Health Professions Education in
Minnesota:
Results of the 2001 Minnesota
Health Professions Trainee Exit
Surveys
June 2002
h ealth e conomics p rog ram
Health Policy and Systems Compliance Division
Minnesota Department of Health
Printed with a minimum of 10% post-consumer materials. Please recycle.
Health Professions Education in
Minnesota:
Results of the 2001 Minnesota
Health Professions Trainee Exit
Surveys
June 2002
h ealth e conomics p rog ram
Health Policy and Systems Compliance Division
Minnesota Department of Health
Table of Contents
Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1
Highlights . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
Chapter 1: Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7
Chapter 2: Demographics, Education and Debt . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
Chapter 3: Post-Training Plans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19
Chapter 4: Labor Market Experiences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .31
Chapter 5: Policy Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .39
Appendix A: Survey methodology and response rates . . . . . . . . . . . . . . . . . . . . . . . . .41
Appendix B: Responses and survey instrument: Advanced Practice Nurses . . . . . . . . . .43
Appendix C: Responses and survey instrument: Chiropractors . . . . . . . . . . . . . . . . . .49
Appendix D: Responses and survey instrument: Dental Students/Residents . . . . . . . . .55
Appendix E: Responses and survey instrument: Resident Physicians . . . . . . . . . . . . . .61
Appendix F: Responses and survey instrument: Physician Assistants . . . . . . . . . . . . . .69
Appendix G: Responses and survey instrument: Pharmacy Students/Residents . . . . . .75
Endnotes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .83
iii
iv
Executive Summary
In Minnesota, debates around the existence of worker shortages in the health care industry have
been ongoing for the past several years. These debates have gained a new urgency in light of
Minnesota’s budget deficit and the spending cuts to which it might lead. In particular, the specter
of a nurse shortage loomed large during last summer’s negotiations between the state’s nurses union
and several large hospitals. Questions regarding potential shortages also take on additional importance given ongoing concerns about access to health care among underserved populations. These
and other events have led to the formation, in recent years, of several new collaborative efforts
designed to develop a better understanding of the distribution of the state’s healthcare workforce.
These efforts also seek to design policy mechanisms that would result in a more adequate distribution of workers throughout the healthcare system or, alternatively, new ways of delivering patient
care in a time when sufficient numbers of trained professionals may not be available.
The Minnesota Department of Health’s Medical Education and Research Costs (MERC) Advisory
Committee, a group of educators, administrators and clinicians who advise the Department on
administration of the MERC Fund and on appropriate policy directions for health professions education in Minnesota, has also been examining the issue of worker shortages and how state-level policy can impact prospective provider decisions about specialization, geographic location, and work
with underserved populations.
The relative lack of reliable data on how health professionals choose where and how they will practice and how they move through the system over time has hindered efforts to develop such policies.
In response to this lack of data, the Health Economics Program at the Minnesota Department of
Health has developed the Minnesota Health Professions Trainee Exit Surveys. Findings in this
report mark the first year of a longitudinal survey effort showing trends in employment, demo1
graphics and labor market experiences for recent graduates of medical, dental, pharmacy, advanced
practice nursing, physician assistant, and chiropractic programs in Minnesota. The surveys are
designed to shed new light on the labor market experiences and movements of health professionals
entering the Minnesota workforce.
Surveys were distributed to program directors and graduate medical education administrators at 19
institutions during the spring and summer of 2001. Together, these institutions sponsored over 200
programs with 1,323 expected graduates. A total of 904 graduates responded, 68.3% of the total
population. For additional detail on methodology and response rates, see Appendix A.
The results of these surveys, presented in this report, are intended for use both by policy makers
interested in developing strategies to retain health professionals within Minnesota and by program
or institution-level administrators interested in a more detailed understanding about where graduates go upon program completion – and why. MDH will administer these surveys annually. Over
time, we hope this data will be a valuable tool for designing interventions to address maldistributions of labor by region or specialty and for developing new insight into the dynamics of the health
professions labor market.
2
Highlights
Characteristics and Educational Background of Trainees
z
Women represent at least a third of all respondents in each of the six surveyed provider type
groups, and represent the majority of pharmacy, P.A. and advanced practice nursing respondents.
z
Among medical residents, women were much more strongly represented in Primary Care
specialties and OB/GYN than in non-Primary Care specialties.
z
Physician Assistants were more likely than other provider types to have attended high school
or college in Minnesota, with over three-quarters having attended in-state high schools or
colleges. In comparison, less than one-quarter of medical residents had graduated from
Minnesota high schools or colleges.
z
Almost a quarter of medical resident respondents were international medical graduates
(IMGs), and less than one-third had attended Minnesota medical schools.
Educational Debt
z
Chiropractic respondents reported the highest levels of educational debt, with 95% owing at
least $60,000 (including both undergraduate and professional school debt) and 69.3%
reporting that they owed $100,000 or more.
z
Graduates of Minnesota medical schools had lower debt levels than did graduates of other
U.S. medical schools, but not as low as IMGs. More than three-quarters of IMGs had no
debt.
3
z
Medical residents completing programs in OB, Family Practice, and General Internal
Medicine had the highest average debt among the physician specialty groups.
z
Physician Assistants and chiropractors had the highest debt-to-income ratio of the six
provider types.
Future Plans
z
Just over 20% of medical and dental respondents intended to pursue additional specialty or
sub-specialty training upon completion of their current training program. In some medical
specialty areas, more than 30% of respondents reported plans to subspecialize.
z
Among respondents with confirmed practice plans, just 55% of medical residents and 59%
of Chiropractors were staying in Minnesota. Medical residents from Primary Care programs
were significantly more likely to be remaining in Minnesota to practice than were respondents from non-Primary Care programs.
z
Across all provider types, those who had attended Minnesota high schools, colleges, or professional schools were more likely to remain in Minnesota to practice than were those who
attended school elsewhere. While over 86% of Minnesota medical school graduates with
confirmed practice plans were remaining in the state to practice, fewer than half of graduates from medical schools in other states or other countries had made commitments to
remain in Minnesota.
z
Fewer than 10% of respondents had committed to practicing in rural areas and even fewer
planned to work in a federally-designated Health Professional Shortage Area (HPSA).
Likelihood of working in a HPSA was greatest for Physician Assistants, pharmacists, and
Family Practice physicians.
z
Primary Care respondents, particularly those in Family Practice, were more likely to have
accepted positions in rural areas or small towns than were non-Primary Care respondents.
Expected First Year Income and Hours
z
Median anticipated first year income for medical residents was $142,500. Respondents in
Primary Care specialties reported lower anticipated first year income than respondents in
non-Primary Care specialties, at $122,500 and $162,500 respectively. Primary Care respondents also reported higher levels of educational debt than non-Primary Care respondents.
z
Among medical resident respondents, females anticipated working roughly 6 fewer hours
per week than males (42.4 vs 48.6).
z
The majority of dentists (68.1%) and chiropractors (53.4%) anticipated working 39 or
fewer hours per week or less.
z
Medical residents completing Primary Care residencies anticipated working about eight
hours fewer per week than non-Primary Care residents (41.1 hours vs 49.3 hours).
4
Job Search and Labor Market Perceptions
z
Pharmacist and Physician Assistant respondents tended to search exclusively in Minnesota –
mostly in the Twin Cities metropolitan area - while medical residents and chiropractors were
more likely to only search outside of Minnesota.
z
On the whole, chiropractors searched longer for a position than did other provider types,
with almost 30% searching for six months or more.
z
The average number of job offers over the course of a job search was lowest for Physician
Assistants at 1.2, compared with 3.7 for medical residents and 3.6 for pharmacists.
Physician Assistants were also the most likely to report having received no offers.
z
Physician Assistants were the most likely to report difficulties in finding a satisfactory position, with almost 80% indicating at least some difficulty. Most often, these difficulties were
attributed to a lack of jobs in the desired practice setting.
z
Across all provider types, practice setting was the single most important factor considered in
the job search. Geographic location and family/spouse considerations were also widely taken
into account, particularly by medical residents and Physician Assistants.
z
Few respondents considered military, loan, or visa obligations to be important factors in
their job search.
z
Physician Assistants had the most negative view of the Minnesota job market, with more
than half of those who had searched for a job indicating that there were “few” or “very few”
jobs available. Dental and pharmacy respondents were the most optimistic, with more than
two-thirds reporting that there were many jobs available.
5
6
1
Introduction
In recent years, concerns about present and future shortages of certain healthcare providers have
prompted a new wave of research into the healthcare workforce both nationally and at the state
level. In Minnesota alone, numerous organizations or collaborative efforts have been established to
examine the size, composition, and distribution of the healthcare workforce, while others have
expanded or revised their missions to more closely address issues related to recruitment and retention. In general, these efforts are focused not on shortage identification in and of itself, but rather
on determining whether such shortages or maldistributions of healthcare providers have an impact
on access to healthcare and, if so, on developing appropriate policy responses.
Issues related to the size and distribution of the healthcare workforce in Minnesota have long been
of concern to the Medical Education and Research Costs (MERC) Advisory Committee and the
Department of Health, as well. In 1996, when legislation establishing the MERC Fund was passed,
the stated purpose of the fund was relatively straightforward: offsetting a portion of the clinical
training costs faced by hospitals and clinics around the state who are involved in the clinical training of a set of health professionals. However, the question of whether training of certain provider
types or specialties should be supported at a higher level than others was never far below the surface. In a 1996 report to the Legislature, MDH recommended establishing a set of ‘guiding principles’ for the development of the future MERC distribution formula that included a consideration
of whether or not programs “encouraged the expansion of any area of training where there is an
anticipated ‘oversupply’ of providers.”1 The current MERC legislation acknowledges this issue as
well, stating that to be eligible for grants from the MERC Fund, programs must ‘emphasize
Primary Care or specialties that are in undersupply in Minnesota.’
7
While workforce issues have long been debated by MERC and have been included in the MERC
statute, the formula governing distribution of MERC funds has not included a component that
would more highly reward any given provider type or specialty, nor have any alternative funding
mechanisms yet been developed to address the distribution of the health professional workforce in
Minnesota. Amidst renewed interest in the issue, the MERC Advisory Committee, a group of educators, administrators and clinicians who advise the Department on administration of the MERC
Fund and on appropriate policy directions for health professions education in Minnesota, formed a
subcommittee to determine whether or not it would be appropriate and feasible for MERC to take
a more proactive role in the workforce issue, either through a modification of the distribution formula or through the establishment of a new funding mechanism that could more explicitly incent
the training of specific provider types, specialties or geographic areas.
The workforce subcommittee met several times during late 2000 to study available state-level
employment, vacancy and demand data for the provider types covered by the MERC Fund, as well
as national data sources, in an effort to determine whether existing data were at a sufficient level of
detail to allow for identification of specialty-level demand or shortages. The committee determined
that additional detail by specialty and geography would be needed before any modifications to
MERC distribution mechanisms could be made. The committee also felt that many of the existing
demand-focused data collection tools did not fully address issues related to how and why health
professionals make practice-related decisions, key information for developing policy responses related to recruitment and retention of these workers. Based on these findings, the committee determined that new, more detailed data would be necessary before MERC could undertake any serious
discussions of taking a more active role in influencing the size, distribution or composition of the
health professions workforce.
After examining medical resident exit surveys designed by the State University of New York at
Albany’s Center for Health Workforce Studies, the committee recommended that MDH develop a
set of similar tools to survey graduating students and residents who were completing programs in
Minnesota that would qualify them to enter one of the professions included in the MERC Fund.
The MERC Advisory Committee voted to undertake this new project, and a set of six surveys was
developed in the fall of 2000 to be administered to graduating dental students and residents, pharmacy students and residents, resident physicians, and advanced practice nursing, physician assistant,
and chiropractic students.
The first round of surveys was administered by the Health Economics Program at the Minnesota
Department of Health in the spring and summer of 2001. A total of 1,323 surveys were administered to expected graduates in over 200 programs at 19 institutions. In order to increase the
response rate, surveys were administered by institutional coordinators (usually faculty members or
administration, GME coordinators, or student services directors) who were given discretion to distribute the surveys in whichever manner they felt would be best for their students; as a result, surveys were given to students before final exams, at graduation ceremonies, during final class sessions,
during exit interviews, as an item to be completed on an exit checklist, and even during focus
groups, with many programs managing to obtain a 100% response rate.
8
It is important to note that while the overwhelming majority of students and residents in the target
programs received surveys, the results are still, in a sense, a point in time snapshot. In some cases, as
with the chiropractic program, surveys were administered at multiple points throughout the year to
reflect multiple possible graduation dates. However, in general, exiting students or residents who
did not complete their program within several months of survey administration, as in the case of a
student needing an extra quarter or semester to complete courses, may have been missed.
Usable responses were received by
Table 1.1
904 respondents, for a final response
Response rates by provider type
rate of 68.3%, which ranged from a
Provider Type
Graduates Returned
high of 100% for Physician
Medical (MD)
670
403
Assistants to a low of 58.4% for
Dental (DDS)
127
103
pharmacy. This report presents
Pharmacy (PhD)
89
52
Physician
Assistant
(PA)
26
26
results for these respondents, with an
Advanced Practice Nursing (APN)
203
123
emphasis on comparing the respons- Chiropractic (CH)
208
197
es of respondents from each provider
1323
904
type to questions that were common
across all surveys, with findings of particular interest highlighted.
Rate
60.2%
81.1%
58.4%
100.0%
60.6%
94.7%
68.3%
The body of the report is divided into chapters that follow the same general organizational structure as the surveys themselves. Chapter 2 of this report presents demographic data on all 904
respondents, including gender, race, citizenship and age, as well as responses to questions about
where the respondent attended high school, college, and professional school and their level of educational debt at the time of program completion. Chapter 3 contains information on the immediate post-training plans of all respondents and, for those who had accepted a practice position, information about the characteristics of that practice. Practice-related questions include anticipated firstyear salary, practice setting, ownership level, anticipated weekly hours, and demographics of the
area surrounding the practice. Chapter 4 presents information on respondents’ job search experiences, including the geographic areas in which the respondent searched, search duration, level of
difficulty finding a satisfactory practice position, factors that were considered during the job search,
and perception of practice opportunities in Minnesota and nationally. Chapter 5 concludes the
report with a discussion of the implications these findings have for the development of policies
related to the health professions workforce in Minnesota. A set of appendices to this report presents
results for each provider type, along with the survey instruments.
Technical Note
For the purposes of this report, “Primary Care’ medical specialties are defined as Family Practice,
General Internal Medicine, General Pediatrics and combined Internal Medicine/Pediatrics programs. The definition of Primary Care used in this report does not include OB/GYN.
9
10
2
Demographics,
Education, and Debt
Factors as diverse as gender, race/ethnicity, educational debt level, geographic location of training,
and exposure to diverse populations or settings during training can have a significant impact on
how and where health professionals choose to practice. Recently published studies have found links
between gender and rural location among physicians on a national level, with female physicians less
likely to work in rural areas than male physicians.2 Closer to home, the Minnesota Department of
Health’s Office of Rural Health and Primary Care has found that this trend also holds true among
Minnesota’s practicing dentists.3 Other research has uncovered links between a provider’s race and
service to racially and ethnically diverse populations.4 In Minnesota, as in many other states, the
state, region, or even county in which a new health professional received his or her training can be
a strong predictor of where that provider will eventually practice. For example, more than half of all
pharmacists practicing in Minnesota in 2001 attended the University of Minnesota School of
Pharmacy, and virtually all attended pharmacy school in Minnesota, North Dakota, South Dakota,
Wisconsin or Iowa.5
Given the potential importance of these factors in determining the level of service to underserved
geographic areas or population groups, and in projecting the size and composition of the future
workforce, the ability to more accurately describe the demographics of the newest health professional cohort will be key for the development of policies to address access to health care and
recruitment/retention issues.
This chapter examines demographic characteristics of respondents, including gender, age, race and
citizenship status, and presents responses to questions about where the respondent attended high
school, college, and professional school. This chapter also presents data on educational debt level.
11
Cases used for analysis in Chapter 2
Advanced Practice Nursing Students (APN)
Chiropractic Students (CH)
Dental Students/Residents (DDS)
Resident Physicians (MD)
Facility-based specialties
(Anesthesiology, Radiology, Pathology)
Family Practice (FP)
Internal Medicine-General (IM)
Internal Medicine-Specialties (IM-SPEC)
Obstetrics/Gynecology (OB)
Other (OTHER)
Pediatrics-General (PEDS)
Surgery-General and Specialties (SURG)
Physician Assistant Students (PA)
Pharmacy Students/Residents (PhD)
Total:
N
123
197
103
403
Response Rate
60.6%
94.7%
81.1%
60.1%
55
70
58
40
14
81
21
64
26
52
904
64.0%
70.0%
56.3%
53.3%
93.3%
56.3%
52.5%
59.8%
100.0%
58.4%
68.3%
Analysis in this chapter is based on responses of all survey respondents, a total of 904 students/residents. Where possible, medical resident respondents are aggregated into eight specialty groups;
facility-based specialties (Anesthesiology, Radiology and Pathology or ARP), Family Practice,
General Internal Medicine, Internal Medicine specialties, OB, General Pediatrics, Surgery (including both General Surgery and surgical specialties) and other specialties. Abbreviations that will be
used for all provider type and specialty groups in charts in this chapter are included in the table
above.
12
Gender
Figure 2.1
Percentage Female, by Provider Type
100%
84.6%
90%
40.3%
37.5%
12.3%
10%
20.0%
20%
31.1%
34.9%
30%
42.9%
36.0%
40%
49.5%
50%
42.4%
60%
56.7%
67.3%
70%
74.4%
80%
z
z
z
z
SURG
PEDS
OTHER
OB
IM-SPEC
IM
FP
ARP
MD
PhD
PA
DDS
CH
APN
0%
Roughly a quarter (25.6%) of responding graduates in advanced practice nursing, traditionally a female-dominated field, were men. Survey responses indicate that the majority of
pharmacy and P.A. completers are women, and women represent at least a third of all completers in the other surveyed professions as well.
In 2001, only 17.4% of practicing Minnesota dentists were women.6 However, new dentists
are much more likely to be female, with women representing 42.9% of dental respondents –
39% of graduating dental students and 46% of exiting dental residents.
The trend towards more female representation in the health professions also holds true
among Physician Assistant respondents, 84.5% of whom were female. Nationally, the
American Academy of Physician Assistants estimated that 56.5% of practicing P.A.s were
female in 2001.7
2001, women made up 23.2% of all Minnesota physicians8 but 34.9% of graduating residents, indicating that the gender balance among practicing physicians may begin to more
closely reflect Minnesota’s population in the coming years. Mirroring national patterns,
women were much more strongly represented in Primary Care specialties (and in OB/GYN)
than in non-Primary Care specialties. Women represented 43.8% of respondents in Primary
Care and 29.6% in non-Primary Care specialties.

