three. Approximately 42% (n=20) of the NPs in Central Minnesota reported themselves as Family NPs. Twenty-five percent (n=12) reported as Adult NPs, 20% as Geriatric and 22% as Women NPs (Table 5). Eight of the 48 NPs reported as practicing as Psychiatric NPs.

Table 5. 2004-2006 Active Nurse Practitioner Specialties by County in Central MN

County Acute Adult Family Geriatric Neonatal Pediatric Psychiatric School Women Other Total Big Stone 0 0 1 0 0 0 0 0 1 0 2

Clay 0 0 2 1 0 0 0 0 1 0 4

Crow Wing 0 2 3 0 0 1 2 0 2 0 10 Douglas 0 0 0 0 0 0 0 0 1 0 1 Grant 0 0 0 0 0 0 0 0 0 0 0 Morrison 0 1 1 1 0 1 1 0 0 0 5

Otter Tail 0 2 0 1 0 0 1 0 1 0 5

Pope 0 0 1 0 0 0 0 0 0 0 1 Stearns 1 6 9 5 1 3 3 2 4 3* 37 Stevens 0 0 1 1 0 0 0 0 0 0 2 Todd 1 0 1 0 0 0 0 0 0 1* 3

Traverse 1 1 1 1 1 1 1 0 1 0 8

Wadena 0 0 0 0 0 0 0 0 0 0 0 Wilkin 0 0 0 0 0 0 0 0 0 0 0 Total 3 12 20 10 2 6 8 2 11 4 77

Source: 2004-2006 Minnesota Registered Nurse Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health.

*Other specialties include Occupational Health, Internal Medicine and Reproductive Medicine. Some Nurse Practitioners may have chosen more than one specialty, therefore the total exceeding 48.

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Of the nurse practitioners licensed in Central Minnesota, the majority (58%) were practicing in a clinic setting (Figure 3). Hospitals were also the primary practice setting for many nurse practitioners.

Figure 3. 2004-2006 Active Nurse Practitioners by Practice Setting in Central MN

Hospital In-Patient

Hospital Out-Patient

Clinic

Practice Setting Nursing Home School

Indirect Practice

Other

0 5 10 15 20 25 30

Nurse Practitioners

Source: 2004-2006 Minnesota Registered Nurse Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health.

*Other practice settings include VA Hospital and State Hospital.

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Occupational Therapists in Central MN In 2006, a total of 130 occupational therapists were reported as practicing in Central Minnesota (Table 6). Stearns County had the highest number of occupational therapists at 39 (30%) followed by Otter Tail County with 24 (18%). Traverse and Wilkin Counties did not have any licensed occupational therapists. Practice setting data was not available for occupational therapists.

Table 6. 2006 Active Occupational Therapists by County in Central MN

Number of Licensed County Occupational Therapists

Big Stone 1

Clay 10

Crow Wing 17 Douglas 15 Grant 2 Morrison 7 Otter Tail 24 Pope 4 Stearns 39 Stevens 4 Todd 3 Traverse 0 Wadena 4

Wilkin 0

Total 130

*100% based on licensure response.

Source: 2006 Occupational Therapy Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health.

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Pharmacists in Central MN Central Minnesota had 416 active, licensed pharmacists in 2005 (Table 7). Stearns County had 36% (n=150) of the pharmacists and Crow Wing County had 15% (n= 64). Big Stone County had the lowest number at 4.

Table 7.

2005 Active Pharmacists by County in Central MN

# of Licensed County Pharmacists Big Stone 4 Clay 36 Crow Wing 64 Douglas 35 Grant 7

Morrison 17

Otter Tail 48 Pope 8 Stearns 150 Stevens 7 Todd 13 Traverse 7 Wadena 13 Wilkin 7 Total 416

*100% based on licensure response.

Source: 2005 Minnesota Pharmacist Licensure Database, University of Minnesota, College of Pharmacy

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Dentists in Central MN A total of 199 dentists were reported as actively practicing in Central Minnesota (Table 8). The counties with the highest number of practicing dentists were Stearns (n=75) and Crow Wing (n=35). Big Stone, Grant, Pope and Traverse Counties had only one active dentist reported in each county.

Table 8. 2005 Active Dentists by County in Central MN

# of Licensed County Dentists Big Stone 1 Clay 25

Crow Wing 35 Douglas 15 Grant 1

Morrison 5 Otter Tail 22 Pope 1 Stearns 75

Stevens 3 Todd 8 Traverse 1

Wadena 4 Wilkin 3 Total 199

*100% based on licensure response.

Source: 2005 Minnesota Dentist Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health.

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The greatest percentage of dentists, 53% of the 199 licensed dentists in Central Minnesota reported solo practice for their practice setting followed by 37% in a group practice (Figure 4).

Figure 4. 2005 Dental Practice Settings in Central MN

Solo Group Education Clinic Institution Public Health Other Practice Setting

0 10 20 30 40 50 60 70 80 90 100

Dentists

Source: 2005 Minnesota Dentist Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health.

*Other reflects non-profit, research, partnership and associate.

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Dental Hygienists in Central MN Of the 243 licensed dental hygienists practicing in Central Minnesota, the greatest number were practicing in Stearns County (n=83) and Crow Wing County (n=38) (Table 9). There were several counties with less than 10 dental hygienists. The practice locations follow the same pattern of distribution of the dentists in the region with 52% located in solo practices. Forty percent were practicing in a group setting.

Table 9.

2005 Active Dental Hygienists by County in Central MN

# of Licensed County Dental Hygienists

Big Stone 1

Clay 35 Crow Wing 38 Douglas 20 Grant 2 Morrison 10 Otter Tail 26 Pope 2 Stearns 83 Stevens 4 Todd 7 Traverse 4

Wadena 7

Wilkin 4 Total 243

Source: 2005 Minnesota Dental Hygienist Licensure Database, Office of Rural Health & Primary Care- Minnesota Department of Health.

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Physician Assistants in Central MN In 2006, 87 physician assistants were practicing in Central Minnesota (Table 10). The highest number of physician assistants was reported practicing in Stearns County, 53, followed by 8 in Otter Tail County. Four counties in the region did not have a physician assistant. These included: Big Stone, Pope, Stevens and Wilkin. The majority of physician assistants, 79%, practice in a clinic setting.

Table 10. 2006 Active Physician Assistants by County in Central MN Number of Licensed County Physician Assistants Big Stone 0 Clay 4 Crow Wing 4 Douglas 5 Grant 2

Morrison 4

Otter Tail 8 Pope 0 Stearns 53 Stevens 0 Todd 3 Traverse 2 Wadena 2 Wilkin 0 Total 87

*100% Response based on licensure database.

Source: 2006 Physician Assistant Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health.

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Veterinarians Central MN One hundred seventy-four veterinarians were practicing in Central Minnesota (Table 11). Stearns, Otter Tail, Douglas and Morrison Counties reported the highest number of veterinarians. All of the counties had at least one veterinarian practicing.

Table 11. 2006 Active Veterinarians by County in Central MN

Number of Licensed County Veterinarians

Big Stone 1 Clay 6 Crow Wing 17

Douglas 15

Grant 5 Morrison 14 Otter Tail 24

Pope 4 Stearns 69 Stevens 7

Todd 8 Traverse 1 Wadena 2 Wilkin 1

Total 174 *100% based on licensure response.

Source: 2006 Veterinarian Licensure Database, Minnesota Board of Veterinary Medicine.

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Physical Therapists in Central MN A total of 143 licensed physical therapists were reported active in Central Minnesota (Table 12) in 2006. The counties with the highest number of practicing physical therapists were Stearns with 72 and Crow Wing, 21. Pope, Stevens and Grant Counties had only one practicing physical therapist reported in the county and Traverse had zero. The practice setting of physical therapists is divided in Central Minnesota. Thirty percent were in a clinic setting and 25% in an outpatient practice setting.

Table 12.

2006 Active Physical Therapists by County in Central MN

Number of Licensed County Physical Therapists Big Stone 3 Clay 3

Crow Wing 21 Douglas 11 Grant 1

Morrison 5 Otter Tail 13 Pope 1

Stearns 72

Stevens 1 Todd 5 Traverse 0

Wadena 5 Wilkin 2 Total 143

*100% based on licensure response.

Source: 2006 Physical Therapy Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health.

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Occupational Therapists in Central MN A total of 130 licensed occupational therapists were reported active in Central Minnesota (Table 13) in 2006. Stearns (n=39) and Otter Tail (n=24) had the highest number of practicing occupational therapists. Big Stone had only one practicing occupational therapist reported in the county and Traverse and Wilkin had zero. The practice setting of occupational therapists was not available with licensure data.

Table 13. 2006 Active Occupational Therapists by County in Central MN

Number of Licensed County Occupational Therapists Big Stone 1

Clay 10

Crow Wing 17 Douglas 15 Grant 2

Morrison 7 Otter Tail 24 Pope 4

Stearns 39 Stevens 4 Todd 3 Traverse 0

Wadena 4 Wilkin 0 Total 130

*100% based on licensure response.

Source: 2006 Occupational Therapy Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health.

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Overall Supply of Health Care Professionals in Central Minnesota Table 14 illustrates the number of health care professionals in the Central Minnesota AHEC region compared to the state overall. Physical therapists, veterinarians and physician assistants in the region account for 9% of the licensed professionals in the state and certified nurse midwives and occupational therapists have the lowest representation at 5% or lower. The Central Minnesota population is 9% of Minnesota’s overall population.

Table 14

Percent of Central Health Health Professions MN Minnesota Professionals Region Working in Central MN Certified Nurse 3 74 4% Midwives Nurse Practitioners 48 703 7% Occupational 130 2,602 5% Therapists Physical Therapists 143 1,570 9% Veterinarians 174 1,852 9% Dentists 199 2,444 8% Dental Hygienists 243 2,912 8% Pharmacists 416 7,324 6% Physician Assistants 87 955 9% Primary Care 261 3,861 7% Physicians Clinical Laboratory NA NA NA Scientists Total 1704 24,297 7%

Sources: Minnesota Registered Nurse Licensure Database, Minnesota Department of Health, Office of Rural Health and Primary Care; 2006 Occupational Therapy Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health; 2006 Physical Therapy Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health; 2006 Veterinarian Licensure Database, Minnesota Board of Veterinary Medicine; 2005 Minnesota Dentist Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health; 2005 Minnesota Dental Hygienist Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health; 2005 Minnesota Pharmacist Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health; 2006 Physician Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health.

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Section 2. Health Professional Compensation

The average annual compensation of the health professions identified for this analysis was reviewed for Midwest United States and St. Cloud (Table 15). For all physician specialties, the average salary in St. Cloud was lower than the Midwest average. Orthopeadic surgery was the highest compensated specialty and pediatrics was the lowest.

Table 15 Physician Compensation Midwest St. Cloud w/ob $177,876.00 Family Practice w/o ob $159,736.00 $148,860.00

Internal Medicine $169,744.00 $154,448.50

OB/GYN $268,964.00 $221,074.00

Pediatrics $162,922.00 $142,952.50

General Surgery $331,029.00 $271,298.50

Psychiatry $173,493.00 $162,197.50

Orthopaedic Surgery $454,079.00 $358,649.00

$457,153.00 Diagnostic Radiology $331,129.00

Ophthalmology $352,713.00 $237,261.50 Invasive $436,033.00 Invasive $268,468.50 Cardiology Non-Invasive $365,949.00 Non-Invasive $262,668.00

Hematology/Oncology $426,719.00 $245,379.00

Emergency Medicine $250,563.00 $205,021.50

Gastroenterology $434,152.00 $285,103.00 Neurology $236,499.00 $186,172.50 Urology $394,591.00 $280,408.50 Dermatology $369,590.00 $213,880.50 Otolaryngology $331,135.00 $274,444.50 Child Psychiatry $181,487.00 $165,980.00 Source: Physician Compensation & Production Survey – 2006 Report, Medical Group Management Association http://www.salary.com/

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Advanced practice nursing compensation was reviewed for the same geographic areas, Midwest United States and St. Cloud (Table 16). Pediatric and psychiatric nurse practitioners were the highest compensated advanced practice nursing specialties and geriatric was the lowest. Many specialties were compensated at a higher level in St. Cloud compared to the Midwest.