The specialties with the highest percentage of females were OB/GYN with 56.7%,
Family Practice with 49.5% and General Pediatrics with 42.4%. Women represented just 12.3% of all respondents in Internal Medicine specialties.
13
Race
Figure 2.2
Percentage Non-white, by Provider Type and Specialty
32.5%
35%
26.6%
23.7%
20%
21.1%
23.1%
25%
21.5%
28.3%
30%
14.2%
5.0%
7.2%
CH
7.7%
7.4%
APN
5%
12.3%
MN Pop:
10% 11.8%
14.3%
15%
SURG
PEDS
OTHER
OB
IM-SPEC
IM
FP
ARP
MD
PhD
PA
DDS
0%
Of the provider types surveyed, medical residents had the highest percentage of non-white
or Hispanic respondents, at 23.1%, compared with 11.8% of Minnesota’s population that
classified itself as non-white or Hispanic according to the 2000 Census9.
z

Non-Primary Care respondents were significantly more likely to be non-white
(26.7%) than were Primary Care respondents (16.9%).

Internal Medicine specialties had the highest percentage of non-white respondents
(32.5%), followed by the facility-based specialties (Anesthesiology, Radiology, and
Pathology) at 28.3%.

Nationally, African Americans, American Indians/Alaskan Natives, and certain persons of Hispanic origin are considered to be under-represented minorities in medicine. Members of these groups represented 10.3% of responding medical residents.

Across all provider types and medical specialties, Asian/Pacific Islanders were the
single largest non-white group. Among medical residents, Asian/Pacific Islanders
ranged from 4.3% of Family Practice respondents to 22.5% in Internal Medicine
specialties. Asian/Pacific Islanders are not usually considered to be an under-represented minority in medicine.
With the exception of dentistry and medicine, responses from all other provider types indicated that non-whites and/or Hispanics were underrepresented in the surveyed health professions compared with Minnesota’s overall racial and ethnic makeup.
z
14
HS/College
Figure 2.3
62.2%
59.3%
26.8%
24.1%
19.8%
43.0%
46.7%
57.2%
31.9%
20%
25.6%
40%
56.8%
46.2%
60%
77.0%
74.0%
80%
83.6%
84.7%
100.0%
100%
100.0%
Respondents who attended MN High School, College or Professional School
0%
APN
CH
Minnesota High School
DDS
Minnesota College
MD
PA
PhD
Minnesota Professional School
z
Among the provider types surveyed, Physician Assistants were the most likely to have graduated from a Minnesota high school (77%) or college (84.7%). Medical residents were the
least likely to have graduated from Minnesota schools, with only 24.1% graduating from
high school and 19.8% from college within the state.
z
The majority of medical residents attended out-of-state professional schools. Only roughly
one-fourth (26.8%) of medical residents attended medical school in Minnesota. Among
advanced practice nurses, just over half (56.8%) received their baccalaureate nursing degree
from a Minnesota school.
Citizenship
z
The overwhelming majority of respondents in all six groups were either native-born or naturalized U.S. citizens or permanent residents. J-1 or J-2 temporary visa holders represented
just 6.1% of dental respondents and 12% of medical residents. H-1, H-2, or H-3 visas were
even less common, at just 1% for medical residents and 3.6% for Chiropractors.10
z
While almost a quarter of medical resident respondents (24.1%) were international medical
graduates, roughly half of IMG’s were either U.S. citizens or permanent residents.

The specialties with the highest percentage of graduates on temporary visas were
Internal Medicine specialties (27.6%) and facility-based specialties (20.4%).
Primary Care specialties, in particular General Pediatrics, had the lowest percentage
of graduates on temporary visas, averaging less than 5% in that category.
15
Educational debt
Figure 2.4
Educational Debt (U.S. Graduates only)
100%
11.5%
7.9%
90%
25.8%
80%
70%
26.8%
54.3%
40.8%
69.3%
19.2%
60%
35.1%
65.4%
50%
15.5%
40%
23.9%
13.8%
30%
8.0%
2.9%
20%
25.7%
30.5%
10%
0%
38.1%
15.4%
22.3%
21.8%
1.0%
APN*
4.0%
1.0%
CH
None
6.6%
< $20,000
DDS
$20,000-$59,999
MD
$60,000-$99,999
3.8%
3.8%
6.6%
PA
PhD
$100,000 +
z
Among the provider types, chiropractors reported the highest debt level. Virtually all had at
least some debt, with 95% owing at least $60,000 (including undergraduate and professional school debt) and 69.2% reporting that they owed $100,000 or more.
z
Among all U.S. medical graduates (graduates of medical schools in Minnesota and other
states), the average debt load of medical residents was $75,670. The average debt load of
indebted medical residents who graduated from U.S. medical schools was $90,132.
z
International medical graduates (IMG’s) had significantly lower debt than did U.S. medical
school graduates. Graduates of Minnesota medical schools, while facing higher debt loads
than IMG’s, were still better off than graduates of other U.S. medical schools.

More than three-quarters (76.9%) of IMG’s had no debt, compared with just 16%
of U.S. graduates. According to the American Association of Medical Colleges
(AAMC), 18.0% of all U.S. medical students who graduated in 1996, the median
medical school graduation year for respondents to this survey, had no debt.11

The average debt load of indebted respondents was $49,500 for IMG’s, $82,000 for
Minnesota graduates and $95,000 for graduates of other U.S. schools.
The medical specialties with the highest debt levels were OB (an average of $97,000,
including both those with debt and those without), Family Practice ($91,200) and General
Internal Medicine ($64,200). Due to their longer training requirements, respondents from
z
16
non-primary care specialties who have not deferred their loans may have been paying down
debt for a longer period, contributing to the differential between average primary care and
non-primary care debt loads.
z
Physician Assistants and chiropractors had the highest debt to expected income ratio. On
average, P.A.s owed an amount equal to 134% of their expected first year income, and chiropractors owed roughly 240% of their expected first year income. Advanced Practice
Nurses had the lowest debt to income ratio.
Table 2.1
Provider
Type
APN
CH
DDS
MD
PA
PHD
Average Debt
Load (U.S. grads
only)
$24,773
$107,730
$74,740
$75,670
$73,461
$57,724
Median Expected
Annual Income
$80,000
$45,000
$87,499
$142,499
$55,000
$82,952
Ratio
31.0%
239.4%
85.4%
53.1%
133.6%
69.6%
17
18
3
Post-Training Plans
As outlined in Chapter 2, it is important to have a clear picture of the people in the health professions ‘pipeline’ in order to predict the size and composition of the future health workforce and to
project where –or if- these professionals will choose to practice. However, it is equally important to
know whether program graduates choose to remain within the state to practice or to pursue further
training, and the types of practices at which they choose to work.
For example, more clearly
Cases used for analysis in Chapter 3*
understanding the outflow of
graduates who complete
N
Minnesota training programs
Advanced Practice Nursing Students (APN)
59
but leave the state to pursue fur- Chiropractic Students (CH)
91
Dental
Students/Residents
(DDS)
52
ther training or to practice else245
where, as well as the number of Resident Physicians (MD)
Physician Assistant Students (PA)
14
graduates who follow the oppo- Pharmacy Students/Residents (PhD)
36
site pattern, is crucial to translatTotal:
497
ing raw enrollment and graduation counts into a true projec- *For questions on general future plans, all 904 respondents are included in the
analysis in this chapter. For all questions related to characteristics of the
tion of future practitioners.
respondent’s practice, analysis is limited to the 497 respondents who indicated
they had accepted a practice position.
Better information on hours
worked and anticipated tenure
in a geographic area can help to refine estimates of level of service, turnover, and ease of access to
medical, dental or other treatments. Changes in anticipated first-year income over time can be an
important indicator of shifts in relative demand for an occupation or specialty.
19
Chapter 3 presents data related to respondents’ immediate post-training plans. All survey recipients
were asked about their future plans. Those who indicated they had accepted a practice position or
would be self-employed were then asked a series of questions about the characteristics of their practice, including the setting (inpatient hospital, community-based facility, long term care, etc), level
of ownership, anticipated hours and income, the demographics of the surrounding area, and how
they anticipated that their time would primarily be spent. Analysis in this chapter is limited to
respondents who indicated that they had accepted a practice position or would be self-employed;
this represented approximately two-thirds of all respondents. It is important to note that this chapter includes the responses of those who had accepted positions outside of Minnesota and/or outside
of the U.S.
20
Future Plans
Figure 3.1
Future Plans
PhD
80.9%
PA
13.1%
6.0%
100.0%
1.7%
MD
72.4%
21.1%
4.7%
2.1%
DDS
70.9%
21.5%
5.4%
1.5%
CH
APN
0%
2.0%
96.4%
0.8%
6.1%
90.2%
20%
Patient Care
40%
Additional Training
60%
Teaching/Research
80%
3.0%
100%
Other/Undec/DKY
z
Across the provider types studied, a large majority plan to go directly into clinical practice
upon completion of their current training program, as opposed to working in teaching or
research positions or going on for additional training. In the case of Physician Assistants,
100% of respondents plan to go directly into patient care. While post-graduate programs
for Physician Assistants do exist, relatively few P.A.s go on to complete such programs, and
no post-graduate option is currently available for P.A.s in Minnesota.
z
Medical resident and dental respondents were the most likely to be going on for additional
training, at 21.1% and 21.5% respectively.
z

Among medical residents, the specialty groups which were most likely to indicate
plans to pursue further training in a subspecialty were the facility-based specialties
(Anesthesiology, Radiology and Pathology) at 34.5%, Surgery (31.2%) and General
Internal Medicine (31.1%). Respondents in Family Practice and OB/GYN (both
7.2%) were the least likely to report plans for additional training in a subspecialty.