Table 16 Advanced Practice Nursing Compensation

Midwest St. Cloud

Certified Nurse Midwife $80,437.00 $79,409.50 Nurse Practitioner - Adult $70,875.00 $74,793.50 Nurse Practitioner - Family $69,816.00 $74,793.50 Nurse Practitioner - Obstetrics $74,934.00 $80,663.50 Nurse Practitioner - Pediatric $57,819.00 $80,663.50 Nurse Practitioner - Psych No information available $80,663.50 Nurse Practitioner - Geriatric $74,450.00 $66,715.00 Source: Physician Compensation & Production Survey – 2006 Report, Medical Group Management Association http://www.salary.com/

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Table 17 lists the annual compensation of other health professions identified for the Central MN AHEC analysis. Some professions were paid a higher rate in St. Cloud compared to the Midwest; however all were within 10% of the Midwest averages.

Other Health Professions Compensation Table 17 Midwest St. Cloud

Physician Assistants $73,784.00 $74,519.00 Pharmacists - Pharm D or BS $100,720.00 $97,559.50

Dentists - DDS $126,844.00 $125,569.50

Dental Hygienists $63,278.00 $57,937.50

Veterinarians $69,740.00 No information available

Occupational Therapists $54,695.50 $60,347.50

Physical Therapists $62,461.00 $63,097.50 Clinical Laboratory Scientists -MLT $53,413.00 $53,097.00 Source: Physician Compensation & Production Survey – 2006 Report, Medical Group Management Association http://www.salary.com/ Occupational Outlook Handbook, 2006-07 Edition, Department of Labor, Bureau of Statistics, http://www.stats.bls.gov/oco/reprints/ocor008.pdf

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Section 3. Potential Supply of Health Care Professionals in Central MN

The future supply of health care professionals for a region is impacted by the number of health professional educational programs available directly in the region. All of the higher education sites in the Central Minnesota region were contacted in order to identify the actual number of students enrolled and the number of graduates in 2007 for the professions analyzed in this study (Table 18). Nursing, a popular health care profession offered at the colleges and community colleges in the central region, is not offered at the graduate level for nurse practitioners and certified nurse midwives. The only educational program for the professions noted in this analysis is clinical laboratory scientist (medical laboratory technologist). St. Cloud State University offers a bachelors degree. Four students graduated from St. Cloud State University in 2006 and 12 students are currently enrolled. For several of the health professions analyzed in this study including dentistry, pharmacy and medicine, the educational and degree programs are only offered in Duluth, Rochester, Minneapolis or St. Paul, Minnesota.

Table 18. Number of Health Care Professional Graduates in Central MN Health Professional Programs, 2007

MN Total College of St. Cloud University Concordia State St. John’s Number Total Program St. State of MN, College University, University Grads # 2008 Benedict University Morris Moorhead 2007 Certified Nurse 0 0 0 0 0 0 0 0 Midwife Nurse 0 0 0 0 0 0 0 0 Practitioner

Dentist 0 0 0 0 0 0 0 0

Dental 0 0 0 0 0 0 0 0 Hygienist Occupation 0 0 0 0 0 0 0 0 al Therapy Physical 0 0 0 0 0 0 0 0 Therapy Medical 4 Grads Laboratory 0 0 0 0 0 4 12 12 Enrolled Tech. CLS Veterinary 0 0 0 0 0 0 0 Medicine Pharmacist 0 0 0 0 0 0 0 0 Physician 0 0 0 0 0 0 0 0 Assistant Medicine 0 0 0 0 0 0 0 0

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St. Cloud, Minnesota has a family medicine residency program, the University of Minnesota St. Cloud Hospital Family Medicine Residency Program. A family practice residency requires 3 years to complete following medical school graduation. Four physicians completed the residency in 2006 and 11 are currently enrolled in the residency program (Table 19).

Table 19. Central MN Graduate Medical Education Programs Number of 3rd Year 2nd Year 1st Year Program Name 2006 Grads Residents Residents Residents (Graduate 6/07) Graduate 6/08) (Graduate 6/09) University of MN St. Cloud 4 3 4 4 Hospital Family Medicine Residency

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Projected Supply of Health Care Professionals in Central MN The number of health care professionals in Central Minnesota age 55 years of age and over is shown in Table 20. In 2006, the health professions with the greatest percentage age 55 and older were dentists (35%), nurse practitioners (35%), pharmacists (33%), and certified nurse midwives (33%). Approximately one-third of these health care professionals will reach the average retirement age of 65 by 2016. Dental hygienists had the smallest percentage age 55 and older at 7%. Age breakdowns were not available for clinical laboratory scientists.

Table 20. Number of Health Care Providers Age 55 and Older in Central MN

Provider Type # # 55 yr. % 55 yr. & over Practicing & over Certified Nurse Midwives 3 1 33% Dentists 199 69 35% Dental Hygienists 243 18 7% Nurse Practitioners 48 17 35% Occupational Therapists 130 NA NA Pharmacists 416 137 33% Physical Therapists 143 13 9% Physician Assistants 87 13 15% Physicians 791 218 28% Veterinarians 174 43 25%

Sources: 2004-2006 Minnesota Registered Nurse Licensure Database, Minnesota Department of Health, Office of Rural Health and Primary Care; 2006 Occupational Therapy Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health; 2006 Physical Therapy Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health; 2006 Veterinarian Licensure Database, Minnesota Board of Veterinary Medicine; 2005 Minnesota Dentist Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health; 2005 Minnesota Dental Hygienist Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health; 2005 Minnesota Pharmacist Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health; 2006 Physician Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health.

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Figure 5. Percent of Health Care Professionals Age 55 and Older in Central MN

Physicians 28%

Physician 15% Assistants

Certified Nurse Midwives 33%

Nurse Practitioners 35%

Pharmacists 33%

Dentists 35%

Dental Hygienists 7%

Veterinarians 25%

Physical Therapists 9%

0% 5% 10% 15% 20% 25% 30% 35% 40%

Percent

Sources: 2004-2006 Minnesota Registered Nurse Licensure Database, Minnesota Department of Health, Office of Rural Health and Primary Care; 2006 Occupational Therapy Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health; 2006 Physical Therapy Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health; 2006 Veterinarian Licensure Database, Minnesota Board of Veterinary Medicine; 2005 Minnesota Dentist Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health; 2005 Minnesota Dental Hygienist Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health; 2005 Minnesota Pharmacist Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health; 2006 Physician Licensure Database, Office of Rural Health & Primary Care-Minnesota Department of Health.

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Section 4. Current Demand for Health Care Professionals in Central MN

Physician Demand in Central MN To determine physician demand in Central Minnesota the Center used Solucient, LLC, st Physician Community Requirements in the 21 Century: The 2003 Physicians to Population Ratios and the state’s licensure database. Solucient’s physician-to-population ratios were constructed from a combination of public claims, private claims and several surveys including the National Ambulatory Medical Care Survey (NAMC) and the National Hospital Ambulatory Medical Care Survey (NHAMCS). The ratios represent the number of full-time equivalent (FTE) physicians currently serving the ambulatory care needs of a typical U.S. community in 2003.1 Table 21 illustrates the ratio of physicians to population in the Central region compared to the state and the recommended levels to meet demand.

Table 21. Central MN Physician-to-Population Ratios Physician-to- 2006 2003 Solucient Population Physician-to- Physicians Physician Specialty Ratio in Central Population Population in MN* Ratio in MN* Midwest Primary Care General & Family Medicine 1:2,643 1:2,202 1:3,591 Internal Medicine 1:10,571 1:3,552 1:7,032 Obstetrics & Gynecology 1:73,999 1:12,207 1:10,989 Pediatrics 1:10,999 1:6,612 1:8,396 Medical Specialties Radiology 1:14,322 N/A N/A Cardiology 1:110,999 1:19,368 1:28,169 Dermatology 1:47,998 1:40,657 1:43,478 Gastroenterology NA 1:46,410 1:60,976 Child Psychiatry 1:110,999 1:81,991 N/A Psychiatry 1:22,200 1:11,741 1:20,877 Surgical Specialties General Surgery 1:22,200 1:14,729 1:14,970 Ophthalmology 1:37,000 1:21,672 1:25,126 Orthopaedic Surgery 1:12,333 1:14,8621 1:22,422 Otolaryngology 1:63,428 1:48,708 1:31,056 Urology 1:55,499 1:50,199 1:39,683

* Based on number of licensed physicians that report specialties which is approximately 70%.

Source: Solucient, LLC, Physician Requirements in the 21st Century: The 2003 Physicians to Population Rations and Health Workforce Database, Minnesota Department of Health, Office of Rural Health and Primary Care. Central Minnesota AHEC Region Population = 443,995. Minnesota’s total population = 4,919,479.

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All of the medical specialty physician ratios in Central Minnesota were significantly lower compared to Solucient’s ratio indicating fewer physicians than recommended to meet demand (Table 21). Psychiatry had a ratio of one physician to 22,200 people in Central Minnesota which was close to Solucient’s ratio, but 47% lower than the state ratio. This demonstrates that the region has less access to psychiatry services compared to the state. Family medicine in Central Minnesota was close to the state ratio at 1:2,643, but higher than compared to Solucient’s 1:3,591. There are far fewer internal medicine physicians compared to the ratio statewide and the recommended level to meet demand. The only specialty in the Central region with more physicians than recommended was orthopaedic surgery.

Other Health Care Professional Demand in Central MN Comparisons were made of the actual number of health care professionals in Central Minnesota versus the actual population of 443,995 in the region and the actual number of health care professionals in the entire state to the actual state population of 4,919,479. The ratio of all types of health care professionals was lower for Central Minnesota compared to the state (Table 22). The most significant differences were registered nurses, certified nurse midwives, psychologists, physical therapists and pharmacists.

Table 22. Central MN Health Care Professional-to-Population Ratios 2006 Health Care 2006 Health Care Professionals per Professionals per Health Care Professional Population Population Ratio in Central MN Ratio in MN Certified Nurse Midwives 1:147,998 1:66,479 Nurse Practitioners 1:9,250 1:6,998 Occupational Therapists 1:3,415 1:1,891 Physical Therapists 1:3,105 1:3,133 Veterinarians 1:2,552 1:2,656 Dentists 1:2,231 1:2,013 Dental Hygienists 1:1,827 1:1,689 Pharmacists 1:1,067 1:672 Physician Assistants 1:5,103 1:5,151

Sources: MN Office of Rural Health & Primary Care-MN Department of Health; MN Board of Veterinary Medicine and 2006 Minnesota Pharmacist Licensure Database, University of Minnesota, College of Pharmacy.

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Comparisons were also made to the number of health care professionals per 100,000 individuals for the United States (U.S.), Minnesota, and Central Minnesota (Table 23). Central Minnesota had fewer active physicians per 100,000 people compared to the U.S. and the region had fewer nurse practitioners and dentists per capita compared to the entire state. Central Minnesota had a lower number of nurse practitioners compared to the U.S. and the state. Central Minnesota had fewer pharmacists per capita compared to the state, but a greater number compared to the U.S.

Table 23. U.S. and MN Health Care Professional-to-Population Ratios # of Active # of Active # of Active Health Care Professionals per Professionals per Professionals per Practitioner Type 100,000 Population 100,000 Population 100,000 Population in U.S. in Minnesota in Central MN Physicians 198.0 (Yr 1998) 278.2 (Yr 2006) 178.6 (Yr 2006) Nurse Practitioners 26.3 ( Yr 1998) 14.3 (Yr 2006) 10.8 (Yr 2006) Pharmacists 65.9 (Yr 1998) 149.0 (Yr 2006) 93.9 (Yr 2006) Dentists 48.4 (Yr 1998) 49.7 (Yr 2006) 44.9 (Yr 2006) Source: Services Administration, Bureau of Health Professions’ Minnesota: The Health Care Workforce in Eight States: Education, Practice and Policy, National Center for Health Workforce Analysis.

Health Care Professional Vacancies in the Region A state assessment of occupational demand, the Job Vacancy Survey, is conducted twice a year by the Minnesota Department of Employment and Economic Development (DEED). Of the health care professional types studied and analyzed by the Job Vacancy Survey, physical therapists were reported to have the highest vacancy rate according to DEED in the Northwest Planning Region (Table 24). The Northwest Region includes 12 of the 14 counties in the Central region. This region had 164 vacancies in health care practitioner and technical occupations and 371 vacancies in health care support vacancies. The greatest number of vacancies for a single occupation was 7 in occupational therapy. The job titles of certified nurse midwife, dentist, dental hygienist, nurse practitioner, physician, physician assistant and veterinarian had fewer than four vacancies and were not listed in the DEED Job Vacancy Survey for the second quarter of 2007. A vacancy rate over 6% is considered a shortage.

Table 24. Health Care Professional Vacancy Rates in Northwest MN

# of Professional Type Vacancy Rate Vacancies

Health Care Practitioner and Technical 164 1.4% Health Care Support 371 4.8%

Source: Minnesota Department of Employment & Economic Development, Labor Market Information Office, Minnesota Job Vacancy Survey, second quarter 2007.

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Minnesota Health Care Professional Shortage Areas A Health Professional Shortage Area (HPSA) is defined as population groups and facilities with a shortage of health professionals. 2 The HPSA designation made by the United States Department of Health and Human Services, Bureau of Primary Health Care, allows public and non-profit organizations to apply for National Health Service Corps personnel, as well as other federally funded programs. Three criteria must be met in order for an area to be designated as a HPSA: • The area is a rational area for the delivery of primary medical services. • There is a ratio of population to Primary Care Physicians of at least 3500 to 1. • Primary Care in the contiguous area is overtaxed, excessively distant or inaccessible to the population of the area under consideration. 3

The Minnesota Department of Health, Office of Rural Health and Primary Care utilizes the federal government’s criteria to determine shortages of health care professionals based on population-to-practitioner ratios, geographic distances and income. The Minnesota Office also works with the Shortage Designation Branch, Bureau of Health Professions, to establish Health Professional Shortage Area (HPSA) designations, which are a prerequisite to apply for National Health Service Corps recruitment assistance.

Currently 12 counties in Central Minnesota are partially or fully designated as Primary Care Health Professional Shortage Areas (HPSAs), indicating less than one primary care physician to 3,500 people and lack of access to physician care in contiguous areas (within 30 minutes travel time (Figure 10). Douglas, Grant and Todd Counties are full Primary Care HPSAs. Figure 11 illustrates that the entire central region is designated as a Mental Health Shortage Area, determined by less than one psychiatrist to a population of 30,000. Six counties in the Central Minnesota AHEC region are designated as Dental Health Professional Shortage Areas (Figure 12). The Dental HPSA designation is based on less than one dentist to a population of 5,000. The county detail for HPSAs is included in Appendix A.

Eleven of the 14 Central Minnesota counties are designated as partial or full Medically Underserved Areas (MUA) or Medically Underserved Populations (MUP) (Figure 13). MUA designation involves four variables: ratio of primary medical care physicians per 1,000 population, infant mortality rate, percentage of the population with incomes below the poverty level and percentage of the population age 65 or over. MUP designations are communities with economic barriers (low-income or Medicaid-eligible populations) or cultural and/or linguistic access barriers to primary medical care services. Designations by county are included in Appendix C.

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Figure 6.

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Figure 7.

Shading defines different regions. All shaded counties are designated as Mental Health - Health Professional Shortage Areas.

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Figure 8.

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Figure 9.

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Section 5. Projected Demand for Health Care Professionals in Central MN

Projecting health care practitioner demand began with an analysis of the anticipated population changes in Central Minnesota over the next two decades to determine if a higher number of health care professionals will be needed. According to the State Department of Administration, Minnesota is one of the fastest growing states in the Midwest, although population growth had slowed from an average annual rate over the past 10 years of more than 1 percent. Minnesota is projected to have a 20% increase in population or nearly 1 million additional people by 2020 (Table 25). The areas projected to have the largest growth are Central Minnesota, North Central Minnesota and Metropolitan Minnesota.

Table 25. MN* Population Projections by Region 2000-2020% Region 2000 2010 2020 Change

Statewide 4,919,479 5,452,500 5,909,700 20.1% Rural 1,952,888 2,134,710 2,315,800 18.6% Metro * 2,966,591 3,317,790 3,593,900 21.1%

* Includes seven county Metropolitan area, Duluth and Rochester. Source: Minnesota Department of Administration Information Center, 2004.

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In Central Minnesota, most counties are projected to gain population by 2020 (Table 26). The region is projected to grow by 19.6% overall by 2020. Crow Wing County is projected to have the highest population gain at 44.1% and other counties projected to grow include Douglas, Morrison, Otter Tail, Stearns, Todd and Wadena. Counties projected to lose population included Big Stone, Traverse and Wilkin. Overall, the region is projected to grow by 19.6% or 86,915 people.

Table 26. Central MN Population Projections by County

2000 Projected Projected % change County Population 2010 2020 + or - Population Population

Big Stone 5,820 5,570 5,450 -6.4%

Clay 51,229 52,590 52,810 3.1%

Crow Wing 55,099 67,060 79,390 44.1%

Douglas 32,821 36,940 41,700 27.1%

Grant 6,289 6,390 6,670 6.1% Morrison 31,712 33,560 35,580 12.2%

Otter Tail 57,159 63,240 70,900 24.0%

Pope 11,236 11,540 12,120 7.9% Stearns 133,166 148,480 163,170 22.5%

Stevens 10,053 10,110 10,120 0.7%

Todd 24,426 25,640 27,070 10.8%

Traverse 4,134 3,830 3,730 -9.8% Wadena 13,713 14,520 15,210 10.9%

Wilkin 7,138 6,930 6,990 -2.1%

Total 443,995 486,400 530,910 19.6%

Source: Minnesota Department of Administration, Population Projections for Minnesota Counties, 2000 to 2030.

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The impact of Central Minnesota’s population growth from 2000 to 2020 was compared to health care professional supply (Table 27). If the number of active, licensed professionals remains stable through 2020, with a similar rate of professionals starting new practices, retiring and relocating, the ratio of practitioners compared to population in the Central region will decline as the population grows by 19%.

Table 27.

Ratio of Health Care Professionals per 100,000 Individuals 2000-2020 in Central MN Practitioner Practitioner to Practitioner to Actual # to 100,000 100,000 100,000 Practitioner Type Licensed in Population Population Population Region 2000 Ratio 2010 Ratio 2020 Primary Care Physicians 261 58.9 53.5 49.2

Dental Hygienists 243 54.9 49.8 45.8

Dentists 199 44.9 40.8 37.5 Nurse Practitioners 48 10.8 9.8 9.1 Certified Nurse Midwives 3 .67 .61 .56 Pharmacists 416 93.9 85.2 78.5 Physical Therapists 143 32.3 29.3 27.0

Occupational Therapists 130 29.3 26.6 24.5

Veterinarians 174 39.3 35.7 32.8

Source: Minnesota Department of Administration, Population Projections for Minnesota Counties, 2000 to 2030 and MN Office of Rural Health & Primary Care-MN Department of Health; MN Board of Veterinary Medicine and 2006 Minnesota Pharmacist Licensure Database, University of Minnesota, College of Pharmacy.

Rural Minnesota is undergoing major shifts that have serious implications for the future. 3 Major trends reported by Minnesota Planning include:

• Aging of the population: Thirty percent of Minnesota’s population lives in rural areas and 41% of rural residents are age 65 and older. (In this report, rural refers to the 80 counties outside the seven county metropolitan area.)

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• Exodus of young adults: In 1990, 5 times as many college graduates moved to the Metropolitan area from elsewhere in Minnesota than moved in the opposite direction – a trend that continues today. • Concentrated population growth: Seventy-five percent of Minnesota’s population growth from 1990 to 1998 occurred in 26 counties, primarily located in a corridor running from Olmsted in the southeast to Lake of the Woods in the north.

The Department of Administration reports that 20% of Minnesota residents were age 65 and older in 2003 (15% of rural Minnesota residents and 10% of metropolitan Minnesota residents). 3 By 2020, both metropolitan and rural Minnesota are projected to age, with the largest increases in population occurring in the 65-84 age groups. The number of Minnesota residents age 65 and older will increase by over 45% in Stearns County alone, indicating an increased need for long-term care services.4

According to the Minnesota Department of Employment and Economic Development (DEED), Employment Outlook, 2004-2014, there were 30,482 individuals employed in health care professional, technical and support occupations in the northwest planning region of Minnesota. 5 DEED predicts that by 2014, there will be an additional 9,204 individuals employed in health care occupations in this region, a 30.2% increase compared to 11.8% for all occupations. DEED predicts that the 55 and over age bracket will comprise the fastest-growing segment of the population as the baby boomers retire and continue to live longer. According to DEED, unless labor force participation rates see a dramatic change, of which they have been fairly constant over the past decade, the size of the active workforce will level off.

Section 6. Community Health Analysis for Central MN

MN Public Health Goals The community health status of Central Minnesota’s counties was assessed by gathering and synthesizing county health plans, county health profiles, and reports from the Minnesota Department of Health. The objectives of the analyses were to assess health status and health care access, as well as prioritize health care issues for the region. This information will assist the Central Minnesota AHEC in identifying baseline data for evaluation purposes and developing health professions service learning programs.

Minnesota uses a nationally recognized and well-established local assessment and planning process, with the 49 Community Health Boards conducting assessments and identifying priority health problems. The resulting Community Health Services plans are invaluable sources of information on the health needs of communities across the state. These local plans serve as a foundation for the overall state goals (Table 28). It should be noted that the data submitted by the local units were based upon differing methods of community assessment and soliciting community input. Data are self-reported, and there are many different ways, using many different words, that local units characterized their public health issues and priorities. Every attempt was made to be consistent in coding this information; nonetheless, comparisons between and among local public health departments and community health boards and regions should be made with caution.

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Health promotion to reduce behavioral risks such as tobacco use, alcohol, physical activity, nutrition and weight management that contribute to morbidity and mortality is the top goal for the state (Table 28). Other top public health priorities in Minnesota address birth and early childhood outcomes, unintended pregnancies, child and adolescent development and mental health care.

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Table 28. MN Public Health Improvement Goals - 2004 Goal 1 Reduce the behavioral risks that are primary contributors to morbidity and mortality. • Tobacco use • Alcohol and other drug use • Physical activity/inactivity • Nutrition • Weight management

Goal 2 Improve birth outcomes and early childhood development. • Prenatal care and birth outcomes • Breastfeeding • Women’s health • Early childhood development

Goal 3 Reduce unintended pregnancies.

Goal 4 Promote health for all children, adolescents and their families.

Goal 5 Promote, protect and improve mental health. • Depression • Mental illness • Children’s mental health

Goal 6 Promote a violence-free society. • Interpersonal violence • Suicide

Goal 7 Reduce the behavioral and environmental health risks that are primary contributors to unintentional injury. • Motor vehicle-related injury • Home and leisure injury

Goal 8 Improve the outcomes of medical emergencies. • Emergency medical services infrastructure

Goal 9 Reduce infectious disease. • Tuberculosis • Vaccine-preventable diseases • Sexually transmitted diseases, human immunodeficiency virus and acquired immunodeficiency syndrome • Emerging infectious disease • Refugee health

Source: Minnesota Department of Health: http://www.health.state.mn.us/divs/chs/phg/goals.html

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The Center reviewed the priorities identified by the Community Health Services Boards in the Central Minnesota AHEC region to assess the public health priorities identified by local partners within the health care system (Table 29). The priorities listed by public health category were determined by the counties for 2005-2009. Specific problems and proposed strategies were identified by many of the Community Health Services Boards and the detailed plans are included in Appendix C. The goals provide a framework for Minnesota’s Central region public, private and nonprofit sectors in improving health.

Alcohol, tobacco and other drug use received a priority ranking from all of the Community Health Services Boards. All also identified child and adolescent growth and development and mental health as a priority. Chronic/non-infectious disease and disability were ranked as top priorities for the majority of the Boards. The service delivery system with issues such as health care costs, workforce shortages and access to oral health care services were high priorities noted by several Boards.