Of medical residents who planned to pursue training in a subspecialty, fewer than
half (43.5%) planned to remain in Minnesota for their training. Of those that were
leaving the state, less than one-third intended to return to Minnesota following
completion of their subspecialty training.
International medical graduates (IMGs) were significantly more likely to be pursuing additional training than were graduates of U.S. medical schools (31.3% for IMGs, 15.9% for
Minnesota medical school graduates, 19.4% for other U.S. graduates).
21
Location of Practice: within/outside of MN
Figure 3.2
Respondents Whose Confirmed Patient Care Plans Are in Minnesota
92.9%
90%
50%
77.6%
55.0%
59.2%
60%
68.1%
70%
80.7%
80%
88.2%
100%
43.1%
40%
30%
20%
10%
0%
APN
CH
DDS
MD
PA
PhD
Primary Care
Non-Primary Care
Among respondents with confirmed practice plans, medical residents and chiropractors were the
least likely to be staying in Minnesota to practice. Just 55% of the medical residents with confirmed
plans were remaining in the state, along with just 59.2% of chiropractors. Physician Assistants and
pharmacists were the most likely to be staying in Minnesota, at 92.9% and 88.2% of those with
confirmed positions.
z

Respondents completing Primary Care residencies were significantly more likely than those
from non-Primary Care residencies to be remaining in Minnesota for their upcoming practice (77.6% vs 43.1%).
Exit survey respondents bear out the theory that the location where a health professional grew up is
an important predictor of where they will eventually practice. Graduates of Minnesota high schools
were significantly more likely to remain in Minnesota to practice than were non-Minnesota high
school graduates, a factor which largely explains why medical residents and chiropractors are less
likely to remain in-state than other groups.
z

The difference between Minnesota and non-Minnesota high school graduates was statistically significant for all provider types, but most pronounced among chiropractors (93.8%
of Minnesota graduates with confirmed plans remaining in Minnesota vs 40.7% of nonMinnesota graduates) and dentists (96.3% vs 36%).
Graduates of Minnesota medical schools were significantly more likely to be remaining in Minnesota
to practice than graduates of other U.S. medical schools or IMGs.
z

22
Among medical residents with confirmed practice plans, 86.3% of Minnesota medical
school graduates were remaining in the state to practice, compared to just 48.8% of IMGs.
Conversely, while 23.3% of IMGs with confirmed plans had accepted positions abroad, no
Minnesota medical graduates had.
Practice Setting
Figure 3.3
Practice Setting
70.0%
64.3%
62.4%
58.6%
60.0%
51.5%
50.0%
40.0%
36.8%
30.0%
26.5%
25.1%
21.4%
20.0%
18.4%
14.3%
9.3%
10.0%
3.6%
3.2%
4.7%
0.0%
Hospital Inpatient
Hospital Ambulatory
APN
MD
Community
PA
Other
PhD
Note: Dentists and Chiropractors are not included in this chart, as the overwhelming majority indicated plans to work in solo or small group
practices, and all planned to work in ambulatory settings.
z
Responses from medical residents showed that a majority planned to work in ambulatory
settings, with just over half of respondents with confirmed plans (51.5%) having accepted
positions in community-based settings and an additional 18.4% in hospital-based ambulatory settings.

Medical residents who had accepted positions in small cities or rural areas were significantly more likely to be working in ambulatory facilities than were their urban
counterparts. 71.8% of those planning to work in small cities or rural communities
had accepted positions in community-based settings, compared to 36.7% of those
in major cities.
z
More than half of pharmacists who had accepted positions were committed to working in
community or retail pharmacies (58.6%), while 36.8% had committed to inpatient hospital
positions. This may signify a coming shift in pharmacy employment in Minnesota;
statewide, just 20.3% of licensed pharmacists worked in hospital settings in 2001.
z
A large majority of Physician Assistant respondents indicated that they would be working in
ambulatory settings, either community-based (64.3%) or hospital-based (21.4%).
z
Physician Assistants were also asked about the specialty of the physician with whom they
would primarily be working; the majority indicated that they would be working with a
Family Practice (35.7%) or an emergency medicine physician (14.3%). This distribution is
very similar to the national distribution of Physician Assistants by specialty of supervising
physician.
23
Employer and Ownership
Medical residents were asked to report not only the practice setting in which they would be
working but also whether their employer would be a hospital, a managed care organization,
a group practice, or other entity. The largest group of respondents (41.2%) indicated that
they would be employed by a group practice, with 28.1% employed by a hospital/clinic.
z
Figure 3.4
Physician Employers
Military/gov't org.
4.4%
Other
3.5%
Self-employed
13.6%
Managed care org.
9.2%
Hospital or clinic
28.1%
Group practice
41.2%
z
Even if a medical resident’s upcoming practice was in a hospital setting, the hospital was not
always the actual employer. Among respondents who will be practicing in a hospital (inpatient or ambulatory setting), 42.4% indicated that they would be employed by a group
practice.
z
Just 13.6% of medical residents indicated that they would be self-employed in their upcoming practice.
24
Figure 3.5
Level of Ownership
92.8%
100.0%
100.0%
80.0%
CH
DDS
None
MD
None currently, but
expected in future
7.2%
14.1%
34.2%
0.0%
z
51.8%
12.7%
33.3%
45.6%
27.9%
26.5%
40.0%
20.0%
54.0%
60.0%
PA
PhD
Currently partner or
owner/partner
Relatively few respondents reported that they would have any level of ownership in their
upcoming practice. Only chiropractors will be partners or owners/partners in significant
numbers, at 45.6% of respondents. In the future, however, 34.2% of medical residents and
54% of dentists expected to have the opportunity to become owners or partners.
25
Location of Practice: Urban/Rural
Figure 3.6
Location of Post-Training Practice
PhD
34.4%
PA
51.5%
21.4%
57.2%
MD
55.4%
DDS
20%
30%
7.7
18.8
40%
Major City
50%
Suburban
60%
Small City
70%
7.4%
11.2%
24.4%
64.0
10%
5.4%
17.7%
41.0%
APN
0%
15.2%
57.2%
23.4%
4.7%
21.4%
24.1%
17.7%
CH
9.4%
80%
9.5
90%
100%
Rural
Very few respondents had committed to practices in rural areas. Chiropractic respondents
indicated the highest likelihood to locate in a rural area, at 11.2%.
z

Reflecting national and state trends showing that Family Practice physicians represent a disproportionate share of rural physicians, Family Practice residents were
more likely than respondents in other specialties to locate in rural areas. More than
a third (36.3%) of Family Practice respondents with confirmed plans were committed to practices in rural areas or cities with populations under 25,000, compared to
just 20.6% of medical residents in other specialties.
z
More than half of advanced practice nurses, medical residents, and Physician Assistants had
committed to working in the urban core, either in the inner city or in another area within a
major city. Conversely, pharmacists and dentists were much less likely to have committed to
an urban practice, with the majority of those with confirmed plans headed for suburban
areas.
z
Nationally, 22.7% of Physician Assistants worked in rural areas; however, no Minnesota P.A.
respondents indicated plans to practice in a rural area.12
z
Health Professional Shortage Areas (HPSAs) are geographic areas or population groups in
which the U.S. Department of Health and Human Services’ Division of Shortage
Designation has determined that there is a shortage of health professionals. Certain health
professionals, including Primary Care physicians, dentists, and P.A.s are eligible for the
26
National Health Service Corps Loan Repayment Program if they serve for at least two years
in a HPSA. The Minnesota State Loan Repayment Program is also available to these
providers. Overall, very few respondents had accepted positions in a federally designated
Health Professional Shortage Area (HPSA). However, Physician Assistant (21.4%) and pharmacy respondents (25%) had a significant percentage reporting a commitment to work in a
HPSA, even though pharmacists are not eligible for NHSC programs, and roughly a fifth
(19.1%) of Family Practice respondents indicated that their upcoming practice was in a
HPSA. Many respondents did not know whether or not their upcoming practice was in a
HPSA.
Figure 3.7
Upcoming Practice in HPSA
30%
25%
25.0%
21.4%
20%
15%
12.2%
10%
7.9%
5%
5.7%
4.0%
2.1%
0%
1.1%
APN
CH
DDS
MD
PA
PhD
Primary Non-Primary
Care MDs Care MDs
27
Expected Annual Income
Figure 3.8
Median Expected First Year Income
(Base Salary Plus Incentive Income)
$180,000
$120,000
$45,000
$40,000
$20,000
$-
$55,000
$60,000
$80,000
$80,000
APN
CH
$83,000
$87,500
$100,000
$122,500
$142,500
$140,000
$162,500
$160,000
DDS
PA
PhD
MD
Primary
Non-Primary
Care MD's Care MD's
z
Among medical resident respondents, the ‘facility-based’ specialties (anesthesiology, radiology and pathology) reported the highest median expected first year income, at roughly
$194,000 per year, and general pediatrics respondents the lowest at $102,000.
z
Overall, Primary Care respondents expected significantly lower annual first year incomes
than non-Primary Care respondents. Median expected first year income for medical residents completing Primary Care programs was $40,000 less per year than for respondents in
non-Primary Care specialties. Primary Care respondents also faced a higher average debt
load than non-Primary Care respondents; Family Practice and General Internal Medicine
respondents had among the highest debt levels of all medical specialties.
z
While the majority of respondents in
Table 3.1
all six major groups pronounced themSatisfaction
with
anticipated income
selves at least ‘somewhat’ satisfied with
Not Very
their anticipated first-year income, chiProvider
Very
Somewhat
Satisfied/
ropractic respondents were the least
Type
Satisfied
Satisfied
Dissatisfied
likely to be ‘very’ satisfied. Just 16% of
APN
47.1%
44.8%
15.4%
chiropractic respondents declared
CH
16.0%
62.6%
21.4%
themselves ‘very’ satisfied with their
DDS
52.8%
45.4%
1.9%
45.2%
47.8%
7.0%
first-year income, compared to 52.8% MD
28.6%
57.1%
14.3%
of dentists and 58.5% of pharmacists. PA
PHD
58.5%
41.5%
0.0%
Chiropractors had the highest average
debt, the lowest expected income and the highest debt-to income ratio of the surveyed
provider types.
28
Hours Worked
FIgure 3.9
Average Weekly Hours Worked
60.0
49.3
41.1
46.3
43.3
39.9
37.1
39.7
40.0
42.6
50.0
30.0
20.0
10.0
0.0
APN
CH
DDS
PA
PhD
MD
Primary Care Non-Primary
Care
z
Medical residents anticipated working more hours per week than other provider types, at an
average of 46.3 hours. More than a third (36.9%) anticipated working more than 50 hours
per week, not including on-call hours.
z
Among medical residents, non-Primary Care respondents expected to work more hours per
week than Primary Care respondents. Respondents completing residencies in Internal
Medicine specialties (55.2 hours) and Surgery (53.7 hours) anticipated working the greatest
number of hours per week, excluding on-call hours, while Family Practice (39.6 hours) and
OB/GYN (40.5 hours) respondents expected to work the fewest hours per week.
z
Medical residents working in major cities anticipated working significantly more hours per
week than those in small cities or rural areas. Just 21.9% of respondents with commitments
in small cities or rural areas anticipated working over 50 hours per week, compared with
46% of their urban counterparts. This difference is partly due to variations in specialty mix
in urban/rural areas; non-Primary Care respondents were more likely to indicate location in
urban areas than were Primary Care respondents.
z
The majority of dentists (68.1%) and chiropractors (53.4%) anticipated working 39 hours
per week or less upon completion of training.
z
Among medical resident respondents, females anticipated working roughly 13% fewer hours
per week than male respondents (42.4 hours vs. 48.6 hours).
29
30
4
Labor Market
Experiences
While many recent reports have attempted to shed light on the existence of, or severity of, worker
shortages in the health professions, these studies have focused almost exclusively on demand-side
measures such as number of current or projected openings or relative difficulty filling positions.
Reliable supply-side measures, such as difficulty finding a position, have not yet been developed, in
part because it can be challenging to identify and survey job seekers who are looking for specific
classes of work.
Recipients of the 2001 Trainee
Cases used for analysis in Chapter 4
Exit Surveys were asked a variety
N
of questions that, taken together,
Advanced Practice Nursing Students (APN)
111
can shed light on demand for
190
occupations from the job seekers Chiropractic Students (CH)
73
viewpoint. Each respondent was Dental Students/Residents (DDS)
Resident Physicians (MD)
290
asked about length of time spent
Facility-based specialties
looking for a position, geographic
(Anesthesiology, Radiology, Pathology)
31
areas in which the respondent
F
amily
Practice
(FP)
62
searched for a position, number
Internal Medicine – General (IM)
30
of offers received, ease or difficulInternal Medicine Specialties (IM-SPEC)
27
ty in finding a satisfactory posiObstetrics/Gynecology
(OB)
13
tion, whether or not difficulty in
Other (OTHER)
67
finding a satisfactory position led
Pediatrics – General (PEDS)
16
to a change in search strategies,
Surgery
–
General
and
Specialties
(SURG)
44
and the factors that were imporPhysician Assistant Students (PA)
26
tant to the respondent in their
Pharmacy Students/Residents (PhD)
42
search for, and selection of, a
Total
Cases
used
in
Chapter
4
732
practice position. Over time,
changes in these measures may allow for more detailed analysis of trends in the market for specific
occupations or specialties.
31
This section includes data only on those respondents who were planning to go directly into a
patient care position upon completion of training and who had searched for a job; a total of 732
respondents. Respondents on temporary (H1, H2, H3, J1 or J2) visas were excluded from all analyses in this chapter. Because these respondents were more likely to experience problems in their job
search due to their visa status than other respondents, their inclusion in this analysis could have
biased the results for many provider types or specialties with high numbers of temporary visa holders.
32
Location of Search
Figure 4.1
Location of Search
100%
18.2%
39.4%
26.2%
39.2%
90%
80%
16.7%
10.6%
14.0%
15.2%
13.3%
70%
60%
8.3%
75.0%
75.4%
PA
PhD
66.5%
17.2%
60.5%
16.3%
50%
40%
44.5%
43.4%
30%
20%
10%
0%
APN
CH
Within MN Only
DDS
Within/Outside MN
MD
Outside MN Only
z
Pharmacy and Physician Assistant respondents were the most likely to have searched only
within Minnesota, at roughly 75% of respondents. Of those who searched only within
Minnesota, most focused their searches on the Twin Cities metropolitan area rather than
searching statewide.
z
Conversely, roughly 39% of medical resident and chiropractic respondents did not search
for a position within Minnesota at all, a higher proportion than other provider types.
z
Very few respondents in any group did statewide searches, nor did many respondents search
in Southwest, Northwest or Northeast Minnesota.
33
Job Offers
The average number of job
offers was lowest for Physician
Assistants at 1.2, compared to
3.7 for medical residents and
3.6 for pharmacists.
z
Table 4.1
Provider
Type
APN
CH
DDS
MD
PA
PhD
Avg. Job
Offers
2.57
1.76
2.83
3.67
1.21
3.64
No Offers
21.1%
15.1%
3.2%
1.7%
33.3%
0.0%
5 or more
Offers
14.3%
5.7%
14.8%
26.0%
0.0%
26.2%
z
Physician Assistants were the
most likely to report having
received no job offers; 33.3%
had not received any offers, and
another third had received just one in the course of their search.
z
All pharmacy respondents who had searched had received at least one job offer. Roughly a
quarter of medical resident and pharmacy respondents had gotten five or more offers.
Length of Search
Chiropractors on the whole
searched for a practice position
longer than the other surveyed
provider types. While most chiropractic respondents found satisfactory positions relatively
quickly, more than a quarter
(28.4%) had spent over six
months searching before finding
and accepting a practice position.
z
Table 4.2
Time taken to find satisfactory practice position
Less than 1
6 months or
month
1-2 months 3-6 months
more
APN
CH
DDS
MD
PA
PhD
48.4%
30.8%
21.8%
21.5%
28.6%
49.6%
26.5%
19.3%
23.4%
15.3%
28.6%
34.4%
15.4%
21.5%
38.1%
45.9%
42.9%
13.7%
9.8%
28.4%
16.7%
17.4%
0.0%
2.4%
z
Advanced Practice Nursing and pharmacy respondents did not generally search long before
finding a position; roughly half in each group had spent less than a month searching before
accepting a position. In comparison, almost two-thirds of medical residents looked for at
least three months before finding and accepting a position.
z
Of those who were planning to go into patient care and had begun looking for a job, the
percentage that had found a job varied widely. Only 58.7% of chiropractors and 58.3% of
Physician Assistants had found jobs at the time they completed the survey, compared with
89.8% of pharmacists and 93.9% of medical residents.
34
Difficulty of Job Search
Figure 4.2
Level of Difficulty in Job Search
1.3%
100%
11.7%
9.2%
6.1%
6.6%
16.7%
90%
26.4%
80%
24.5%
37.7%
40.9%
70%
72.3%
50.1%
60%
63.8%
62.5%
50%
56.3%
52.5%
40%
40.7%
30%
20%
20.8%
10%
0%
APN
CH
DDS
No Difficulty
MD
Some Difficulty
PA
PhD
Severe Difficulty
z
Physician Assistant respondents were the most likely to report difficulty finding a satisfactory position. The majority of P.A. respondents (79.2%) indicated they had some/severe difficulty finding a position, compared to just 27.7% of medical residents and 36.2% of
advanced practice nurses.
z
There was no significant difference in job search difficulty between Primary Care and nonPrimary Care medical residents.
z
For P.A. and pharmacy respondents, a lack of positions in the desired practice setting was
the most common complaint (37.5% of P.A respondents who had experienced difficulties,
43.6% of pharmacy respondents who had difficulties). For chiropractors, the primary reason
for difficulties was low salary/compensation (35.5%).
z
Among dental respondents who were having difficulties, 59.3% complained of a lack of
positions in the desired geographic location.
z
Physician Assistants were the most likely to have changed their plans due to a difficult job
search. Among P.A. respondents who had problems finding a job, almost a third had
changed their search plans, usually by adding new practice settings or changing salary expectations.
z
Fewer than 10 percent of pharmacists reported altering their job searches due to difficulties
in finding a satisfactory position; but of those who did change their plans, 100% broadened
the search to include new practice settings.
35
Factors in Job Search
Figure 4.3
Factors Considered “Very Important” in Job Search
40%
48.3%
73.9%
69.6%
61.0%
50%
57.5%
71.6%
56.1%
77.5%
77.2%
73.6%
75.0%
65.2%
70.1%
60%
71.8%
70%
63.2%
80%
83.7%
90%
78.3%
93.6%
100%
30%
0%
Salary
Practice Setting
APN
CH
DDS
Family/Spouse
Considerations
MD
PA
17.4%
5.9%
4.8%
12.5%
9.9%
10%
12.0%
20%
Loan/Visa/Military
Obligations
PHD
z
Practice setting was the single most important factor that graduates considered in their job
search. Respondents were asked about the relative importance of a series of factors, and
roughly three-quarters or more of respondents in all provider types listed practice setting as
“very important.”
z
Geographic location of the practice and family/spouse considerations were also very important to most respondents, particularly medical residents and Physician Assistants.
z
Relatively few respondents took military, loan or other obligations into account when
searching for a job. With the exception of Physician Assistants, at least two-thirds of respondents in each provider type indicated that these obligations were not important factors in
their search.
z
For pharmacy respondents, opportunities for professional growth and opportunities for
direct patient care were also very important factors in their job search.
36
Perceptions of Job Market
Table 4.3
Perception of Job Opportunities in Minnesota
Many Jobs
Some Jobs
Few Jobs
Very Few/No Jobs
z
APN
46.1%
28.6%
14.2%
11.2%
CH
21.8%
52.6%
15.2%
10.4%
DDS
68.1%
27.2%
3.0%
1.8%
MD
48.8%
40.4%
7.4%
3.5%
PA
0.0%
43.5%
47.8%
8.7%
PhD
71.9%
15.4%
4.1%
8.6%
Respondents who had searched for a job were asked about their perception of the availability of practice opportunities in Minnesota. Again, Physician Assistants were markedly more
pessimistic about the labor market than were respondents from other provider types. More
than half of the P.A.s who had searched for a job (56.5%) reported that there were “few,”
“very few,” or “no” opportunities available. In contrast, fewer than a quarter of respondents
in other provider types responded in this way.

According to the MDH Office of Rural Health and Primary Care’s 2001 Demand
Assessment, conducted during the fourth quarter of 2001, facilities in Greater and
underserved Minnesota were recruiting 18.5 Physician Assistants at the time data
were collected and anticipated recruiting 18 within the year.13 These data indicate
that there may be a mismatch between the search areas of P.A. grads and where the
greatest job availability lies.
z
Dental and pharmacy respondents were the most optimistic about the state labor market,
with roughly two-thirds of each reporting that there are many jobs available in Minnesota.
z
Perceptions of the national labor market were generally more favorable than perceptions of
Minnesota opportunities. Among respondents who had searched outside of Minnesota for a
position, over 85% in each provider type reported that there were ‘many jobs’ available
nationally.
37
38
5
Policy Implications
Although debates around the existence and impact of worker shortages in the health professions
have been ongoing both nationally and in Minnesota, an overall lack of data on the labor market
experiences of these workers has made it difficult to design policy interventions to address issues of
distribution, labor force composition, in-state retention and lack of access to care in underserved
areas. The results presented in this report are an important first step towards the development of a
better understanding of the practice decisions made by a key group of new practitioners and the
factors that play into those decisions.
In the coming years, MDH will use multiple years of data from these surveys to construct a longitudinal database, which will make changes in relative demand for the surveyed health professions
easier to track. However, many questions remain unanswered. As long as access to healthcare
remains an issue, debates about the number and mix of health professionals needed in the state will
continue, as will questions about the best methods of recruiting new people into fields that are
anticipating large numbers of retirees in the coming years, the accuracy of predictions about future
supply and demand, and the appropriate role of the State and other stakeholders in ensuring an
adequate size and mix of health professionals in the future.
Several of the findings in this report point to areas in which state-level policies might be able to
impact retention of health professionals within Minnesota or to influence the mix of Primary Care
and non-Primary Care professionals working around the state. For example, survey results show
that across all six provider types, one of the strongest predictors of in-state practice is having attended a Minnesota high school, college or professional school. Given this finding, one of the best
approaches for increasing retention within the state may be to increase the number of entering professional students or residents who have Minnesota ties through preferential admissions or financial
39
aid policies or through the use of incentives to institutions to increase the number of ‘home grown’
students or residents admitted. Working to increase awareness of and interest in healthcare careers
at the high school and pre-high school levels would also be an important component of such an
approach; several existing Minnesota organizations and collaboratives, such as the Healthcare
Education-Industry Partnership (HEIP), have begun to focus on this strategy in recent years.
Another area where it might be possible to influence practice decisions is by expanding loan repayment programs that are tied to HPSA service or to increased service to underserved populations.
The majority of respondents indicated that service requirements related to loan repayment, visa status or military obligations were not a major factor they considered when looking for a practice position. But for those that had committed to a HPSA practice, such obligations were likely to have
been an important factor leading to that choice.
According to the Minnesota Department of Health’s Office of Rural Health and Primary Care
(ORHPC), applications for Minnesota’s various midlevel practitioner, physician and other loan
repayment programs routinely outweigh the relatively small number of slots currently available.
Evaluations of loan repayment programs have shown that a significant percentage of program completers continue practicing in an underserved area after completion of their service obligation.
Given the finding that Primary Care respondents tended to have slightly higher debt levels than did
non-Primary Care respondents while expecting a lower average income, this implies that expanding
loan repayment or other incentive programs could have an impact on practice decisions and lead to
a greater number of practitioners opting to practice in rural or urban HPSAs.
The responses from Physician Assistants also highlight an interesting dynamic. Nationally, P.A.s
have taken on greater visibility and responsibility as healthcare providers, practicing in a wide variety of settings and specialties, often in rural areas or small cities. Physician Assistants have also
made great inroads in Minnesota; over 1,000 P.A.s were employed in Minnesota in 2000,14 and the
profession is expected to grow by 44% between 1998 and 2008, making it one of the fastest-growing occupations in the state in terms of percentage growth.15 Additionally, the use of
P.A./NP/physician teams is widely recognized as a way to maintain or increase services at lower
costs, an important consideration at a time when many practices are feeling pressure to reduce
costs.
However, despite these factors, the responses of Physician Assistants to questions about job opportunities were markedly more pessimistic than those of other provider types. While it is possible that
the outlook of P.A. respondents is partially due to a mismatch between job search area and job location or to unrealistic expectations in terms of salary or level of responsibility, the responses of
Minnesota P.A. grads could also indicate underutilization of P.A.s in certain practice settings or geographic areas in the state. It is unclear from these results whether the appropriate policy response
would be a change in reimbursement policies for P.A. services, a change in the current status of
P.A.s as registered rather than licensed health professionals, or the promotion of other incentives to
utilize P.A.s as a critical part of a healthcare delivery team. Given the potential of P.A.s, along with
Nurse Practitioners and other physician extenders, to provide a wide variety of services at lower
costs, further research into the dynamics of the market for these providers may be warranted.
40
A
About the 2002
Minnesota Health
Professional Trainee
Exit Surveys
The 2001 Minnesota Health Professions Trainee Exit Surveys were developed in conjunction with
the Medical Education and Research Costs (MERC) workforce subcommittee, with additional
input provided by representatives of specific Minnesota health professions educational programs. Ed
Salsberg and Joseph Nolan from the Center for Health Workforce Studies at the University of
Albany (NY) School of Public Health also provided valuable input on survey design and administration. The surveys were administered through GME coordinators and other institutional contacts
in the spring of 2001 to 1,323 students and residents at 19 institutions who were intending to
complete a dental, pharmacy or medical residency, an entry-level Pharm D or DDS degree, or an
advanced practice nursing, chiropractic, or Physician Assistant program between May and
December 2001.
Table A.1
Response Rates by Provider Type an d Physician Specialty Group
Provider Type
Advanced Practice Nursing
Chiropractic
Dental
Medical Resident
Physician Assistant
Pharmacy
Physician Specialty Categories
Anesthesiology, Radiology, Pathology ( ARP)
Family Practice (FP)
General Internal Medicine (IM)
Internal Medicine Specialties (IM-SPEC)
Obstetrics/Gynecology (OB)
Other (OTHER)
General Pediatrics (PEDS)
General and Specialty Surgery (SURG)
Trainees
Grads
Returned
Rate
571
680
428
1944
55
402
203
208
127
670
26
89
123
197
103
403
26
52
60.6%
94.7%
81.1%
60.1%
100.0%
58.4%
4080
1323
904
68.3%
Returned
Rate
Trainees
Grads
239
283
316
226
57
380
94
349
86
100
103
75
15
144
40
107
55
70
58
40
14
81
21
64
64.0%
70.0%
56.3%
53.3%
93.3%
56.3%
52.5%
59.8%
1944
670
403
60.1%
41
A total of 904 valid responses were received, or 68.3% of the total population of exiting
students/residents. Tables A.1 and A.2 show the response rate by provider type, physician specialty
area and institution. The gender and race/ethnicity distributions of respondents in each provider
type were tested for any significant variation from known gender and race/ethnicity distributions of
all graduating students/residents within the provider type. As a result of these comparisons, responses were weighted by gender to ensure that the gender distribution of respondents was reflective of
the entire population surveyed.
Table A.2
Response Rates by Institution
TOTALS
Abbott Northwestern Hospital: Medical
Abbott Northwestern Hospital: Pharmacy
Children's Hospital
United Hospital
Augsburg College
College of St. Catherine
College of St. Scholastica
Duluth Graduate Medical Education Council
Hennepin County Medical Center: Medical
Hennepin County Medical Center: Dental
Metropolitan State University
Minnesota State University, Mankato
Mayo Medical Programs
Mayo Dental Programs
Mayo Nursing Programs
Mayo Pharmacy Programs
Minneapolis Sports Medicine Center
Northwestern College of Chiropractic
Regions Hospital
St. Mary's University of Minnesota
United Pharmacy
Winona State University
University of MN AHC: Pharmacy Students
University of MN AHC: Pharmacy Residents
University of MN AHC: Dental Students
University of MN AHC: Dental Residents
University of MN AHC: Nursing School
University of MN AHC: Medical School
Veteran's Administration
42
Trainees
Grads
Returned
Rate
29
1
2
18
55
44
35
30
175
3
1
24
894
18
82
5
3
680
73
58
2
107
388
4
339
68
204
722
16
9
1
2
6
26
21
16
10
47
3
1
12
310
5
22
5
3
208
30
24
2
19
77
2
82
37
80
255
8
9
1
2
6
26
10
9
6
24
2
1
12
191
4
9
5
2
197
20
22
2
11
40
2
67
30
41
145
8
100.0%
100.0%
100.0%
100.0%
100.0%
47.6%
56.3%
60.0%
51.1%
66.7%
100.0%
100.0%
61.6%
80.0%
40.9%
100.0%
66.7%
94.7%
66.7%
91.7%
100.0%
57.9%
51.9%
100.0%
81.7%
81.1%
51.3%
56.9%
100.0%
4080
1323
904
68.3%
B
Advanced Practice
Nursing Exit Survey
Part 1. Identification Information
MN Nursing License Number: _____________
First Name: ___________________ M.I. __________
Last Name: ____________________
Name of program you are completing:
_____________________________________________________
Part 2. Background/Education
1. Gender 25.6%
(n=123)
2. Age
median=35
3. Citizenship status
94.0%
3.4%
2.6%
0.0%
0.0%
0.0%
M
74.4%
F
(n=118)
28.3%
17.9%
50.1%
3.6%
Greater Minnesota
Twin Cities metropolitan area
Other U.S. state
Other country
(n=120)
Native Born U.S.
Naturalized U.S.
Permanent Resident
H-1, H-2, H-3 Temp. Worker
J-1, J-2 Exchange visitor
Other
4. Race/Ethnicity
5. Where did you graduate from high school?
(n=123)
(n=123)
1.5% American Indian/Alaskan Native
3.3% Asian/Pacific Islander
1.8% Black/African American
(non-Hispanic)
0.0% Hispanic
(Spanish/Hispanic/Chicano/Latino)
0.8% Multiracial
92.6% White (non-Hispanic)
0.0% Other ______________
6. Where did you receive your baccalaureate
nursing degree?
(n=122)
1.5%
0.0%
4.5%
7.1%
7.6%
0.0%
3.0%
3.8%
6.8%
3.0%
3.3%
8.5%
5.3%
38.0%
0.0%
7.5%
Augsburg College
Bemidji State University
Bethel College
College of St. Catherine
College of St. Scholastica
Concordia College
Metropolitan State University
Minnesota Intercollegiate Nursing
Consortium (St. Olaf/Gustavus)
MN State University - Mankato
MN State University - Moorhead
St. Benedict/St. John’s
University of Minnesota
Winona State University
Non-Minnesota U.S. school
(Please specify state: _____)
Non-U.S. nursing school
(Please specify country: _________)
Other ___________________
43
7. What year did you receive your baccalaureate nursing degree?
median = 1994
(n=113)
8. What is your current level of educational debt (including undergraduate loans)?
(n=123)
21.8%
11.9%
12.0%
9.3%
13.7%
19.6%
11.7%
None
Less than $10,000
$10,000-$19,999
$20,000-$29,999
$30,000-$39,999
$40,000-$49,999
Over $50,000
9. What type of program are you completing in 2001? Check all that apply.
7.5%
1.5%
36.3%
4.5%
3.0%
46.5%
0.8%
Clinical Nurse Specialist
Nurse Administrator
Nurse Anesthesia
Nurse Educator
Nurse Midwifery
Nurse Practitioner
Other _______________________________
10. Please indicate the clinical specialty for which you are preparing:
4.1%
2.3%
7.5%
35.2%
4.5%
3.8%
23.6%
10.1%
0.8%
9.3%
6.0%
0.8%
6.8%
3.8%
44
(n=123)
Acute Care Nursing
Adolescent Nursing
Adult Health Nursing
Anesthesia Nursing
Child and Family Nursing
Children with Special Health Care Needs
Family Nursing
Gerontological Nursing
Oncology Nursing
Pediatric Nursing
Psychiatric-Mental Health
Public Health Nursing/Community Health Nursing
Women’s Health Care
Other ____________________________
(n=123)
Part 3. Future Plans
11. What do you expect to be doing after completion of your current educational program?
(n=123)
Primary Activity (mark only one)
90.2%
0.8%
0.0%
5.3%
0.8%
0.0%
1.5%
1.5%
Patient care/clinical practice
Additional nursing education
Nursing administration
Teaching
Research
Working in another field
Other
Undecided/don’t know yet
12. Where is the location of your primary activity after completion of your current educational
program?
(n=123)
78.8%
16.7%
0.0%
4.5%
Within Minnesota
Other U.S. state
Outside of U.S.
Don’t know yet
13. If you are leaving the state to continue your
education, do you plan to return to Minnesota
to practice when your education is complete?
(n=0)
Yes
No
Don’t know yet
Does not apply
14. If you are planning to enter or have considered entering patient care/clinical practice, have
you actively searched for a job as an APN?
(n=111)
72.3% Yes
26.9% No, not yet (Go To Q. 32)
0.8% No, I plan to stay with my current
employer for at least six months
(Go To Q. 32)
15. Have you accepted a practice position?
(n=78)
76.5% Yes
24.2% No (Go To Q. 25)
16. Which best describes the type of patient
care practice you will be entering?
(n=59)
61.4% Hospital - inpatient
3.1% Hospital-based ambulatory care
24.7% Community (non-hospital based)
health center, clinic or other outpatient facility
3.1% Long-term care facility
0.0% Public health agency
7.6% Other: __________________
17. What is the ZIP code and county of the
principal practice address at which you will be
working (if ZIP is unknown, please provide
city/town and state)?
ZIP: ________ County: ______________
City: __________________ State: _____
(If non-U.S., specify country:___________)
18. Is your practice in a federally designated
Health Professional Shortage Area?
(n=58)
7.9% Yes 59.5% No
32.6% Unknown
19. How long do you expect to be at your principal practice location?
(n=58)
13.1% Less than 2 years
37.8% 2-4 years
49.1% 4 years or more
* If you have not considered entering patient
care/clinical practice, stop here and return your
completed survey.
45
20. Which best describes the demographics of the
area in which you will be practicing?
(n=58)
43.2%
20.8%
18.8%
7.7%
9.5%
Inner city
Other area within major city
Suburban
Small city (pop. below 25,000)
Rural
21. Expected Gross Income during first year of practice:
(n=57)
Base Salary (Full-time equivalent salary)
0.0%
0.0%
8.1%
1.6%
16.8%
8.7%
0.0%
3.9%
4.8%
56.0%
Less than $40,000
$40,000-$44,999
$45,000-$49,999
$50,000-$54,999
$55,000-$59,999
$60,000-$64,999
$65,000-$69,999
$70,000-$74,999
$75,000-$79,999
Over $80,000
22. How satisfied are you with your expected gross
income?
(n=57)
47.1%
44.8%
4.8%
3.2%
Very Satisfied
Somewhat Satisfied
Not Very Satisfied
Very Dissatisfied
23. How many total hours will you be working per
week, not including on-call hours?
(n=58)
3.8%
0.0%
16.5%
72.6%
7.0%
0.0%
46
Less than 20
20 to 29
30 to 39
40 to 49
50 to 59
60 or more
24. What percentage of your time will be spent on
the following activities?
(n=59)
Patient care - ambulatory
Patient care - inpatient
Patient care - long term care
Teaching
Research
Consultation
Case Management
Administration
Other _________________
median
40.0%
50.0%
0.0%
0.0%
0.0%
0.0%
0.1%
0.0%
0.0%
Part 4. Job Search Experience
(Does not include temporary visa holders)
25. How long have you been actively searching/did
you search for a position?
(n=78)
48.5%
26.0%
12.8%
2.9%
8.6%
1.2%
Less than one month
1-2 months
3-4 months
5-6 months
More than 6 months
Haven=t looked yet (Go to Q. 32)
26. How many positions have you applied for?
(n=78)
3.6% -0
45.8% -1
20.3% -2
13.3% -3
7.6% -4
1.2% -5
3.6% -6 to 10
3.6% -over 10
1.2% -n/a
27. In which geographic areas have you focused
your search (check all that apply)?
(n=78)
6.3%
50.6%
5.1%
3.8%
8.9%
12.7%
5.1%
13.9%
All of Minnesota
Twin Cities metropolitan area
Northeastern Minnesota
Northwestern Minnesota
Central Minnesota
Southeastern Minnesota
Southwestern/S.Central Minnesota
Midwest U.S. (ND, SD, WI, IA,
IL)
5.1% Eastern U.S.
8.9% Western U.S.
10.1% Southern U.S.
0.0% Outside of U.S.
28. How many offers for employment/practice positions did you receive (excluding fellowships and
other training positions)?
(n=78)
19.4% -0
34.5% -1
15.5% -2
6.9% -3
6.9% -4
5.7% -5
0.0% -6 to 10
8.6% -over 10
2.4% -n/a
29. How much difficulty did you have/are you having finding a practice position you are satisfied
with?
(n=78)
63.8%
24.5%
11.7%
29a.
No difficulty
Some difficulty
Severe difficulty
If you have had some difficulty or severe difficulty finding a satisfactory position,
what was the main reason? (mark only one)
(n=26)
30.0%
27.9%
14.2%
12.2%
8.6%
0.0%
7.1%
Overall lack of jobs in your specialty
Lack of jobs in desired geographic location
Lack of jobs in desired practice setting (i.e. hospital, LTC, etc)
Inadequate salary/compensation
Family/spouse considerations
Limited jobs due to visa status
Other ___________________________
30. Did you change your plans because of limited practice opportunities?
14.8%
30a.
Yes
85.2%
If yes, how? (check all that apply)
81.8%
45.5%
18.2%
9.1%
0.0%
(n=77)
No
(n=11)
Broadened search to new geographic area
Broadened search to new practice settings
Changed salary expectations/requirements
Going on for additional training
Other ___________________________
47
31. How important were the following factors in your job search and in the selection of your
upcoming practice position?
Very Important
Salary/benefits (n=78)
Practice setting (n=78)
Coworkers in the practice (n=77)
Family/spouse considerations (n=75)
Demographics of area (n=77)
Military, visa, or loan obligation (n=77)
Geographic location (n=77)
Other (n=3)
71.8%
93.6%
62.9%
71.6%
36.9%
9.9%
54.7%
33.3%
Somewhat Important Not Important
27.1%
6.4%
33.0%
18.7%
47.0%
13.7%
34.5%
66.7%
1.2%
0.0%
4.1%
9.6%
16.1%
76.4%
10.8%
0.0%
32. What is your perception of opportunities for practice in your specialty within Minnesota?
(n=80)
44.8% Many Jobs
27.8% Some Jobs
13.8% Few Jobs
10.8% Very Few Jobs
0.0% No Jobs
0.0% Unknown
2.8% n/a - didn't=t search in Minnesota
33.What is your perception of opportunities for practice in your specialty nationally?
60.6% Many Jobs
15.5% Some Jobs
12.0% Few Jobs
1.2% Very Few Jobs
0.0% No Jobs
48
6.2% Unknown
4.6% n/a - didn't=t search nationally
(n=80)
C
Chiropractic Student
Exit Survey
Part 1. Identification Information
MN Chiropractic License Number (if available):
First Name:
M.I.
Part 2. Background/Education
1. Gender
(n=197)
64% M
2. Age
(n=191)
26 (median)
3. Citizenship status
83.3%
4.5%
0.5%
3.6%
1.0%
7.0%
36% F
(n=197)
Native Born U.S.
Naturalized U.S.
Permanent Resident
H-1, H-2, H-3 Temp. Worker
J-1, J-2 Exchange Visitor
Other
4. Race/Ethnicity
(n=196)
3.6% American Indian/Alaskan Native
0.0% Asian/Pacific Islander
2.1% Black/African American
(non-Hispanic)
1.0% Hispanic/Latino
(Spanish/Hispanic/Chicano/Latino)
0.5% Multiracial
91.8% White (non-Hispanic)
1.0% Other ______________
Last Name:
6. Where did you graduate from college (undergraduate degree)?
(n=195)
15.9% Greater Minnesota
9.7% Twin Cities metropolitan area
(Not concurrent with chiropractic
program)
36.4% Other U.S. state
9.7% Other country
23.2% Undergraduate degree concurrent
with chiropractic degree
5.1% n/a
7. What is your current level of educational
debt (including both undergraduate and chiropractic school loans)?
(n=195)
0.0%
1.0%
1.0%
3.0%
5.7%
20.0%
50.2%
16.5%
2.1%
0.5%
None
Less than $20,000
$20,000-$39,999
$40,000-$59,999
$60,000-$79,999
$80,000-$99,999
$100,000-$124,999
$125,000-$149,999
$150,000-$199,999
Over $200,000
5. Where did you graduate from high school?
(n=197)
19.2%
12.7%
53.9%
14.2%
Greater Minnesota
Twin Cities metropolitan area
Other U.S. state
Other country
49
Part 3. Future Plans
8. What do you expect to be doing after completion
of your current training program?
(n=197)
Primary Activity (mark only one)
95.9% Private patient care/clinical practice
0.5% Academic patient care
1.5% Additional professional training
0.0% Teaching
0.0% Research
0.0% Working in another field
0.5% Other ____________________
1.5% Undecided/Don’t know yet
9. Where is the location of your primary activity
after current training?
(n=197)
47.6%
40.7%
4.5%
7.2%
Within Minnesota
Other U.S. state
Outside of U.S.
Don’t know yet
10. If you are leaving the state to continue your
training, do you plan to return to MN to practice
when your training is complete?
(n=3)
33.3%
33.3%
33.4%
0.0%
Yes
No
Don’t know yet
Does not apply
11. If you are planning to enter or have considered
entering patient care/clinical practice, have you
actively searched for a job?
(n=190)
64.2% Yes
17.4% No, not yet (Go To Q. 29)
18.4% No, I will be self-employed in private
practice
* If you have not considered entering clinical practice, stop here and return your completed survey.
50
12. Have you accepted a practice position?
(n=155)
58.7% Yes
41.3% No (Go to Q. 23)
13. Which best describes the type of patient care
practice you will be entering?
(n=90)
23.5%
9.9%
46.7%
17.7%
0.0%
2.3%
Solo practice
Group practice - salaried employee
Group practice - as associate
Group practice - as partner
Academic group practice
Other: _____________________
14. What level of ownership will you have in your
upcoming practice?
(n=90)
33.3% None, I will be an employee
54.0% None currently, but I may have the
option to become a partner in the
future
1.8% I will be a partner, but will not have
any capital invested in the practice
10.9% I will be an owner/partner (i.e. I will
have capital invested and own a financial stake in the practice).
15. What is the ZIP code and county of the principal practice address at which you will be working (if
ZIP is unknown, please provide city/town and
state)?
County:____________
City: __________________ State: _____
(If non-U.S., specify country:___________)
16. Is your practice in a federally designated Health
Professional Shortage Area?
(n=90)
1.1% Yes
42.3% No
38.8% Unknown
17. How long do you expect to be at your principal
practice location?
(n=90)
16.7% Less than 2 years
38.6% 2-4 years
44.7% 4 years or more
18. Which best describes the demographics of the
area in which you will be practicing?
(n=90)
22. What percentage of your time will be spent on
the following activities?
(n=88)
Patient Care
Teaching
Research
Administration
Other _________________
Median
77.6%
5.0%
0.0%
5.0%
0.0%
Part 4. Job Search Experience
10.0%
13.4%
41.0%
24.4%
11.2%
Inner city
Other area within major city
Suburban
Small city (pop. below 25,000)
Rural
19. Expected pre-tax personal (not clinic revenue)
income during first year of practice:
(n=86)
Base Salary
23.1% Less than $30,000
23.3% $30,000-$39,999
20.9% $40,000-$49,999
16.2% $50,000-$59,999
7.0% $60,000-$69,999
2.3% $70,000-$79,999
3.5% $80,000-$89,999
1.2% $90,000-$99,999
2.4% $100,000-$149,999
0.0% Over $150,000
20. How satisfied are you with your expected gross
income?
(n=88)
16.0%
62.6%
19.1%
2.3%
Very Satisfied
Somewhat Satisfied
Not Very Satisfied
Very Dissatisfied
21. How many total hours will you be working per
week, not including on-call hours?
(n=90)
1.1%
7.8%
44.5%
34.4%
7.7%
4.5%
Less than 20
20 to 29
30 to 39
40 to 49
50 to 59
60 or more
(Does not include temporary visa holders)
23. How long have you been actively searching or
did you search for a position?
(n=142)
25.4%
26.0%
14.7%
9.2%
23.3%
1.4%
Less than one month
1-2 months
3-4 months
5-6 months
More than 6 months
Haven’t looked yet (Go to Q. 29)
24. In which geographic areas have you focused
your search (check all that apply)?
(n=142)
9.9%
All of Minnesota
40.4% Twin Cities metropolitan area
2.8%
2.8%
7.1%
4.3%
2.8%
33.3%
9.9%
19.1%
7.1%
7.1%
Northeastern Minnesota
Northwestern Minnesota
Central Minnesota
Southeastern Minnesota
SW/South Central Minnesota
Midwest reg. (ND, SD, WI, IL, IA)
Eastern U.S.
Western U.S.
Southern U.S.
Outside of U.S.
25. How many offers for employment/practice positions did you receive (excluding fellowships and
other training positions)
(n=141)
13.5% - 0
19.7% - 1
27.8% - 2
18.5% - 3
3.5% - 4
11.3% - n/a
5.0% - 5
0.7% - 6 to 10
0.0% - Over 10
51
26. How much difficulty did you have/are you having finding a practice position you are satisfied
with?
(n=140)
40.7 No difficulty
50.1% Some difficulty
9.2% Severe difficulty