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Table 29. Regional Public Health Priorities by County, 2005-2009

Preparedness Emergency Conditions Environmental Disease Infectious Mental Health Birth Pregnancy & System Service Delivery Injury Unintentional Pregnancy Unintended Violence Drugs Tobacco & Other Alcohol, Development & Growth & Child Adolescent Disease Chronic/ Noninfectious Independence – Disability Decreased

County

Big Stone * * * * * * * * * * *

Clay, Wilkin * * * * * * * *

Crow Wing * * * * * * * * * * *

Douglas * * * * * * * *

Grant, Pope, * * * * * * * * * * Stevens, & Traverse CHB Morrison * * * * * * * * * *

Otter Tail * * * * * * * * * * *

Stearns * * * * * * * * * *

Todd * * * * * * * * * * * * *

Wadena * * * * * * * * * * *

Source: Minnesota Department of Health, Community and Family Health, Office of Public Health Practice, June 2007

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Behavioral Risk Factors in Central MN Behavioral risk factors of adults in Central Minnesota were compared to the nation and the state using the 2005 Minnesota Department of Health’s Behavioral Risk Factor Surveillance System (Table 30). The table reports by percent, the portion of the adult population in each county which is at risk for various factors. Central Minnesota has a lower percentage of overweight adults compared to the state in 7 of the 14 counties. Overweight is defined as a Body mass Index greater than or equal to 25 for men and women. The lowest percentage was reported in Stevens County with 56.2% compared to the state average of 59.9%. The estimated smoking prevalence in Central Minnesota was lower overall than the state rate of 20.0%. Smoking had the highest percent in Clay County with 21.1% and Stearns County with 20.9%. Acute drinking was ranked at 18.8% in Minnesota. Stearns County had the highest rate at 20.4% followed by Clay with 19.7% and Stevens 1.3%. The prevalence of chronic drinking was lower in Central Minnesota compared to the state, except for Stearns, Clay and Stevens Counties which had a rate higher than 5%, compared. All of the Central Minnesota Counties had a higher percentage of the population reporting their perceived health status as fair to poor compared to the state except for Stearns County. The percentage was the highest in Big Stone, Grant, Pope and Traverse Counties that also have a greater percentage of population over age 65.

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Table 30. MN Behavioral Risk Factors of Adults – County Synthetic Estimates and State Estimates, 2005

Estimated Percent of: Overweight Current Acute Chronic Perceiving Health Smokers Drinking Drinking Status as Fair or Poor State of 59.9 20.0 18.8 5.0 11.3 Minnesota Big Stone 60.4 17.4 14.9 4.7 14.0 Clay 56.8 21.1 19.7 5.4 11.3 Crow Wing 59.8 19.1 17.4 4.8 12.4 Douglas 59.6 18.9 17.6 4.8 12.6 Grant 60.2 17.7 15.7 4.7 13.8 Morrison 59.8 19.4 18.2 4.9 12.0 Otter Tail 60.4 18.6 16.6 4.8 12.9 Pope 60.2 18.2 16.3 4.8 13.2 Stearns 57.7 20.9 20.4 5.3 11.0 Stevens 56.1 20.4 19.3 5.6 12.3 Todd 60.2 19.1 17.6 4.9 12.3 Traverse 59.9 17.0 14.6 4.6 14.8 Wadena 59.8 18.2 16.4 4.8 13.3 Wilkin 60.4 19.1 17.2 4.9 12.3

Source: Minnesota Department of Health, 2006 Minnesota County Health Tables http://www.health.state.mn.us/divs/chs/countytables/profiles2006/D_Morbidity_Util_05.pdf

Synthetic Estimates: County level estimated percentages for behavioral risk factors represent the percent of adults considered to be at risk for those behaviors in that county. These estimated percentages were derived through a synthetic estimation method, which adjusts statewide BRFSS percentages by the age and gender distributions of adults in each county.

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Infant Mortality in Central MN The Center reviewed the causes of death in Central Minnesota to determine if there were mortality factors specific to the region or individual counties of concern. Infant mortality is reported in Table 31. The highest number of infant deaths in the region occurred in Clay and Stearns Counties with 3 each. The infant mortality rate was too low to be calculated from 2001- 2005 in all of the counties except Crow Wing and Stearns. The rates were also too low to calculate in infant, neonatal, post-neonatal, fetal and perinatal mortality or death rates compared to the state.

Table 31. Minnesota Infant Mortality by State and County, 2001-2005

Number of Infant Neonatal Post- Fetal Perinatal Infant Mortality Mortality neonatal Death Death Rate Deaths 2001 Rate 2001- Rate 2001- Mortality Rate 2001- 2001-2005 - 2005 2005 2005 Rate 2001- 2005 2005 MN2004 --- 5.0 ------HP2010 --- 4.4 2.9 1.2 4.1 --- State of 363 5.0 3.3 1.7 4.9 6.3 Minnesota Big Stone 0 * * 0.0 * * Clay 8 * * * * * Crow Wing 6 6.0* * * * 6.7 Douglas 2 * * * * * Grant 0 0.0 0.0 0.0 * * Morrison 3 * * * * * Otter Tail 1 * * * * * Pope 0 * * * * * Stearns 13 4.9 3.0 * 4.6 6.3 Stevens 0 * * * * * Todd 3 * * * * * Traverse 0 0.0 0.0 0.0 * * Wadena 1 * * * * * Wilkin 0 * * 0.0 * *

Source: Minnesota Department of Health, Center for Health Statistics, 2004 Minnesota County Health Tables, Natality Table 3, http://www.health.state.mn.us/divs/chs/countytables/profiles2006/B_Birth_05.pdf MN2004: Healthy Minnesotans: Public Health Improvement Goals (2004) http://www.health.state.mn.us/divs/chs/phg/pdf/goal2.pdf HP2010: Healthy People 2010 Goals (U.S. Public Health Service) http://www.healthypeople.gov/data/midcourse/html/focusareas/FA16Objectives.htm

*Rate not calculated for less than 20 events

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Unintentional Injury, Homicide and Suicide Fatalities in MN Fatality due to unintentional injuries under the age of 20 occurred in half of the counties in Central Minnesota and accounted for 9.5% of the total unintentional injury fatalities (Table 32). Over the age of 20, the greatest number of fatalities due to unintentional injuries was reported in Crow Wing and Stearns Counties. Seven homicides occurred in central Minnesota. A slightly lower percentage of suicides occurred in those individuals under the age of 20 in Central Minnesota, 9%, compared to the state suicide rate of 10%.

Table 32. Number of Fatal Unintentional Injuries, Homicides and Suicides In MN by County, 2005

Unintentional Injury Homicide Suicide Under 20 All Under 20 All Under 20 All 20 Years Ages 20 Years Ages 20 Years Ages Years and Years and Years and Older Older Older State of 152 1,763 1,915 25 114 139 55 489 544 Minnesota Big Stone 2 0 2 0 0 0 0 0 0 Clay 2 21 23 0 0 0 0 8 8 Crow Wing 4 35 39 0 2 2 1 4 5 Douglas 0 10 10 0 1 1 0 1 1 Grant 0 0 0 0 0 0 0 0 0 Morrison 1 17 18 0 0 0 0 2 2 Otter Tail 2 21 23 1 0 1 0 6 6 Pope 0 3 3 0 1 1 0 0 0 Stearns 1 45 46 0 3 3 3 13 16 Stevens 0 3 3 0 0 0 0 0 0 Todd 6 4 10 0 0 0 0 3 3 Traverse 0 3 3 0 0 0 0 1 1 Wadena 0 9 9 0 0 0 0 1 1 Wilkin 0 1 1 0 0 0 0 0 0 Region Total 18 172 190 1 7 7 4 39 43

Source: Minnesota Department of Health, Health Data and Statistics http://www.health.state.mn.us/divs/chs/countytables/profiles2006/D_Morbidity_Util_05.pdf

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Cancer Deaths in MN The types of cancer with the greatest mortality rate are lung, breast, colon and rectum and prostate. The number and percent of cancer deaths in each county in Central Minnesota were compared to the state for breast and colon and rectum cancer in males and females (Table 33). Deaths from breast cancer in women were higher than the state in a few counties, most notably Todd and Traverse at 23.3% and 22.7%. In men, cancer deaths from colon and rectum cancer varied with about half of the counties above the state percentage of 9.3%. The highest level for men was in Wilkin County at 17.4%. The prevalence of colon and rectum cancer in women was higher than the state percent in several counties in central Minnesota including Clay, Crow Wing, Douglas, Grant, Morrison, Otter Tail, Stearns, Stevens, Wadena and Wilkin with over 10%.

Table 33. Number and Percent of Cancer Deaths by Type of Cancer Site and Sex in Minnesota by State and County, 2001-2003**

Breast Colon and Rectum Men Women Men Women Number Percent* Number Percent^ Number Percent* Number Percent^ State of 20 0.1% 9 14.8% 7 9.3% 6 9.8% Minnesota Big Stone 0 0.0% 4 12.5% 4 10.3% 2 6.3% Clay 0 0.0% 17 12.0% 10 7.9% 18 12.7% Crow Wing 0 0.0% 29 14.6% 11 5.5% 22 11.1% Douglas 0 0.0% 16 14.5% 12 9.7% 14 12.7% Grant 0 0.0% 1 4.8% 3 12.0% 6 28.6% Morrison 0 0.0% 4 4.2% 16 11.9% 16 16.8% Otter Tail 1 0.4% 23 13.0% 30 12.6% 22 12.4% Pope 0 0.0% 4 10.3% 4 7.7% 3 7.7% Stearns 1 0.3% 38 14.0% 29 8.5% 33 12.1% Stevens 0 0.0% 1 3.4% 4 10.3% 4 13.8% Todd 0 0.0% 7 23.3% 9 9.3% 7 9.6% Traverse 0 0.0% 5 22.7% 3 18.8% 2 9.1% Wadena 0 0.0% 8 17.4% 6 9.1% 5 10.9% Wilkin 0 0.0% 2 6.7% 4 17.4% 6 20.0% Source: Minnesota Department of Health, Minnesota Cancer Surveillance System, 2004 Minnesota County Health tables, http://www.health.state.mn.us/divs/chs/countytables/profiles2006/D_Morbidity_Util_05.pdf ** Includes number of cases diagnosed for the years 2001, 2002, 2003 *Percent = # specific cancer cases diagnosed in males for county (or state)/ total cancer cases diagnosed in males for county (or state) ^Percent = # specific cancer cases diagnosed in females for county (or state) / total cancer cases diagnosed in females for county (or state)

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A higher portion of cancer deaths were due to lung cancer in seven out of 14 central Minnesota’s counties for men and in three counties for women compared to the state (Table 34). The highest percentage of lung cancer deaths occurred in men in Todd County, 16.6%. Crow Wing, Todd and Wilkin Counties had the highest number of lung cancer deaths in women. Prostate cancer accounted for over 40% of cancer deaths in Otter Tail and Stearns Counties.

Table 34. Number and Percent of Cancer Deaths by Type of Cancer Site and Sex in Minnesota by State and County, 2001-2003**

Lung Prostate Men Women Men Women Number Percent* Number Percent^ Number Percent* Number Percent ^ State of 4,622 12.6% 3,908 11.7% 12,248 33.4% 0 0.0% Minnesota Big Stone 10 12.3% 5 9.1% 27 33.3% 0 0.0% Clay 60 15.0% 36 10.5% 130 32.4% 0 0.0% Crow Wing 82 14.5% 70 14.6% 208 36.9% 0 0.0% Douglas 52 13.6% 29 10.8% 129 33.7% 0 0.0% Grant 7 9.5% 6 10.2% 28 37.8% 0 0.0% Morrison 45 14.0% 25 10.6% 118 36.6% 0 0.0% Otter Tail 56 9.1% 36 8.8% 264 42.7% 0 0.0% Pope 15 11.6% 11 8.5% 43 33.3% 0 0.0% Stearns 104 9.6% 76 9.0% 499 46.0% 0 0.0% Stevens 10 12.7% 4 6.3% 27 34.2% 0 0.0% Todd 40 16.6% 24 15.5% 89 36.9% 0 0.0% Traverse 7 14.3% 1 2.9% 18 36.7% 0 0.0% Wadena 18 8.7% 15 11.6% 64 31.1% 0 0.0% Wilkin 5 7.5% 11 18.3% 18 26.9% 0 0.0% Source: Minnesota Department of Health, Minnesota Cancer Surveillance System, 2004 Minnesota County Health tables, http://www.health.state.mn.us/divs/chs/countytables/profiles2006/D_Morbidity_Util_05.pdf

** Includes number of cases diagnosed for the years 2001, 2002, 2003 *Percent = # specific cancer cases diagnosed in males for county (or state)/ total cancer cases diagnosed in males for county (or state) ^Percent = # specific cancer cases diagnosed in females for county (or state) / total cancer cases diagnosed in females for county (or state)

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Other types of cancer accounted for approximately 50% of all cancer deaths statewide in men and women (Table 35). In Central Minnesota, approximately 50% of cancer deaths in men were due to other types than those previously reported. In women, the greatest variation from the state was in Big Stone with 65.6% and 36.7% in Wilkin.