26a.
If you had some or severe difficulty finding a satisfactory position, what was the
main reason?
(n=79)
7.5%
20.2%
10.2%
2.5%
35.5%
3.9%
1.2%
19.0%
Overall lack of jobs in your specialty
Lack of jobs in desired geographic location
Lack of jobs in desired practice setting (i.e. academic practice, etc)
Lack of jobs at desired level of ownership
Inadequate salary/compensation
Family/spouse considerations
Limited jobs due to visa status
Other ___________________________
27. Did you change your plans because of limited practice opportunities?
17.8% Yes
27a.
If yes, how?
82.2% No
(n=17)
52.9% Broadened search to new geographic area
17.6% Broadened search to new settings
17.6% Broadened search to include different levels of ownership
35.3% Changed salary expectations/requirements
0.0% Going on for additional training
0.0% Other ___________________________
52
(n=95)
28. How important were the following factors in your job search and in the selection of your
upcoming practice position?
Very Important
Salary/benefits (n=141)
63.2%
Ownership level (n=140)
45.8%
Practice setting (n=141)
73.6%
Family/spouse considerations (n=139)
56.1%
Demographics of area (n=138)
48.6%
Military, visa, loan obligation (n=132)
12.0%
Geographic location (n=138)
56.4%
Partners in the practice(n=137)
39.4%
Partnership buy-in costs (n=136)
30.9%
Waiting period for partnership (n=134) 25.4%
Other _____(n=10)
30.0%
Somewhat Important Not Important
34.7%
2.1%
42.1%
12.1%
25.6%
0.7%
23.1%
20.8%
44.9%
6.5%
21.4%
66.6%
38.5%
5.1%
34.5%
26.2%
36.8%
32.3%
32.8%
41.8%
50.0%
20.0%
29. What is your perception of opportunities for practice of chiropractic within Minnesota?
(n=145)
15.8% Many Jobs
38.0% Some Jobs
11.0% Few Jobs
5.5% Very Few Jobs
2.1% No Jobs
14.0% Unknown
13.7% n/a - didn’t search in Minnesota
30. What is your perception of opportunities for practice of chiropractic nationally?
(n=144)
44.4% Many Jobs
29.1% Some Jobs
4.2% Few Jobs
1.4% Very Few Jobs
13.9% Unknown
5.5% n/a - didn't=t search nationally
1.4% No Jobs
53
54
D
Dental
Graduate/Resident Exit
Survey
Part 1. Identification Information
MN Dental License Number (if available): _____________
First Name: ___________________ M.I. __________ Last Name: ____________________
Name of program you are completing:
_____________________________________________________
Part 2. Background/Education
1. Gender
2. Age
57.1% M
Median=27.0 (n=102)
3. Citizenship status:
81.4%
4.1%
6.3%
0.0%
6.1%
2.1%
42.9% F
(n=103)
23.8%
22.9%
37.8%
15.4%
Greater Minnesota
Twin Cities metropolitan area
Other U.S. state
Other country
(n=103)
Native Born U.S.
Naturalized U.S.
Permanent Resident
H-1, H-2, H-3 Temporary Worker
J-1, J-2 Exchange visitor
Other
4. Race/Ethnicity
5. Where did you graduate from high school?
(n=103)
(n=102)
0.0% American Indian/Alaskan Native
4.3% Asian/Pacific Islander
0.9% Black/African American
(non-Hispanic)
6.0% Hispanic
(Spanish/Hispanic/Chicano/Latino)
0.0% Multiracial
87.7% White (non-Hispanic)
1.1% Other ______________
6. Where did you graduate from college (undergraduate degree)?
(n=102)
23.9%
19.1%
43.6%
13.4%
Greater Minnesota
Twin Cities metropolitan area
Other U.S. state
Other country
7. Where did you attend, or are you attending,
dental school?
(n=102)
74.0% University of MN
13.5 %Non-Minnesota U.S. dental school
(Please specify state: _____)
12.5% Non-U.S. dental school
(Please specify country:________)
8. What year did you complete, or will you
complete, dental school?
(n=102)
Median=2001
55
9. What is your current level of educational
debt (including both undergraduate and dental
school loans)?
(n=101)
22.3%
2.9%
8.1%
5.7%
10.1%
25.0%
19.8%
4.0%
1.1%
0.9%
None
Less than $20,000
$20,000-$39,999
$40,000-$59,999
$60,000-$79,999
$80,000-$99,999
$100,000-$124,999
$125,000-$149,999
$150,000-$199,999
Over $200,000
10.What type of dental training program are
you now completing?
(n=103)
65.3%
34.7%
General dentistry program
(DDS degree)
Advanced specialty or advanced
general dentistry residency program
11. Residents only: Please indicate the specialty
you are completing in 2001. (n=38)
19.2% Advanced Education in General
Dentistry
0.0% Dental Public Health
10.8% Endodontics
25.1% General Practice Residency
0.0% Geriatric Dentistry
0.0% Orofacial Pain
0.0% Oral and Maxillofacial Pathology
10.4% Oral and Maxillofacial Surgery
0.0% Oral Radiology
20.8% Orthodontics
5.4% Pediatric Dentistry
5.9% Periodontics
2.5% Prosthodontics
0.0% Other _______________________
56
Part 3. Future Plans
12. What do you expect to be doing after completion of your current training program?
(n=103)
Primary Activity (mark only one)
68.8% Private patient care/clinical practice
2.1% Academic patient care/clinical practice
21.5% Additional dental training or fellowship
2.1% Teaching
0.0% Research
0.0% Working in another field
1.1% Other
4.3% Undecided/Don’t know yet
13. Where is the location of your primary activity after your current training?
(n=103)
60.0%
27.4%
5.2%
7.3%
Within Minnesota
Other U.S. state
Outside of U.S.
Don*t know yet
14. If you are leaving the state to continue your
training, do you plan to return to Minnesota to
practice when your training is complete?
(n=11)
54.4% Yes
26.4% No
10.4% Don’t know yet
8.8 % Does not apply
15. If you are planning to enter or have considered entering patient care/clinical practice, have
you actively searched for a job?
(n=73)
18. What level of ownership will you have in
your upcoming practice?
(n=51)
33.3% None, I will be an employee
91.4% Yes
7.1% No, not yet (Go to Q. 33)
1.5% No, I will be self-employed
54.0% None currently, but I may have the
option to become a partner in the
future
* If you have not considered entering clinical
practice, stop here and return your completed
survey.
1.8% I will be a partner, but will not have
any capital invested in the practice
16. Have you accepted a practice position?
(n=68)
10.9% I will be an owner/partner (i.e. I
will have capital invested and own a
financial stake in the practice)
77.1% Yes
22.9% No (Go to Q. 27)
17. Which best describes the type of patient
care practice you will be entering?
(n=49)
94.0% Private practice
(owner/partner/employee)
19. What is the ZIP code and county of the
principal practice address at which you will be
working (if ZIP is unknown, please provide
city/town and state)?
(n=51)
ZIP: ________ County: ______________
City: __________________ State: _____
0.0% Dental school faculty member
(If non-U.S., specify country:___________)
0.0% Hospital faculty member
0.0% Governmental service (military,
NHSC, VA, state/local health dept.)
20. Is your practice in a federally designated
Health Professional Shortage Area?
(n=51)
6.0% Staff model HMO
0.0% Community clinic
0.0% Ind. Contractor at multiple clinics
4.0% Yes
67.4%No
28.6% Unknown
21. How long do you expect to be at your principal practice location?
(n=51)
0.0% Other _______________________
7.9% Less than 2 years
19.9% 2-4 years
72.2% 4 years or more
57
22. Which best describes the demographics of
the area in which you will be practicing?
(n=50)
8.1% Inner city
9.6%Other area within major city
57.2% Suburban
17.7% Small city (pop. below 25,000)
7.4% Rural
23.
Expected gross income during first year
of practice:
(n=48)
(n=26)
Base Salary
Incentive Income
12.3 < $70,000
33.3% $70,000-$79,999
22.9% $80,000-$89,999
10.0% $90,000-$99,999
8.1% $100,000-$109,999
1.9% $110,000-$119,999
5.8% $120,000-$129,999
0.0% $130,000-$139,999
1.9% $140,000-$149,999
0.0% $150,000-$174,999
1.9% $175,000-$200,000
1.9% Over $200,000
18.9% Zero
0.0% < $5,000
22.5% $5,000-$9,999
15.9% $10,000-$14,999
11.6% $15,000-$19,999
7.3% $20,000-$24,999
7.9% $25,000-$29,999
4.3% $30,000-$34,999
0.0% $35,000-$39,999
0.0% $40,000-$44,999
3.6% $45,000-$50,000
7.9% Over $50,000
24. How satisfied are you with your expected
gross income?
(n=50)
52.8%
45.4%
1.9%
0.0%
Very Satisfied
Somewhat Satisfied
Not Very Satisfied
Very Dissatisfied
25. How many total hours will you be working
per week, not including on-call hours?
(n=51)
0.0%
5.5%
62.6%
31.9%
0.0%
0.0%
58
Less than 20
20 to 29
30 to 39
40 to 49
50 to 59
60 or more
26. What percentage of your time will be spent
on the following activities?
(n=45)
Patient care - ambulatory
Patient care - inpatient hospital
Teaching
Research
Administration
Other _________________
median
100%
0.0%
0.0%
0.0%
0.0%
0.0%
Part 4. Job Search Experience
(Does not include temporary visa holders)
27. How long have you been actively searching
or did you search for a position?
(n=64)
19.3%
22.3%
30.7%
9.0%
16.9%
1.7%
Less than one month
1-2 months
3-4 months
5-6 months
More than 6 months
Haven’t looked yet (Go to Q. 33)
28. In which geographic areas have you focused
your search (check all that apply)?
(n=64)
4.6% All of Minnesota
58.5% Twin Cities metropolitan area
6.2% Northeastern Minnesota
4.6% Northwestern Minnesota
4.6% Central Minnesota
6.2% Southeastern Minnesota
3.1% Southwestern/South Central
Minnesota
16.9% Midwest region (ND, SD, WI, IA,
IL)
9.2% Eastern U.S.
12.3% Western U.S.
3.1% Southern U.S.
0.0% Outside of U.S.
29. How many offers for employment/practice positions did you receive (excluding fellowships and
other training positions)?
(n=64)
3.5% -0
18.3% -1
29.9% -2
20.6% -3
9.6% -4
5.8% -5
7.3% -6 to 10
1.7% -over 10
3.2% -n/a
30. How much difficulty did you have/are you having finding a practice position you are satisfied
with?
(n=65)
52.5%
40.9%
6.6%
30a.
no difficulty
some difficulty
severe difficulty
If you have had some difficulty or severe difficulty finding a satisfactory position,
what was the main reason? (mark only one)
(n=30)
0.0%
59.3%
0.0%
10.0%
20.1%
3.7%
0.0%
6.9%
Overall lack of jobs in your specialty
Lack of jobs in desired geographic location
Lack of jobs in desired practice setting (i.e. group practice, VA, etc)
Lack of jobs at desired level of ownership
Inadequate salary/compensation
Family/spouse considerations
Limited jobs due to visa status
Other ___________________________
31. Did you change your plans because of limited practice opportunities?
14.0% Yes
(n=64)
86.0% No
31a. If yes, how? (check all that apply)
42.9%
7.1%
14.3%
14.3%
0.0%
0.0%
(n=14)
Broadened search to new geographic area
Broadened search to new practice settings
Broadened search to include different levels of ownership
Changed salary expectations/requirements
Going on for additional training
Other ___________________________
59
31. How important were the following factors in your job search and in the selection of your
upcoming practice position?
Very Important
Salary/benefits (n=65)
70.1%
Ownership level (n=66)
48.3%
Practice setting (n=66)
77.2%
Family/spouse considerations (n=66) 57.5%
Demog. of surrounding area (n=66) 57.7%
Military, visa, or loan obligation (n=64)
67.2%
Geographic location (n=66)
63.4%
Partners in the practice (n=66)
52.6%
Other (n=3) _______________
33.3%
Somewhat Important Not Important
29.9%
37.9%
21.4%
24.9%
38.0%
12.5%
0.0%
13.8%
1.4%
17.7%
4.3%
20.3%
33.2%
33.4%
0.0%
3.4%
14.0%
66.7%
33. What is your perception of opportunities for practice (for residents, opportunities in your specialty) within Minnesota? (n=66)
64.7% Many Jobs
25.8% Some Jobs
2.8% Few Jobs
1.7% Very Few Jobs
0.0% No Jobs
3.4% Unknown
1.7% n/a – didn’t search in Minnesota
34. What is your perception of opportunities for practice (for residents, opportunities in your specialty) nationally?
(n=64)
53.6% Many Jobs
28.5% Some Jobs
0.0% Few Jobs
0.0% Very Few Jobs
0.0% No Jobs
60
11.8% Unknown
6.1% n/a – didn’t search nationally
E
Resident Physician
Exit Survey
Part 1. Identification Information
MN Medical License Number: _____________
First Name: _______________________ M.I. ___ Last Name:__________________________
Name of program you are completing: ______________________________________________
Part 2. Background/Education
1. Gender
2. Age
65.1% M
Median=33
3. Citizenship status:
72.0%
8.7%
6.0%
1.0%
12.0%
0.3%
34.9% F
(n=402)
(n=398)
(n=401)
Native Born U.S.
Naturalized U.S.
Permanent Resident
H-1, H-2, H-3 Temporary Worker
J-1, J-2 Exchange Visitor
Other
4. Race/Ethnicity
(n=399)
0.7% American Indian/Alaskan Native
12.5% Asian/Pacific Islander
3.5% Black/African American
(non-Hispanic)
3.3% Hispanic/Latino
(Spanish/Hispanic/Chicano/Latino)
0.3% Multiracial
76.2% White (non-Hispanic)
3.5% Other ______________
5. Where did you graduate from high school?
(n=402)
12.9%
11.2%
51.2%
24.7%
Greater Minnesota
Twin Cities metropolitan area
Other U.S. state
Other country
6. Where did you graduate from college (undergraduate degree)?
(n=399)
11.3%
8.5%
56.6%
23.6%
Greater Minnesota
Twin Cities metropolitan area
Other U.S. state
Other country
7. Where did you attend medical school? (If you
began medical school at UMD, indicate University