Table 35. Number and Percent of Cancer Deaths by Type of Cancer Site and Sex in Minnesota by State and County, 2001-2003**

Other Total Men Women Men Women Number Percent* Number Percent^ Number Percent* Number Percent^ State of 7,166 51.0% 6,764 51% 14,055 100% 13,233 100% Minnesota Big Stone 20 51.3% 21 65.6% 39 100% 32 100% Clay 63 49.6% 84 59.2% 127 100% 142 100% Crow Wing 102 50.7% 107 53.8% 201 100% 199 100% Douglas 60 48.4% 57 51.8% 124 100% 110 100% Grant 13 52.0% 9 42.9% 25 100% 21 100% Morrison 69 51.5% 57 60.0% 134 100% 95 100% Otter Tail 125 52.5% 105 59.3% 238 100% 177 100% Pope 28 53.8% 28 71.8% 52 100% 39 100% Stearns 175 51.2% 148 54.4% 342 100% 272 100% Stevens 19 48.7% 18 62.1% 39 100% 29 100% Todd 47 48.5% 36 49.3% 97 100% 73 100% Traverse 7 43.8% 12 54.5% 16 100% 22 100% Wadena 36 54.5% 23 50.0% 66 100% 46 100% Wilkin 12 52.2% 11 36.7% 23 100% 30 100%

Source: Minnesota Department of Health, Minnesota Cancer Surveillance System, 2004 Minnesota County Health tables, http://www.health.state.mn.us/divs/chs/countytables/profiles2006/D_Morbidity_Util_05.pdf ** Includes number of cases diagnosed for the years 2001, 2002, 2003 *Percent = # specific cancer cases diagnosed in males for county (or state)/ total cancer cases diagnosed in males for county (or state) ^Percent = # specific cancer cases diagnosed in females for county (or state) / total cancer cases diagnosed in females for county (or state)

Leading Causes of Death in Minnesota Tables 36 and 37 list the leading causes of death-by-age-group for the state and Central Minnesota. Individual county breakdowns of death-by-age-group are listed in Appendix C. In 2005, Central Minnesota’s leading cause of death was heart disease (24.5%), followed by cancer (23%). Statewide, cancer was the leading cause of death. Sixty-seven percent of Central Minnesota deaths occurred in persons age 75 and older (Table 37). Other was the third leading cause of death. Deaths caused by unintentional injuries accounted for 4.8% of deaths. The leading causes of unintentional injury were motor vehicle accidents and falls in the elderly.

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Table 36.

State of Minnesota Leading Causes of Death by Age Group, 2005

Cause 0-4 5-14 15-24 25-44 45-64 65-74 75+ All Ages AIDS/HIV 0 0 1 26 22 2 0 51 Alzheimer’s 0 0 0 1 12 60 1,246 1,319 Disease Atherosclerosis 0 0 0 0 2 9 125 136 Cancer 4 14 22 243 2,174 2,037 4,328 8,822 Cirrhosis 0 0 1 38 156 73 52 320 Congenital 110 10 3 22 35 7 14 201 Anomalies Chronic Lower 0 1 2 10 211 397 1,340 1,961 Respiratory Disease Diabetes 0 1 4 37 214 186 817 1,259 Heart Disease 2 2 14 164 1,074 979 5,680 7,915 Homicide 4 3 40 49 31 7 5 139 Hypertension 0 0 0 3 54 65 418 540 Nephritis 0 0 1 9 40 81 528 659 Perinatal 158 1 1 0 0 0 1 161 Conditions Pneumonia and 1 0 2 9 49 45 739 845 Influenza Septicemia 3 1 0 15 36 44 163 262 SIDS 44 0 0 0 0 0 0 44 Stroke 1 2 2 46 187 256 1,878 2,372 Suicide 0 11 94 182 190 29 38 544 Unintentional 34 32 208 386 395 129 731 1,915 Injury Other 44 23 37 265 952 874 5,838 8,033 Total 405 101 432 1,505 5,834 5,280 23,941 37,498

Source: Minnesota Department of Health, Center for Health Statistics, 2006 Minnesota County Health Tables, http://www.health.state.mn.us/divs/chs/countytables/profiles2006/C_Mortality_05.pdf

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Table 37. Central Minnesota – Leading Causes of Death by Age Group, 2005

Cause 0-4 5-14 15-24 25-44 45-64 65-74 75+ All Ages AIDS/HIV 0 0 0 0 2 1 0 3 Alzheimer’s 0 0 0 0 3 6 135 144 Disease Atherosclerosis 0 0 0 0 0 0 19 19 Cancer 0 1 1 22 197 200 479 900 Cirrhosis 0 0 0 4 14 5 6 29 Congenital 8 0 0 3 3 2 1 17 Anomalies Chronic Lower 0 0 0 1 19 48 162 230 Respiratory Disease Diabetes 0 0 1 0 16 13 91 121 Heart Disease 1 0 1 15 106 112 706 941 Homicide 0 0 1 1 3 0 3 8 Hypertension 0 0 0 0 4 9 34 47 Nephritis 0 0 0 0 3 8 50 61 Perinatal 21 0 0 0 0 0 0 21 Conditions Pneumonia and 0 0 1 1 6 7 84 99 Influenza Septicemia 0 0 0 0 2 6 9 17 SIDS 4 0 0 0 0 0 0 4 Stroke 0 0 0 1 15 20 233 269 Suicide 0 0 11 17 12 0 3 43 Unintentional 2 3 25 32 40 13 69 184 Injury Other 7 4 3 28 66 71 499 678 Total 43 8 44 125 511 520 2,583 3,835 Counties included: Big Stone, Clay, Crow Wing, Douglas, Grant, Morrison, Otter Tail, Pope, Stearns, Stevens, Todd, Traverse, Wadena, and Wilkin.

Source: Minnesota Department of Health, Center for Health Statistics, 2006 Minnesota County Health Tables, http://www.health.state.mn.us/divs/chs/countytables/profiles2006/C_Mortality_05.pdf

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Health Care Facilities in Central MN Although there are many types of health services provided throughout Central Minnesota, the facilities that are registered or licensed by the Minnesota Department of Health have been selected for analysis in this report (Table 38). These facilities include: assisted living facilities with services, mental health clinics, home care and home health agencies, hospitals, nursing homes, psychiatric hospitals and rural health clinics. In addition, pharmacies are listed as licensed by the Minnesota Board of Pharmacy. These services and facilities have been listed by county to outline primary care, pharmaceutical and mental health care access, as well as potential clinical or community-based health professional education sites. Housing with services or assisted living facilities are the most prevalent type of facility shown in Table 38 with 172 licensed entities. The highest number of assisted living facilities was reported in Stearns (34). One-hundred fifty home care and home health agencies were found in Central Minnesota. Central Minnesota has 23 licensed hospitals including the Veterans Administration Hospital in St. Cloud, with at least one in each county except for Clay. One state psychiatric hospital is located in Fergus Falls, Otter Tail County.

Table 38. Regional Health Care Facilities, 2007

County Housing Mental Home Hospital Nursing Pharmacies Psychiatric Rural With Health Care & (beds) Homes Hospitals Health Services Clinics Home (beds) (beds) Clinics Health Agencies Big Stone 4 0 6 2 (40) 2 (114) 5 0 1 Clay 16 0 12 0 4 (384) 19 0 3 Crow Wing 27 0 21 2 (204) 3 (319) 21 0 1 Douglas 16 0 15 1 (127) 4 (376) 10 0 0 Grant 4 0 2 1 (20) 3 (125) 5 0 1 Morrison 10 1 8 1 (49) 3 (262) 7 0 2 Otter Tail 37 1 27 2 (137) 11 (793) 17 1 (29) 3 Pope 8 0 14 2 (53) 3 (192) 4 0 1 Stearns* 34 1 27 6 (817) 8 (677) 46 0 3 Stevens 3 0 3 1 (54) 1 (104) 4 0 1 Todd 4 0 3 2 (61) 2 (173) 8 0 5 Traverse 1 0 1 1 (25) 2 (91) 2 0 3 Wadena 7 0 7 1 (49) 3 (250) 7 0 2 Wilkin 1 0 4 1 (25) 1 (120) 3 0 0

*Includes St. Cloud VA Hospital Sources: Pharmacies: Minnesota Board of Pharmacy Minnesota Department of Health, Health Care Facility and Provider Database http://www.health.state.mn.us/divs/fpc/directory/providerselect.cfm

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Seventeen of the 23 hospitals reported are federally designated as Critical Access Hospitals (CAHs) and receive cost-based Medicare reimbursement. The hospitals in Central Minnesota with a Critical Access Hospital designation include: • Albany • Morris • Breckenridge • Ortonville • Crosby • Paynesville • Elbow Lake • Perham • Glenwood • Sauk Centre • Graceville • Staples • Little Falls • Wadena • Long Prairie • Wheaton • Melrose

Fifty nursing homes were listed in Central Minnesota. All of the counties had at least one nursing home. Twenty-seven federally designated rural health clinics were listed in Central Minnesota. Rural health clinics receive enhanced reimbursement rates for providing Medicaid and Medicare services in rural areas. One federally funded community health center, Migrant Health Services, is located in Moorhead, Minnesota.

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Health Care Utilization in Central MN Health care utilization was analyzed through the Minnesota County Synthetic Estimates and compared to the state estimates for 2002. The estimates are calculated through monthly telephone surveys that monitor health risk behaviors in Minnesota adults. In the Central region, all counties reported a higher percentage than the state of adults that had not seen a dentist in the past year (Table 39). The percentage reporting no visits to the doctor ranged from 12.0% in Traverse County to 14.1% in Stearns County. All counties were lower than the state average of 14.6% for no visits to the doctor in the past year. A higher percentage of adults in Central Minnesota counties reported requiring hospitalization in the past year, compared to the state average of 11.1%. The highest percentage of adults requiring hospitalization was in Traverse County and the lowest percentages were in Clay and Stearns Counties.

Table 39. Health Care Utilization* - Minnesota County Synthetic Estimates and State Estimates, 2002

Percent Percent Reporting Percent Reporting Reporting No No Visits to the Hospitalization in Visits to the Doctor in the Past the Past Year Dentist in the Year Past Year State of Minnesota 21.8 14.6 11.1 Big Stone 24.0 12.3 12.8 Clay 23.6 13.5 11.9 Crow Wing 23.9 13.2 12.2 Douglas 24.1 13.2 12.3 Grant 24.1 12.6 12.8 Morrison 24.1 13.6 12.0 Otter Tail 23.9 13.0 12.4 Pope 24.0 12.8 12.6 Stearns 24.0 14.1 11.6 Stevens 23.6 13.2 12.3 Todd 23.9 13.5 12.1 Traverse 24.3 12.0 13.4 Wadena 24.1 12.9 12.5 Wilkin 23.9 13.4 12.0 Source: Minnesota Department of Health, 2002 Minnesota County Health Table, Morbidity and Utilization Table 7c http://www.health.state.mn.us/divs/chs/countytables/profiles2003/D_Morbid_Utiliz.pdf County Synthetic Estimates: County level estimated percentages for behavioral risk factors represent the percent of adults considered to be at risk for those behaviors in that county. These estimated percentages were derived through a synthetic estimation method, which adjusts statewide BRFSS (Behavioral Risk Factor Surveillance System) percentages by the age and gender distributions of adults in each county. Behavioral Risk Factor Surveillance System: A continuous monthly telephone survey that monitors health risk behaviors that has impact on chronic diseases and disabilities. Approximately 4,800 interviews of adults 18 years and older are completed yearly.

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Section 7. K - 12 and Community College Inventory of Health Professional Career Activities in Central MN

K – 12 Health Careers Information and Courses Survey for Central MN In order to quantify the level of health career information provided to students in Central Minnesota, a survey was designed by the Center and mailed in May, 2008 to 244 regional school health career teachers or curriculum coordinators including public and private schools (Appendix D). The purpose of the survey was to assess the level of health careers information provided to students in Central Minnesota. Thirteen percent (32) of the teachers or curriculum directors responded. Over half of the respondents (54%) target high school students (grade 7-12) and 35% target elementary students and 19% offer courses for all students (Figure 14).

Figure 10. Target Population for Health Careers Information and Courses in Central MN

Post-Secondary 0%

Out-of-School 0%

Home-School 0%

High School 54%

Elementary 35%

All Students 19%

0% 10% 20% 30% 40% 50% 60%

Percent

Source: 2007 Central Minnesota Area Health Education Center Career Information Courses and Study Survey

Post-Secondary Inventory of Health Care Professions Programs in Central MN Approximately one-third of the respondents offered academic standards/graduation standards for the health care courses offered. Over half of the respondents offered classroom speakers, field trips and tours (Table 40). Two organizations reported that they offer professional or student leadership programs such as HOSA (Health Occupation Students of America) and only one organization listed youth apprenticeships. Summer employment and mentoring were areas with low participation that could be explored, as well as HOSA and youth training. (Respondents could answer all that applied; therefore the total is greater than 100%).

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Table 40.

Health Career Information/Courses Offered by K-12 Schools in Central MN Number of Percent of Type of Information/Course Schools Respondents Offering Academic Standards/Graduation Standards 11 35% Articulation between Secondary and Postsecondary 7 23% Education Associations (Professional & Student Leadership-HOSA) 2 6% Business/Industry/Labor/Collaborations and Partnerships 3 10% Career/Work Experience 9 29%

Classroom Speakers 23 74% Clinical Rotations 2 6% Field Trips/Tours 19 61% Health Career Resource Centers/Counseling 5 16% Job Shadowing 9 29% Leadership Development Opportunities 1 3% Mentoring 5 16% Paid Work Experience 2 6% Scholarships 7 23% Summer Employment Opportunities 6 19% Youth Apprenticeships 1 3% Tuition Assistance 3 10% Other 1 3%

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The organizations were asked if they utilize the Minnesota Health Care Core Curriculum if they are offering health care professions courses. Two respondents indicated their school was using the curriculum. Twenty-nine respondents did not answer the question.

The organizations were queried as to their type of health care professional courses or education (Table 41). Five respondents were offering health careers courses and one was offering a certified nursing assistant program. Five were offering medical terminology, CPR or first aid.

Table 41.

Health Care Professional Courses Offered by Organizations in Central MN

Number of Type of Course Percent Responses

Medical Terminology 5 16%

Health Care Careers 5 16%

Certified Nursing Assistant 1 3%

Emergency Medical Technician 0 0%

Nursing (RN, LPN) 0 0%

First Aid 6 19%

CPR 5 16%

Other 0 0%

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Summary

The Central Minnesota Health Professional Workforce and Community Health Analysis study contains a variety of health care workforce data, health professions education and community health status information in the Central Minnesota region. The data presented is descriptive in nature, and the information is presented in an organized format for ease of use.

This study contains a variety of descriptive data concerning selected health professionals in Minnesota, both practice and education. The analysis provides relevant information in order to identify specific provider shortages based on supply and demand and potential gaps between supply and demand. Shortages of health care professionals exist in Central Minnesota for many professions based on hospital and clinic vacancies, provider-to-population ratio, demand indicators and Federal Health Professional Shortage Area designations in Primary Care and Mental Health. The gaps between supply and demand are more prevalent outside of Otter Tail and Stearns Counties, especially for non-primary care physicians, dentists and mental health providers. The number of providers to 100,000 people in Central Minnesota was lower for physicians, nurse practitioners and dentists.

Factors that further influence health care professional access, and could be further analyzed, include medical technology (including telemedicine), universal access to health insurance, the economy, and provider work effort. Although there were limitations in the available data, the gaps found between health care professional supply and demand in Central Minnesota include: • Dentists • Family medicine physicians • Medical specialists • Surgical specialists

The demand for health care services will increase as a result of the aging population including retiring health professionals. People age 65 and older have twice as many physician visits per year as compared to those under age 45.6 An aging population will significantly increase the demand for surgical procedures by 2020.7 The Annals of Surgery reported that the demand for surgical procedures will increase 47% for ophthalmology, 33% for urology, 28% for general surgery and 25% for orthopaedic surgery. Currently, 35% of the physicians in Central Minnesota are non-Primary Care physicians, primarily located in Otter Tail and Stearns Counties. With the limited access to the above specialists, family medicine and internal medicine physicians and nurse practitioners will need to manage more elderly patients as the number of people age 65 and older increases.

Central Minnesota has a limited number of health care professional educational programs for a region outside the seven-county metropolitan area. These programs include: a family practice residency program and clinical laboratory technologist program. The lack of dentistry, graduate nursing, pharmacy and non-primary care medicine impacts the supply of new providers starting practice in the region.

Several health care professionals are facing substantial retirements within their profession in the next 10 years (over 30% of the workforce), including physicians, dentists, pharmacists and

Rural Health Resource Center 59 veterinarians. The number of new physicians completing graduate medical education in Minnesota has declined, but pharmacy, dentistry and nursing have increased, which will help address the number of anticipated vacancies. The population in Central Minnesota is projected to grow by nearly 19% by 2020, with the greatest increase in people age 65 to 84. The ratio of providers-per-capita is expected to decline in Central Minnesota, if the number of practicing providers remains stable over the next two decades. In the future, with Minnesota’s projected population growth, projected retirements and a static educational capacity in the region, the supply of health professionals will fall short of demand.

Through an analysis of regional public health goals, the Center identified community health priorities for each county. Overall, the County Health Services Boards cited alcohol, tobacco and other drug use most frequently as the highest priority category. Other categories of focus were child and adolescent growth and development and mental health. The percentage of overweight adults was higher in Central Minnesota compared to the state average for half of the counties. Smoking prevalence was also lower in the region compared to the state rate. Chronic drinking was lower compared to the state average for most counties except Stearns County. Certain types of cancer were more prevalent than the state average in the region including breast cancer in women. Heart disease was the leading cause of death in Central Minnesota and it occurred at a higher rate than statewide. These are possible community health promotion topics for the Central AHEC.

Central Minnesota health care professionals were described in the study. Many counties have a single hospital and a limited number of pharmacies. There are a large number of long-term care facilities including assisted living with services, home care and nursing homes. This is reflective of the large number of elderly in the region. Central Minnesota has one community health center providing primary care services on a sliding fee scale and also a small number of community mental health centers that provide state funded services and a sliding fee scale. These facilities are important health care access points for the underserved and uninsured. The region has 17 Critical Access Hospitals that receive cost - based Medicare reimbursement.

Health care career promotion and activities are an important element of Area Health Education Centers. A survey of schools in the Central region found that the high school students are the target population for most organizations that provide information and courses. Less than 20% were targeting all students. Based on the survey, areas for expansion by the AHEC could include professional and student leadership associations, health career resource centers, mentoring, training and tuition assistance or scholarship programs. There were several health care courses offered in the region.

There are limitations to both the primary and secondary data collected for the study. Original data collected from schools is limited by short response times available for respondents to complete and respond to the survey, resulting in lower response rates. Secondary data was gathered from a variety of state agency and national sources, frequently in different formats and/or containing different data elements. These limitations should be considered when using this data for decision-making.

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References

st 1 Physician Community Requirements in the 21 Century: The 2003 Physicians to Population Ratios. Solucient, LLC, www.solucient.com.

2 Spire, M.: A Review of Physician Recruitment and Training in Rural America. The World of Rural Medical Education, http://www.unmc.edu/Community/ruralmeded/.

3 Implications of Rural Minnesota’s Changing Demographics. Minnesota Planning, July 2000.

4 Reshaping Long-Term Care in Minnesota. State of Minnesota Long-Term Care Task Force, January 2001.

5 Minnesota Department of Employment and Economic Development, Labor Market Information Office, Regional Analysis & Outreach, August 2005.

6 Valente, E., Wyatt, Suzane M., Moy, Ernest, et al: Market Influences on Internal Medicine Residents’ Decisions to Subspecialize. Annals of Internal Medicine, June 1, 1998, Vol. 128, Issue 11, pp 915-921.

7 Etzioni, David A., Liu, Jerome H., Maggard, Melinda A., Ko, Clifford Y.: The Aging Population and it’s Impact on the Surgery Workforce. Annals of Surgery, August 2003, Vol. 238(2), pp. 170-177.

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Appendix A. Health Professional Shortage Areas (HPSA) PRIMARY CARE

County Area Designated Category/Type

Big Stone Graceville Health Center RHC

• Barnesville SA GA Clay • Migrant Health Service CHC

Crow Wing Mille Lacs Population – Low Income

Whole County Population – Low Income Douglas

Grant Whole County SCTY • Mille Lacs Population – Low Income Morrison • Morrison SA Population – Low Income

• Pelican Rapids RSA 89 MCD Otter Tail • Elbow Lake/Dalton MCD RSA 17 • East Otter Tail RSA 91 MCD

Pope ND N/A • Albany Medical Center RHC Stearns • Albany Area Hosp & Medical Center RHC • Albany Area Hosp & • Medical Center – Avon RHC

Stevens ND N/A

Todd Whole County SCTY

Traverse ND N/A • Southern Wadena Population – Low Income Wadena • N. Wadena SA MCD RSA 104 • South Wadena Population – Low Income RSA 105

Wilkin Barnesville SA MCD ABBREVIATION KEY: CT: Census Track MCD: Minor Civil Division City or Town POP: Population FCI: Federal Correction Institution PSN: Prison FMC: Federal Medical Center OFAC: Other Facilities SCTY: Single County ND: Not Designated NA: Not Applicable GA: Geographic Area RHC: Rural Health Clinic Source: http://hpsafind.hrsa.gov/HPSASearch.aspx

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Health Professional Shortage Areas (HPSA)

MENTAL HEALTH

County Area Designated Category/Type

Big Stone Whole County GA – SCTY

Clay Whole County GA – SCTY

Crow Wing Whole County GA – SCTY

Douglas Whole County GA – SCTY

Grant Whole County GA – SCTY

Morrison Whole County GA – SCTY

Otter Tail Whole County GA – SCTY

Pope Whole County GA – SCTY • St. Cloud GA Stearns • Albany Medical Center RHC • Whole County SCTY

Stevens Whole County GA – SCTY

Todd Whole County GA – SCTY

Traverse Whole County GA – SCTY

Wadena Whole County GA – SCTY

Wilkin Whole County GA – SCTY ABBREVIATION KEY:

CT: Census Track MCD: Minor Civil Division City or Town POP: Population FCI: Federal Correction Institution PSN: Prison FMC: Federal Medical Center OFAC: Other Facilities SCTY: Single County ND: Not Designated NA: Not Applicable GA: Geographic Area RHC: Rural Health Clinic

Source: http://hpsafind.hrsa.gov/HPSASearch.aspx

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Health Professional Shortage Areas (HPSA)

DENTAL

County Area Designated Category/Type

Big Stone Whole County Population – Low Income

Clay Migrant Health Service CHC

Crow Wing ND NA

Douglas ND NA

Grant Whole County Population – Low Income

Morrison ND NA

Otter Tail Whole County Population – Low Income

Pope ND NA

Stearns Albany Medical Center RHC

Stevens ND NA

Todd ND NA

Traverse Whole County Population – Low Income

Wadena ND NA

Wilkin ND NA ABBREVIATION KEY:

CT: Census Track MCD: Minor Civil Division City or Town POP: Population FCI: Federal Correction Institution PSN: Prison FMC: Federal Medical Center OFAC: Other Facilities SCTY: Single County ND: Not Designated NA: Not Applicable GA: Geographic Area RHC: Rural Health Clinic CHC: Community Health Center

Source: http://hpsafind.hrsa.gov/HPSASearch.aspx

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Appendix B. Medically Underserved Areas (MUA)

County Area Designated Category/Type

Big Stone Clinton/Graceville SA MCD – MUA • Moorhead SA CT – MUA Clay • Clay Service Area CT – MUA