of MN - Duluth)
(n=403)
17.0%
5.0%
4.8%
49.1%
University of MN - Twin Cities
University of MN - Duluth
Mayo Clinic
Non-Minnesota U.S. medical school
(Please specify state: _____)
24.1% Non-U.S. medical school
(Please specify country: _________)
What year did you complete medical school?
Median=1996
(n=402)
9. What is your current level of educational debt
(including both undergraduate and medical school
loans)?
(n=401)
30.5%
8.0%
6.5%
9.0%
7.5%
11.7%
14.4%
5.2%
5.0%
2.2%
None
Less than $20,000
$20,000-$39,999
$40,000-$59,999
$60,000-$79,999
$80,000-$99,999
$100,000-$124,999
$125,000-$149,999
$150,000-$199,999
Over $200,000
61
10. Specialty
you are completing
in 2001 (Select only one)
(n=403)
0.5%
3.8%
0.5%
0.8%
0.3%
1.3%
2.8%
17.4%
13.4%
2.3%
1.0%
0.5%
1.0%
0.5%
2.0%
0.2%
0.8%
0.8%
0.3%
0.8%
1.0%
0.5%
3.5%
0.0%
2.8%
1.0%
2.3%
3.6%
1.0%
1.8%
1.0%
4.3%
0.8%
2.5%
1.0%
3.0%
1.0%
0.8%
5.1%
3.3%
0.0%
0.8%
1.5%
0.3%
0.0%
2.0%
0.8%
3.8%
62
11. If subspecializing/doing
additional fellowship,
Specialty you are entering next year (Select only one)
(n=85)
2.6%
1.3%
0.0%
1.3%
2.6%
0.0%
0.0%
0.0%
1.3%
5.1%
1.3%
1.3%
1.3%
1.3%
1.3%
2.6%
3.9%
2.6%
3.8%
0.0%
0.0%
0.0%
5.1%
0.0%
0.0%
1.3%
2.6%
2.6%
2.5%
0.0%
6.4%
1.3%
3.9%
0.0%
0.0%
1.3%
0.0%
3.8%
7.7%
2.6%
0.0%
0.0%
5.2%
1.3%
0.0%
3.8%
0.0%
12.8%
Allergy and immunology
Anesthesiology (general)
Anesthesiology (critical care medicine)
Anesthesiology (pain management)
Other anesthesiology subspecialty (specify) __________
Dermatology
Emergency Medicine
Family Practice
Internal Medicine (general)
Cardiology
Critical Care Medicine
Endocrinology and Metabolism
Gastroenterology
Geriatrics
Hematology/Oncology
Infectious Disease
Nephrology
Pulmonary Disease/CCM
Rheumatology
Other Internal Medicine subspecialty (specify) _______
Internal Medicine and Pediatrics (Combined)
Neurological Surgery
Neurology
Nuclear Medicine
Obstetrics and Gynecology (General)
OB/GYN subspecialty - specify ___________________
Ophthalmology
Orthopedic Surgery
Otolaryngology
Pathology (General)
Pathology subspecialty - specify __________________
Pediatrics (General)
Pediatrics subspecialty - specify ___________________
Physical Medicine and Rehabilitation
Preventive Medicine/Public Health/Occupational Med.
Psychiatry
Child and Adolescent Psychiatry
Other Psychiatry Subspecialty (specify) _____________
Radiology
Surgery (General)
Pediatric Surgery
Plastic/Reconstructive Surgery
Thoracic/Cardiovascular Surgery
Transplant Surgery
Vascular Surgery
Other Surgical Subspecialty (specify) ______________
Urology
Other (specify) ________________________________
Part 3. Future Plans
12. What do you expect to be doing after completion of your current training program?
(n=403)
Primary Activity (mark only one)
48.1% Patient care/clinical practice - private
24.3% Patient care/clinical practice - academic
21.1% Additional training/fellowship
2.5% Chief Resident
0.2% Teaching
1.5% Research
0.0% Working in another field
0.0% Other ____________________
2.0% Undecided/Don’t know yet
13. Where is the location of your primary activity after your current training?
(n=401)
52.0%
39.0%
6.0%
3.0%
Within Minnesota
Other U.S. state
Outside of U.S.
Don’t know yet
14. If you are leaving the state to continue your
training, do you plan to return to Minnesota to
practice when your training is complete?
(n=48)
29.1%
39.6%
29.2%
2.1%
Yes
No
Don’t know yet
Does not apply
15. If you are planning to enter or have considered entering patient care/clinical practice, have
you actively searched for a job?
(n=290)
88.6% Yes
9.6% No, not yet (Go to Q. 34)
1.7% No, I will be self-employed
* If you have not considered entering clinical
practice, stop here and return your completed
survey.
16. Have you accepted a practice position?
(n=261)
93.9% Yes
6.1% No (Go to Q. 28)
17. Which best describes the type of patient
care practice you will be entering?
(n=223)
26.5% hospital - inpatient
18.4% hospital-based ambulatory care
2.7% Community (non-hospital based)
health center, clinic or other outpatient facility without hospital privileges
48.8% Community (non-hospital based)
health center, clinic or other outpatient facility with hospital privileges
0.0% Long-term care facility
3.6% Other: ____________________
18. What level of ownership will you have in
your upcoming practice?
(n=228)
51.8% None, I will be an employee
34.2% None currently, but I may have the
option to become a partner/owner
in the future
4.4% I will be a partner, but will not have
any capital invested in the practice
9.7% I will be an owner/partner (i.e. I
will have capital invested and own a
financial stake in the practice)
19. Which best describes the type of employer
for whom you will be working? (n=228)
13.6% Self-employed (solo practice or
owner/partner in independent grp.
practice)
41.2% Group practice
28.1% Hospital or clinic
9.2% Managed care organization
4.4% Military or government organization
3.5% Other __________________
63
20. What is the ZIP code and county of the principal
practice address at which you will be working (if ZIP is
unknown, please provide city/town and state)?
ZIP: ________ County: ______________
City: __________________ State: _____
(If non-U.S., specify country:___________)
21. Is your practice in a federally designated Health
Professional Shortage Area?
(n=227)
5.7% Yes
76.6% No
17.7% Unknown
22. How long do you expect to be at your principal practice location?
(n=228)
6.1% Less than 2 years
21.0% 2-4 years
72.8% 4 years or more
Inner city
Other area within major city
Suburban
Small city (population below 25,000)
Rural
24. Expected gross income during first year of practice:
(n=227)
Base Salary/Income
4.4% < $70,000
0.9% $70,000-$79,999
2.2% $80,000-$89,999
5.7% $90,000-$99,999
9.7% $100,000-$109,999
7.9% $110,000-$119,999
17.2% $120,000-$129,999
6.2% $130,000-$139,999
7.5% $140,000-$149,999
15.0% $150,000-$174,999
9.3% $175,000-$200,000
14.1% > $200,000
64
45.2%
47.8%
7.0%
0.0%
Very Satisfied
Somewhat Satisfied
Not Very Satisfied
Very Dissatisfied
26. How many total hours will you be working per week,
not including on-call hours?
(n=228)
1.3%
3.5%
17.1%
41.2%
21.1%
15.8%
Less than 20
20 to 29
30 to 39
40 to 49
50 to 59
60 or more
27. What percentage of your time will be spent on the
following activities?
(n=218)
23. Which best describes the demographics of the area in
which you will be practicing?
(n=224)
22.8%
32.6%
24.1%
15.2%
5.4%
25. How satisfied are you with your expected gross
income?
(n=228)
Additional
Incentive Income
49.6% Zero
5.1% < $5,000
7.7% $5,000-$9,999
13.7% $10,000-$14,999
8.6% $15,000-$19,999
5.2% $20,000-$24,999
0.9% $25,000-$29,999
0.0% $30,000-$34,999
0.0% $35,000-$39,999
0.0% $40,000-$44,999
2.5% $45,000-$50,000
6.8% > $50,000
Patient care - ambulatory
Patient care - inpatient
Patient care - long term care
Rounds
Teaching
Research
Administration
Other _________________
median
70.0%
10.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
Part 4. Job Search Experience
Does not include temporary visa holders
28. How long have you been actively searching or did you search for a position?
(n=233)
20.2%
16.3%
29.1%
19.4%
15.0%
0.0%
Less than one month
1-2 months
3-4 months
5-6 months
More than 6 months
Haven’t looked yet (Go to Q. 34)
29. In which geographic areas have you focused your search (check all that apply)?
(n=233)
8.9%
39.2%
5.9%
0.8%
5.5%
11.8%
2.1%
25.7%
17.3%
14.8%
13.1%
2.5%
All of Minnesota
Twin Cities metropolitan area
Northeastern Minnesota
Northwestern Minnesota
Central Minnesota
Southeastern Minnesota
Southwestern/South Central Minnesota
Midwest region (ND, SD, WI, IA, IL)
Eastern U.S.
Western U.S.
Southern U.S.
Outside of U.S.
30. How many offers for employment/practice positions did you receive (excluding fellowships,
chief residency and other training positions)?
(n=231)
1.3% -0
19.5% -1
19.0% -2
19.5% -3
13.8% -4
8.7% -5
10.4% -6 to 10
6.9% -over 10
0.9% -n/a
31. How much difficulty did you have/are you having finding a practice position you are satisfied
with?
(n=235)
72.3%
26.4%
1.3%
No difficulty
Some difficulty
Severe difficulty
65
31a. If you have had some difficulty or severe difficulty finding a satisfactory position, what
was the main reason? (mark only one)
(n=59)
6.7%
23.8%
20.3%
5.1%
8.5%
23.8%
0.0%
11.8%
Overall lack of jobs in your specialty
Lack of jobs in desired geographic location
Lack of jobs in desired practice setting (i.e. hospital, LTC, etc)
Lack of jobs at desired level of ownership
Inadequate salary/compensation
Family/spouse considerations
Limited opportunities due to visa status
Other ___________________________
32. Did you change your plans because of limited practice opportunities?
11.9% Yes
88.1% No
32a. If yes, how? (check all that apply)
57.1%
32.1%
3.6%
21.4%
3.6%
0.0%
(n=226)
(n=28)
Broadened search to new geographic area
Broadened search to new practice settings
Broadened search to include different levels of ownership
Changed salary expectations/requirements
Going on for additional training
Other ___________________________
33. How important were the following factors in your job search and in the selection of your
upcoming practice position?
Very Important
Salary/benefits (n=234)
Ownership level (n=229)
Practice setting (n=233)
Family/spouse considerations (n=233)
Demog. of surrounding area (n=230)
Military, visa, or loan obligation(n=228)
Geographic location (n=231)
Partners in the practice (n=232)
Partnership buy-in costs (n=229)
Waiting period for partnership(n=230)
Other (n=28)____________
66
48.3%
25.4%
83.7%
73.9%
50.0%
4.8%
74.9%
63.8%
8.3%
10.5%
64.0%
Somewhat Important Not Important
49.1%
35.3%
15.9%
15.0%
41.3%
13.6%
23.4%
27.1%
37.6%
34.3%
14.3%
2.6%
39.3%
0.4%
11.1%
8.7%
81.6%
1.7%
9.1%
54.1%
55.2%
21.6%
34. What is your perception of opportunities for practice in your specialty within Minnesota?
(n=236)
41.9% Many Jobs
34.7% Some Jobs
6.4% Few Jobs
2.6% Very Few Jobs
0.4% No Jobs
5.5% Unknown
8.5% n/a - didn't search in Minnesota
35. What is your perception of opportunities for practice in your specialty nationally?
(n=236)
58.9% Many Jobs
25.5% Some Jobs
2.5% Few Jobs
0.9% Very Few Jobs
0.0% No Jobs
3.0% Unknown
9.3% n/a - didn't search nationally
67
68
F
Physician Assistant
Exit Survey
Part 1. Identification Information
Part 2. Background/Education
1. Gender
15.4% M
84.6% F
(n=26)
2. Age
median=28
(n=25)
Native Born U.S.
Naturalized U.S.
Permanent Resident
H-1, H-2, H-3 Temp. Worker
J-1, J-2 Exchange Visitor
Other
4. Race/Ethnicity
(n=26)
0.0% American Indian/Alaskan Native
7.7% Asian/Pacific Islander
0.0% Black/African American (non-Hisp.)
0.0% Hispanic
(Spanish/Hispanic/Chicano/Latino)
0.0%Multiracial
92.3% White (non-Hispanic)
0.0% Other ______________
5. Where did you graduate from high school?
(n=26)
38.5%
38.5%
23.1%
0.0%
46.2%
38.5%
15.4%
0.0%
Greater Minnesota
Twin Cities metropolitan area
Other U.S. state
Other country
7. What is your current level of educational
debt (including both undergraduate and P.A.
school loans)?
(n=26)
3. Citizenship status:
92.3%
7.7%
0.0%
0.0%
0.0%
0.0%
6. Where did you graduate from college (undergraduate degree)?
(n=26)
Greater Minnesota
Twin Cities metropolitan area
Other U.S. state
Other country
3.8%None
26.9% $60,000-$79,999
3.8% < $20,000
38.5% $80,000-$99,999
0.0% $20,000-$39,999 11.5% Over $100,000
15.4% $40,000-$59,999
Part 3. Future Plans
8. What do you expect to be doing after completion of your current training program?
(n=26)
Primary Activity (mark only one)
100% Patient care/clinical practice as P.A.
0.0% Patient care/clinical practice as
another health care provider
0.0% Additional training as a P.A.
0.0% Teaching
0.0% Research
0.0% Working in another field
0.0% Other ____________________
0.0% Undecided/Don’t know yet
69
9. Where is the location of your primary activity after your current training? (n=26)
84.6%
11.5%
0.0%
3.8%
Within Minnesota
Other U.S. state
Outside of U.S.
Don’t know yet
10. If you are leaving the state to continue your
training, do you plan to return to Minnesota to
practice when your training is complete?
(n=0)
n/a
n/a
n/a
n/a
Yes
No
Don’t know yet
Does not apply
11. If you are planning to enter or have considered entering patient care/clinical practice, have
you actively searched for a job as a P.A.?
(n=26)
92.3% Yes
7.7% No, not yet (Go to Q. 30)
* If you have not considered entering clinical
practice as a P.A., stop here and return your
completed survey.
12. Have you accepted a practice position as a
physician assistant?
(n=24)
58.3% Yes
41.7% No (Go to Q. 24)
13. Which best describes the type of patient
care practice you will be entering?
(n=14)
14.3% hospital - inpatient
21.4% hospital-based ambulatory care
21.4% Community (non-hospital based)