Crow Wing ND N/A

Douglas ND N/A

Grant Grant SA MUA

• Morrison Benton SA MCD – MUA • Scandia Valley SA MUA – MUA Otter Tail • Battle Lake Village MCD – MUA • Henning Service Area MCD – MUA • MCD – MUA New York Mills Village • Parkers Prairie SA • Perham SA MCD – MUA • Pelican Rapids RSA MCD – MUA 89 MCD – MUA

Pope SCTY Low Income – MUP • Brooten Village MCD – MUA Stearns • LI – Kimball Low Income – Gov MUP

Stevens ND N/A Todd • Todd SA MCD – MUA

Traverse Traverse County RSA 51 UNK

Wadena North Wadena RSA 104 MCD – MUA

Wilkin Wilkin SA MUA

ABBREVIATION KEY:

CT: Census Tract LI: Low Income MUA: Medically Underserved Area MUP: Medically Underserved Population MCD: Minor Civil Division NA: Not Applicable ND: Not Designated SCTY: Single County UNK: Unknown

Source: Health Resources and Services Administration, Medically Underserved Area/Population Database. http://muafind.hrsa.gov/index.aspx

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Appendix C. Leading Causes of Death in Central MN

Big Stone County – Leading Causes of Death by Age Group, 2005

Cause 0-4 5-14 15-24 25-44 45-64 65-74 75+ All Ages AIDS/HIV 0 0 0 0 0 0 0 0 Alzheimer’s 0 0 0 0 0 0 0 0 Disease Atherosclerosis 0 0 0 0 0 0 0 0 Cancer 0 0 0 0 7 7 13 27 Cirrhosis 0 0 0 0 0 0 0 0 Congenital 0 0 0 0 1 0 0 1 Anomalies Chronic Lower 0 0 0 0 0 0 5 5 Respiratory Disease Diabetes 0 0 0 0 0 0 1 1 Heart Disease 0 0 0 0 1 2 23 26 Homicide 0 0 0 0 0 0 0 0 Hypertension 0 0 0 0 0 0 0 0 Nephritis 0 0 0 0 0 1 2 3 Perinatal 0 0 0 0 0 0 0 0 Conditions Pneumonia and 0 0 0 0 0 1 1 2 Influenza Septicemia 0 0 0 0 0 0 0 0 SIDS 0 0 0 0 0 0 0 0 Stroke 0 0 0 0 2 1 8 11 Suicide 0 0 0 0 0 0 0 0 Unintentional 0 0 2 0 0 0 0 2 Injury Other 0 0 0 0 1 0 6 7 Total 0 0 2 0 12 12 59 85

Source: Minnesota Department of Health, Center for Health Statistics, 2006 Minnesota County Health Tables, http://www.health.state.mn.us/divs/chs/countytables/profiles2006/C_Mortality_05.pdf

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Clay County – Leading Causes of Death by Age Group, 2005

Cause 0-4 5-14 15-24 25-44 45-64 65-74 75+ All Ages AIDS/HIV 0 0 0 0 0 0 0 0 Alzheimer’s 0 0 0 0 0 1 7 8 Disease Atherosclerosis 0 0 0 0 0 0 1 1 Cancer 0 0 0 1 16 17 63 97 Cirrhosis 0 0 0 0 0 2 2 4 Congenital 1 0 0 0 0 0 0 1 Anomalies Chronic Lower 0 0 0 0 3 3 12 18 Respiratory Disease Diabetes 0 0 1 0 1 1 11 14 Heart Disease 1 0 0 2 10 12 71 96 Homicide 0 0 0 0 0 0 0 0 Hypertension 0 0 0 0 0 0 3 3 Nephritis 0 0 0 0 1 0 3 4 Perinatal 3 0 0 0 0 0 0 3 Conditions Pneumonia and 0 0 0 1 2 3 13 19 Influenza Septicemia 0 0 0 0 0 0 0 0 SIDS 2 0 0 0 0 0 0 2 Stroke 0 0 0 0 1 4 18 23 Suicide 0 0 2 3 3 0 0 8 Unintentional 1 1 1 5 6 2 7 23 Injury Other 1 1 1 3 6 2 59 73 Total 9 2 5 15 49 47 270 397

Source: Minnesota Department of Health, Center for Health Statistics, 2006 Minnesota County Health Tables, http://www.health.state.mn.us/divs/chs/countytables/profiles2006/C_Mortality_05.pdf

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Crow Wing County – Leading Causes of Death by Age Group, 2005

Cause 0-4 5-14 15-24 25-44 45-64 65-74 75+ All Ages AIDS/HIV 0 0 0 0 0 0 0 0 Alzheimer’s 0 0 0 0 2 1 12 15 Disease Atherosclerosis 0 0 0 0 0 0 1 1 Cancer 0 0 0 2 23 31 67 123 Cirrhosis 0 0 0 0 2 0 0 2 Congenital 2 0 0 0 0 1 0 3 Anomalies Chronic Lower 0 0 0 0 3 8 24 35 Respiratory Disease Diabetes 0 0 0 0 2 4 11 17 Heart Disease 0 0 0 4 16 11 81 112 Homicide 0 0 0 1 1 0 0 2 Hypertension 0 0 0 0 2 1 8 11 Nephritis 0 0 0 0 1 2 11 14 Perinatal 2 0 0 0 0 0 0 2 Conditions Pneumonia and 0 0 0 0 1 1 8 10 Influenza Septicemia 0 0 0 0 1 0 2 3 SIDS 1 0 0 0 0 0 0 1 Stroke 0 0 0 0 3 3 32 38 Suicide 0 0 1 3 1 0 0 5 Unintentional 0 0 5 6 9 0 19 39 Injury Other 2 1 0 4 13 10 59 89 Total 7 1 6 20 80 73 335 522

Source: Minnesota Department of Health, Center for Health Statistics, 2006 Minnesota County Health Tables, http://www.health.state.mn.us/divs/chs/countytables/profiles2006/C_Mortality_05.pdf

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Douglas County – Leading Causes of Death by Age Group, 2005

Cause 0-4 5-14 15-24 25-44 45-64 65-74 75+ All Ages AIDS/HIV 0 0 0 0 0 0 0 0 Alzheimer’s 0 0 0 0 0 0 2 2 Disease Atherosclerosis 0 0 0 0 0 0 0 0 Cancer 0 0 1 0 5 7 16 29 Cirrhosis 0 0 0 0 0 0 0 0 Congenital 2 0 0 1 0 0 0 3 Anomalies Chronic Lower 0 0 0 0 1 3 9 13 Respiratory Disease Diabetes 0 0 0 0 0 0 2 2 Heart Disease 0 0 0 0 1 4 24 29 Homicide 0 0 0 0 1 0 0 1 Hypertension 0 0 0 0 0 0 2 2 Nephritis 0 0 0 0 0 0 1 1 Perinatal 4 0 0 0 0 0 0 4 Conditions Pneumonia and 0 0 0 0 0 0 1 1 Influenza Septicemia 0 0 0 0 0 0 0 0 SIDS 0 0 0 0 0 0 0 0 Stroke 0 0 0 0 0 0 7 7 Suicide 0 1 0 1 1 0 0 3 Unintentional 0 0 3 1 1 2 2 9 Injury Other 0 0 0 0 2 3 18 23 Total 6 1 4 3 12 19 84 129

Source: Minnesota Department of Health, Center for Health Statistics, 2006 Minnesota County Health Tables, http://www.health.state.mn.us/divs/chs/countytables/profiles2006/C_Mortality_05.pdf

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Grant County – Leading Causes of Death by Age Group, 2005

Cause 0-4 5-14 15-24 25-44 45-64 65-74 75+ All Ages AIDS/HIV 0 0 0 0 0 0 0 0 Alzheimer’s 0 0 0 0 0 0 0 0 Disease Atherosclerosis 0 0 0 0 0 0 2 2 Cancer 0 0 0 2 1 3 11 17 Cirrhosis 0 0 0 0 1 0 0 1 Congenital 0 0 0 0 0 0 0 0 Anomalies Chronic Lower 0 0 0 0 0 1 3 4 Respiratory Disease Diabetes 0 0 0 1 1 0 3 5 Heart Disease 0 0 0 0 1 2 19 22 Homicide 0 0 0 0 0 0 0 0 Hypertension 0 0 0 0 0 2 1 3 Nephritis 0 0 0 0 0 1 3 4 Perinatal 0 0 0 0 0 0 0 0 Conditions Pneumonia and 0 0 0 0 0 1 0 1 Influenza Septicemia 0 0 0 0 0 0 0 0 SIDS 0 0 0 0 0 0 0 0 Stroke 0 0 0 0 0 0 4 4 Suicide 0 0 0 0 0 0 0 0 Unintentional 0 0 0 0 0 0 0 0 Injury Other 0 0 0 0 0 1 20 21 Total 0 0 0 3 4 11 66 84

Source: Minnesota Department of Health, Center for Health Statistics, 2006 Minnesota County Health Tables, http://www.health.state.mn.us/divs/chs/countytables/profiles2006/C_Mortality_05.pdf

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Morrison County – Leading Causes of Death by Age Group, 2005

Cause 0-4 5-14 15-24 25-44 45-64 65-74 75+ All Ages AIDS/HIV 0 0 0 0 0 0 0 0 Alzheimer’s 0 0 0 0 0 0 15 15 Disease Atherosclerosis 0 0 0 0 0 0 1 1 Cancer 0 0 0 2 18 10 39 69 Cirrhosis 0 0 0 2 2 0 0 4 Congenital 1 0 0 1 0 0 0 2 Anomalies Chronic Lower 0 0 0 0 1 7 16 24 Respiratory Disease Diabetes 0 0 0 0 1 1 12 14 Heart Disease 0 0 0 2 5 6 53 66 Homicide 0 0 0 0 0 0 0 0 Hypertension 0 0 0 0 0 2 1 3 Nephritis 0 0 0 0 0 0 4 4 Perinatal 2 0 0 0 0 0 0 2 Conditions Pneumonia and 0 0 0 0 1 0 7 8 Influenza Septicemia 0 0 0 0 0 0 1 1 SIDS 0 0 0 0 0 0 0 0 Stroke 0 0 0 0 1 3 20 24 Suicide 0 0 0 1 0 0 1 2 Unintentional 0 0 3 5 5 2 3 18 Injury Other 0 0 0 1 5 3 29 38 Total 3 0 3 14 39 34 202 295

Source: Minnesota Department of Health, Center for Health Statistics, 2006 Minnesota County Health Tables, http://www.health.state.mn.us/divs/chs/countytables/profiles2006/C_Mortality_05.pdf

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Otter Tail County – Leading Causes of Death by Age Group, 2005

Cause 0-4 5-14 15-24 25-44 45-64 65-74 75+ All Ages AIDS/HIV 0 0 0 0 0 0 0 0 Alzheimer’s 0 0 0 0 0 0 34 34 Disease Atherosclerosis 0 0 0 0 0 0 10 10 Cancer 0 0 0 2 32 39 75 148 Cirrhosis 0 0 0 1 2 0 1 4 Congenital 0 0 0 0 1 0 0 1 Anomalies Chronic Lower 0 0 0 0 5 6 20 31 Respiratory Disease Diabetes 0 0 0 1 2 2 17 22 Heart Disease 0 0 0 0 17 29 101 147 Homicide 0 0 1 0 0 0 0 1 Hypertension 0 0 0 0 0 1 4 5 Nephritis 0 0 0 0 0 1 9 10 Perinatal 1 0 0 0 0 0 0 1 Conditions Pneumonia and 0 0 0 0 1 0 23 24 Influenza Septicemia 0 0 0 0 0 3 3 6 SIDS 0 0 0 0 0 0 0 0 Stroke 0 0 0 0 2 3 45 50 Suicide 0 0 1 3 1 0 1 6 Unintentional 0 0 3 3 5 4 8 23 Injury Other 0 1 0 5 15 15 88 124 Total 1 1 5 15 83 103 439 647

Source: Minnesota Department of Health, Center for Health Statistics, 2006 Minnesota County Health Tables, http://www.health.state.mn.us/divs/chs/countytables/profiles2006/C_Mortality_05.pdf

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Pope County – Leading Causes of Death by Age Group, 2005

Cause 0-4 5-14 15-24 25-44 45-64 65-74 75+ All Ages AIDS/HIV 0 0 0 0 1 0 0 1 Alzheimer’s 0 0 0 0 0 2 6 8 Disease Atherosclerosis 0 0 0 0 0 0 1 1 Cancer 0 1 0 0 3 5 18 27 Cirrhosis 0 0 0 0 0 0 0 0 Congenital 0 0 0 0 0 0 0 0 Anomalies Chronic Lower 0 0 0 0 1 2 8 11 Respiratory Disease Diabetes 0 0 0 0 0 0 3 3 Heart Disease 0 0 0 0 5 4 29 38 Homicide 0 0 0 0 1 0 0 1 Hypertension 0 0 0 0 0 0 1 1 Nephritis 0 0 0 0 0 0 2 2 Perinatal 0 0 0 0 0 0 0 0 Conditions Pneumonia and 0 0 0 0 0 0 4 4 Influenza Septicemia 0 0 0 0 0 0 0 0 SIDS 0 0 0 0 0 0 0 0 Stroke 0 0 0 0 0 0 11 11 Suicide 0 0 0 0 0 0 0 0 Unintentional 0 0 0 1 1 1 0 3 Injury Other 1 0 0 0 0 1 32 34 Total 1 1 0 1 12 15 115 145

Source: Minnesota Department of Health, Center for Health Statistics, 2006 Minnesota County Health Tables, http://www.health.state.mn.us/divs/chs/countytables/profiles2006/C_Mortality_05.pdf

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Stearns County – Leading Causes of Death by Age Group, 2005

Cause 0-4 5-14 15-24 25-44 45-64 65-74 75+ All Ages AIDS/HIV 0 0 0 0 1 0 0 1 Alzheimer’s 0 0 0 0 1 1 20 22 Disease Atherosclerosis 0 0 0 0 0 0 1 1 Cancer 0 0 1 8 53 38 87 187 Cirrhosis 0 0 0 1 3 1 2 7 Congenital 2 0 0 1 1 1 0 5 Anomalies Chronic Lower 0 0 0 0 4 12 39 55 Respiratory Disease Diabetes 0 0 0 0 6 3 15 24 Heart Disease 0 0 1 3 23 20 143 190 Homicide 0 0 0 0 1 0 2 3 Hypertension 0 0 0 0 2 2 8 12 Nephritis 0 0 0 0 0 2 9 11 Perinatal 10 0 0 0 0 0 0 10 Conditions Pneumonia and 0 0 1 0 1 1 10 13 Influenza Septicemia 0 0 0 0 1 1 2 4 SIDS 0 0 0 0 0 0 0 0 Stroke 0 0 0 1 3 1 44 49 Suicide 0 0 7 4 5 0 0 16 Unintentional 0 0 5 9 9 2 21 46 Injury Other 2 1 0 6 13 19 95 136 Total 14 1 15 33 127 104 498 792

Source: Minnesota Department of Health, Center for Health Statistics, 2006 Minnesota County Health Tables, http://www.health.state.mn.us/divs/chs/countytables/profiles2006/C_Mortality_05.pdf

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Todd County – Leading Causes of Death by Age Group, 2005

Cause 0-4 5-14 15-24 25-44 45-64 65-74 75+ All Ages AIDS/HIV 0 0 0 0 0 0 0 0 Alzheimer’s 0 0 0 0 0 0 5 5 Disease Atherosclerosis 0 0 0 0 0 0 0 0 Cancer 0 0 0 1 10 20 32 63 Cirrhosis 0 0 0 0 0 1 0 1 Congenital 1 0 0 0 0 0 0 1 Anomalies Chronic Lower 0 0 0 1 2 4 10 17 Respiratory Disease Diabetes 0 0 0 0 2 0 6 8 Heart Disease 0 0 0 0 6 7 41 54 Homicide 0 0 0 0 0 0 0 0 Hypertension 0 0 0 0 0 1 4 5 Nephritis 0 0 0 0 0 1 2 3 Perinatal 2 0 0 0 0 0 0 2 Conditions Pneumonia and 0 0 0 0 0 0 3 3 Influenza Septicemia 0 0 0 0 0 1 0 1 SIDS 0 0 0 0 0 0 0 0 Stroke 0 0 0 0 1 1 12 14 Suicide 0 0 0 2 0 0 1 3 Unintentional 1 2 4 0 0 0 3 10 Injury Other 1 0 0 0 4 5 28 38 Total 5 2 4 4 25 41 147 228

Source: Minnesota Department of Health, Center for Health Statistics, 2006 Minnesota County Health Tables, http://www.health.state.mn.us/divs/chs/countytables/profiles2006/C_Mortality_05.pdf

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Traverse County – Leading Causes of Death by Age Group, 2005

Cause 0-4 5-14 15-24 25-44 45-64 65-74 75+ All Ages AIDS/HIV 0 0 0 0 0 0 0 0 Alzheimer’s 0 0 0 0 0 0 4 4 Disease Atherosclerosis 0 0 0 0 0 0 0 0 Cancer 0 0 0 1 1 1 7 10 Cirrhosis 0 0 0 0 0 0 0 0 Congenital 0 0 0 0 0 0 0 0 Anomalies Chronic Lower 0 0 0 0 0 0 1 1 Respiratory Disease Diabetes 0 0 0 0 0 1 0 1 Heart Disease 0 0 0 0 0 2 14 16 Homicide 0 0 0 0 0 0 0 0 Hypertension 0 0 0 0 0 0 0 0 Nephritis 0 0 0 0 0 0 0 0 Perinatal 0 0 0 0 0 0 0 0 Conditions Pneumonia and 0 0 0 0 0 0 0 0 Influenza Septicemia 0 0 0 0 0 0 0 0 SIDS 0 0 0 0 0 0 0 0 Stroke 0 0 0 0 0 0 0 0 Suicide 0 0 0 0 1 0 0 1 Unintentional 0 0 0 2 0 0 1 3 Injury Other 0 0 0 0 0 0 6 6 Total 0 0 0 3 2 4 33 42

Source: Minnesota Department of Health, Center for Health Statistics, 2006 Minnesota County Health Tables, http://www.health.state.mn.us/divs/chs/countytables/profiles2006/C_Mortality_05.pdf

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Wadena County – Leading Causes of Death by Age Group, 2005

Cause 0-4 5-14 15-24 25-44 45-64 65-74 75+ All Ages AIDS/HIV 0 0 0 0 0 0 0 0 Alzheimer’s 0 0 0 0 0 1 11 12 Disease Atherosclerosis 0 0 0 0 0 0 0 0 Cancer 0 0 0 1 4 10 19 34 Cirrhosis 0 0 0 0 1 0 1 2 Congenital 0 0 0 0 0 0 1 1 Anomalies Chronic Lower 0 0 0 0 0 0 5 5 Respiratory Disease Diabetes 0 0 0 0 1 0 5 6 Heart Disease 0 0 0 2 7 6 40 55 Homicide 0 0 0 0 0 0 0 0 Hypertension 0 0 0 0 0 0 3 3 Nephritis 0 0 0 0 1 0 2 3 Perinatal 0 0 0 0 0 0 0 0 Conditions Pneumonia and 0 0 0 0 0 0 3 3 Influenza Septicemia 0 0 0 0 0 1 1 2 SIDS 1 0 0 0 0 0 0 1 Stroke 0 0 0 0 0 1 16 17 Suicide 0 0 0 0 1 0 0 1 Unintentional 0 0 0 0 4 2 3 9 Injury Other 0 0 2 2 2 5 33 44 Total 1 0 2 5 21 26 143 198

Source: Minnesota Department of Health, Center for Health Statistics, 2006 Minnesota County Health Tables, http://www.health.state.mn.us/divs/chs/countytables/profiles2006/C_Mortality_05.pdf

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Wilkin County – Leading Causes of Death by Age Group, 2005

Cause 0-4 5-14 15-24 25-44 45-64 65-74 75+ All Ages AIDS/HIV 0 0 0 0 0 0 0 0 Alzheimer’s 0 0 0 0 0 0 4 4 Disease Atherosclerosis 0 0 0 0 0 0 2 2 Cancer 0 0 0 0 4 2 6 12 Cirrhosis 0 0 0 0 3 0 0 3 Congenital 0 0 0 0 0 0 0 0 Anomalies Chronic Lower 0 0 0 0 0 1 3 4 Respiratory Disease Diabetes 0 0 0 1 0 0 3 4 Heart Disease 0 0 0 1 2 3 15 21 Homicide 0 0 0 0 0 0 0 0 Hypertension 0 0 0 0 0 0 1 1 Nephritis 0 0 0 0 0 0 1 1 Perinatal 0 0 0 0 0 0 0 0 Conditions Pneumonia and 0 0 0 0 0 0 3 3 Influenza Septicemia 0 0 0 0 0 0 0 0 SIDS 0 0 0 0 0 0 0 0 Stroke 0 0 0 0 0 1 4 5 Suicide 0 0 0 0 0 0 0 0 Unintentional 0 0 0 0 0 1 0 1 Injury Other 0 0 0 0 1 4 10 15 Total 0 0 0 2 10 12 52 76

Source: Minnesota Department of Health, Center for Health Statistics, 2006 Minnesota County Health Tables, http://www.health.state.mn.us/divs/chs/countytables/profiles2006/C_Mortality_05.pdf

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Appendix D. K-12 Health Careers Information and Courses Survey for Central MN

May 25, 2007

Dear Health Educator:

The Rural Health Resource Center’s Minnesota Center for Rural Health has been contracted by the Central Minnesota Area Health Education Center (AHEC) based in Fergus Falls, Minnesota, to assess the level of health career information provided to students in central Minnesota. The AHEC is a regional network of academic and community partners committed to meeting the health care workforce needs of greater Minnesota.

This short survey has been sent to K-12 educators in central Minnesota to determine the type of health career activity and awareness provided to regional students. The information will be cataloged to assist students and educators in obtaining health careers information and experience. In addition, an analysis of the results will help identify gaps in health careers activities that the AHEC can address through program development.

If you are not the correct person to respond to this survey, please forward to the appropriate person who can complete the survey. If you agree to participate, please complete the short survey and return in the enclosed postage paid envelope. It will take approximately 10 minutes to complete the survey.

For more information about the Central Minnesota Area Health Education Center, visit: http://www.mnahec.umn.edu/AHEC/Central_AHEC.html.

Please complete this survey by Friday, June 15, 2007.

Thank you for your participation,

Sally Buck Associate Director Rural Health Resource Center 218-727-9390, ext 225 [email protected] www.ruralcenter.org/mcrh

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Central Minnesota Area Health Education Center Career Information and Courses Study

1. Organization/School (Please complete contact information).

Health Careers Contact Name Title Organization/School District Program Name Address City State Zip

2. Additional Contact Information. County Phone Fax Email Address Web Address

3. Target Population (Check all that apply). All Students Home-Schooled Elementary School Students (K-6) Out-of-School Youth High School Students (7-12) Post-secondary Students

4. Type(s) of Health Career information/courses offered by your organization (Check all that apply): Academic Standards/Graduation Standards Articulation between Secondary and Post-Secondary Education Associations (Professional & Student Leadership-HOSA) Business/Industry/Labor/Collaborations and Partnerships Career/Work Experience Classroom Speakers Clinical Rotations Field Trips/Tours Health Career Resource Centers/Counseling Job Shadowing Leadership Development Opportunities Mentoring Paid Work Experience Scholarships Summer Employment Opportunities Youth Apprenticeships Rural Health Resource Center 80

Tuition Assistance Other, Please Specify

5. If your organization is offering Health Care Professions courses, is the MN Health Care Core Curriculum being used?

Yes No

Curriculum Comments:

6. If your organization offers health care professional courses (education), please list the types of courses: Medical Terminology Nursing Health Care Careers First Aid Certified Nursing Assistant Cardio-Pulmonary Resuscitation Emergency Medical Technician Other, Please Specify

7. Approximately how many students participate in your health career courses or events each school year?

1-25 26-50 51-100 101-200 201+

Please return your completed survey by Friday June 15, 2007 to: Rural Health Resource Center 600 E. Superior Street Suite 404 Duluth, MN 55802 Or Fax to: 218-727-9392

THANK YOU FOR YOUR PARTICIPATION!

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