health center, clinic or other outpatient facility without hospital privileges
42.9% Community (non-hospital based)
health center, clinic or other outpatient facility with hospital privileges
0.0% Long-term care facility
0.0% Other: ______________________
70
14. What is the principal specialty of your
supervising physician at your principal practice?
(n=14)
14.3%
35.7%
0.0%
7.1%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
7.1%
7.1%
28.6%
Emergency Medicine
General/Family Practice
Internal Medicine - General
Internal Medicine - Geriatric
Medicine
Internal Medicine - Oncology
Internal Medicine - Other
Pediatrics - General
Pediatric Subspecialty
Surgery - General
Surgery Subspecialty
Obstetrics/Gynecology
Occupational Medicine
Psychiatry
Multiple Specialties
Other (specify _______________)
15. What level of ownership will you have in
your upcoming practice? (n=14)
100.0% None, I will be an employee
0.0% None currently, but I may have the
option to become a partner in the
future
0.0% I will be a partner, but will not have
any capital invested in the practice
0.0% I will be an owner/partner (i.e. I will
have capital invested and own a
financial stake in the practice)
16. What is the ZIP code and county of the
principal practice address at which you will be
working (if ZIP is unknown, please provide
city/town and state)?
ZIP: ________ County: ______________
City: __________________ State: _____
(If non-U.S., specify country:___________)
17. Is your practice in a federally designated
Health Professional Shortage Area?
(n=14)
2.4% Yes
64.3% No
14.3% Unknown
18. How long do you expect to be at your principal practice location?
(n=14)
21.4% Less than 2 years
64.3% 2-4 years
14.3% 4 years or more
19. Which best describes the demographics of
the area in which you will be practicing?
(n=14)
42.9% Inner city
14.3% Other area within major city
21.4% Suburban
21.4% Small city (population below
25,000)
0.0% Rural
20. Expected gross income during first year of
practice:
(n=14)
7.1%
7.1%
14.3%
21.4%
21.4%
21.4%
7.1%
0.0%
0.0%
0.0%
0.0%
0.0%
Base Salary
Less than $40,000
$40,000-$44,999
$45,000-$49,999
$50,000-$54,999
$55,000-$59,999
$60,000-$64,999
$65,000-$69,999
$70,000-$74,999
$75,000-$79,999
$80,000-$84,999
$85,000-$89,999
Over $90,000
21. How satisfied are you with your expected
gross income?
(n=14)
28.6%
57.1%
14.3%
0.0%
Very Satisfied
Somewhat Satisfied
Not Very Satisfied
Very Dissatisfied
22. How many total hours will you be working
per week, not including on-call hours?
(n=14)
7.1%
7.1%
14.3%
71.4%
0.0%
0.0%
Less than 20
20 to 29
30 to 39
40 to 49
50 to 59
60 or more
71
23. What percentage of your time will be spent
on the following activities?(n=14)
Patient care - ambulatory
Patient care - inpatient
Patient care - long term care
Teaching
Research
Administration
Other _________________
median
96.5%
1.0%
0.0%
0.0%
0.0%
0.0%
0.0%
Part 4. Job Search Experience
Does not include temporary visa holders
24. How long have you been actively searching
or did you search for a P.A. position?
(n=24)
25.0%
29.2%
41.7%
4.2%
0.0%
0.0%
Less than one month
1-2 months
3-4 months
5-6 months
More than 6 months
Haven’t looked yet (Go to Q. 30)
25. In which geographic areas have you focused
your search (check all that apply)?
(n=24)
4.2% All of Minnesota
79.2% Twin Cities metropolitan area
12.5% Northeastern Minnesota
8.3% Northwestern Minnesota
33.3% Central Minnesota
4.2% Southeastern Minnesota
0.0% SW/South Central Minnesota
20.8% Midwest region (ND, SD, WI, IA,
IL)
0.0% Eastern U.S.
4.2% Western U.S.
0.0% Southern U.S.
0.0% Outside of U.S.
26. How many offers for employment/practice
positions did you receive (excluding fellowships
and other training positions)?
(n=24)
33.3% -0
12.5% -3
0.0%- 6 to 10
33.3% -1
4.2% -4
0.0% - > 10
16.7% -2
0.0% -5
0.0% - n/a
27. How much difficulty did you have/are you
having finding a P.A. practice position you are
satisfied with?
(n=24)
20.8% No difficulty
62.5% Some difficulty
16.7% Severe difficulty
72
27a. If you have had some difficulty or severe difficulty finding a satisfactory P.A. position,
what was the main reason? (mark only one)
(n=16)
12.5%
Overall lack of jobs for P.A.’s
25.0%
Lack of opportunities for P.A.’s with little or no experience
18.8%
Lack of P.A. jobs in desired geographic location
37.5%
Lack of P.A. jobs in desired practice setting (i.e. hospital, clinic,
LTC, etc)
0.0%
Lack of jobs at desired level of ownership
0.0%
Inadequate salary/compensation
6.3%
Family/spouse considerations
0.0 %
Limited P.A. jobs due to visa status
0.0%
Other (specify):_______________________
28. Did you change your plans because of limited P.A. practice opportunities?
30.4% Yes
(n=23)
69.6% No
28a. If yes, how? (check all that apply)
14.3%
71.4%
0.0%
42.9%
0.0%
0.0%
(n=7)
Broadened search to new geographic area
Broadened search to new practice settings
Broadened search to include different levels of ownership
Changed salary expectations/requirements
Going on for additional training
Other ___________________________
29. How important were the following factors in your job search and in the selection of your
upcoming practice position?
Very Important
Salary/benefits (n=23)
65.2%
Ownership level (n=23)
0.0%
Practice setting )(n=23)
78.3%
Family/spouse considerations (n=23)
69.6%
Demographics of area (n=23)
39.1%
Military, visa, or loan obligation (n=23) 17.4%
Geographic location (n=23)
69.6%
Coworkers in the practice (n=23)
73.9%
Somewhat Important Not Important
34.8%
0.0%
47.8%
52.2%
21.7%
0.0%
17.4%
13.0%
56.5%
4.3%
21.7%
60.9%
30.4%
0.0%
17.4%
8.7%
73
30. What is your perception of P.A. practice opportunities within Minnesota?
0.0% Many Jobs
43.5% Some Jobs
47.8% Few Jobs
8.7% Very Few Jobs
0.0% No Jobs
0.0% Unknown
0.0% n/a - didn’t search in Minnesota
31. What is your perception of P.A. practice opportunities nationally?
21.7% Many Jobs
39.1% Some Jobs
4.3% Few Jobs
0.0% Very Few Jobs
0.0% No Jobs
74
(n=23)
13.0% Unknown
21.7% n/a - didn’t search nationally
(n=23)
G
Pharm D
Graduate/Resident
Exit Survey
Part 1. Identification Information
MN Pharmacy License Number (if available): _____________
First Name: ___________________ M.I. __________ Last Name: ____________________
Name of program you are completing: ______________________________________________
Part 2. Background/Education
1. Gender
32.7% M
(n=52)
67.3% F
2. Age
(n=52)
median=26
3. Citizenship status:
95.1%
3.3%
1.6%
0.0%
0.0%
0.0%
30.8%
28.5%
40.8%
0.0%
Greater Minnesota
Twin Cities metropolitan area
Other U.S. state
Other country
(n=52)
Native Born U.S.
Naturalized U.S.
Permanent Resident
H-1, H-2, H-3 Temporary Worker
J-1, J-2 Exchange visitor
Other
4. Race/Ethnicity
5. Where did you graduate from high school?
(n=51)
(n=51)
0.0% American Indian/Alaskan Native
3.3% Asian/Pacific Islander
1.7% Black/African American
(non-Hispanic)
0.0% Hispanic
(Spanish/Hispanic/Chicano/Latino)
0.0% Multiracial
95.0% White (non-Hispanic)
0.0% Other ______________
6. Where did you graduate from college (undergraduate degree)?
(n=47)
24.0% Greater Minnesota
38.2% Twin Cities metropolitan area
37.8 %Other U.S. state
0.0% Other country
7. Where did you attend, or are you attending,
pharmacy school?
(n=52)
83.6% University of MN
16.4% Non-Minnesota U.S. pharmacy
school
(Please specify state: _____)
0.0% Non-U.S. pharmacy school
(Please specify country: ________)
8. What year did you complete, or will you
complete, pharmacy school? (n=52)
Median=2001
75
9. What is your current level of educational debt (including both undergraduate and pharmacy
school loans)?
(n=52)
6.6%
6.6%
12.8%
25.3%
23.7%
17.1%
7.9%
None
Less than $20,000
$20,000-$39,999
$40,000-$59,999
$60,000-$79,999
$80,000-$99,999
Over $100,000
10. What type of training program are you completing in 2001?
(n=52)
79.0% Entry-level Pharm. D. program
21.0% Post-Pharm. D. residency or fellowship program
11. Residents only: Please indicate the specialty you are completing in 2001.
General Pharmacy Practice Residency
0.0% Community
74.0% Institutional
0.0% Managed Care
26.0% Other (please specify)________________________________
Specialty Residency
0.0%Cardiology
0.0% Critical Care
0.0% Drug Information
0.0% Geriatric
0.0% Infectious Disease
0.0% Internal Medicine
0.0% Managed Care
0.0% Neurology
0.0% Nephrology
0.0% Nutritional Support
0.0% Oncology
0.0% Pediatric
0.0% Primary Care
0.0% Psychiatry
0.0% Other (please specify)________________________________
76
(n=9)
Part 3. Future Plans
NOTE: For the purposes of this survey,
“patient care/clinical practice” refers to pharmacy practice in hospital, hospital-based
ambulatory care, community clinic or other
outpatient facility, or community retail pharmacy settings.
12. What do you expect to be doing after completion of your current training program?
(n=52)
Primary Activity (mark only one)
80.9% Patient care/clinical practice
13.1% Additional pharmacy training or fellowship
0.0% Graduate School
0.0% Administrative pharmacy position
(i.e. industry or managed care position)
0.0% Teaching
0.0% Research
3.0% Working in another field
3.0% Other
0.0 % Undecided
13. Where is the location of your primary activity after your current training?
(n=52)
82.0%
16.4%
0.0%
1.6%
Within Minnesota
Other U.S. state
Outside of U.S.
Don’t know yet
14. If you are leaving the state to continue your
training, do you plan to return to MN to practice when your training is complete?
(n=3)
25.0% Yes
25.0% No
50.0 % Don’t know yet
0.0% Does not apply
14a. If you are leaving the state to continue your training, would the availability of an appropriate residency program
in Minnesota have made you more likely to stay in the state?
(n=3)
25.0% Yes
25.0% No
50.0 % Don’t know yet
0.0% Does not apply
14b. If you answered “Yes” to question
14a, What type of program(s) would
you be interested in seeing added or
expanded in Minnesota? (Check all that
apply)
(n=1)
0.0%
0.0%
0.0%
100.0%
0.0%
Community
Institutional
Managed Care
Other (specify)_______
Does not apply
15. If you are planning to enter or have considered entering patient care/clinical practice, have
you actively searched for a job?
(n=42)
95.9% Yes
4.1% No, not yet (Go to Q. 34)
0.0% No, I will be self-employed
* If you have not considered entering clinical
practice, stop here and return your completed
survey.
16.Have you accepted a practice position?
(n=40)
89.8% Yes
10.2% No (Go to Q. 27)
17. Which best describes the type of patient
care practice you will be entering?
(n=36)
36.8% hospital - inpatient
0.0% hospital-based ambulatory care
9.0% Community (non-hospital based)
health center, clinic or other outpatient
facility 49.6% Community or retail
pharmacy
4.7% Other: _____________________
77
18. What level of ownership will you have in
your upcoming practice?
(n=35)
92.8% None, I will be an employee
0.0% None currently, but I may have the
option to become a partner/owner
in the future
4.8% I will be a partner, but will not have
any capital invested in the practice
2.4% I will be an owner/partner (i.e. I will
have capital invested and own a
financial stake in the practice).
19. What is the ZIP code and county of the
principal practice address at which you will be
working (if ZIP is unknown, please provide
city/town and state)?
ZIP: ________ County: ______________
City: __________________ State: _____
23. Expected Gross Income during first year of
practice:
(n=36)
(n=29)
Base Salary
Incentive Income
0.0% Less than $50,000
0.0% $50,000-$59,999
2.4% $60,000-$69,999
53.2% $70,000-$79,999
26.9% $80,000-$89,999
13.2% $90,000-$99,999
4.3% Over $100,000
1.8% Zero
14.2% <$5,000
53.9% $5,000-$9,999
11.3% $10,000-$14,999
3.0% $15,000-$19,999
3.0% $20,000-$24,999
3.0% > $25,000
24. How satisfied are you with your expected
gross income?
(n=36)
58.5%
41.5%
0.0%
0.0%
Very Satisfied
Somewhat Satisfied
Not Very Satisfied
Very Dissatisfied
25. How many total hours will you be working
per week, not including on-call hours?
(n=36)
(If non-U.S., specify country:___________)
20. Is your practice in a federally designated
Health Professional Shortage Area?
(n=36)
25.0% Yes
16.0% No
59.0% Unknown
21. How long do you expect to be at your principal practice location?
(n=36)
0.0% Less than 2 years
43.8% 2-4 years
56.2% 4 years or more
22. Which best describes the demographics of
the area in which you will be practicing?
(n=36)
20.7%
13.7%
51.5%
9.4%
Inner city
Other area within major city
Suburban
Small city (population below
25,000)
4.7% Rural
78
0.0%
0.0%
11.8%
88.2%
0.0%
0.0%
Less than 20
20 to 29
30 to 39
40 to 49
50 to 59
60 or more
26. What percentage of your time will be spent
on the following activities?
(n=35)
Dispensing Prescriptions
Consulting
Patient care - ambulatory
Patient care - inpatient
Teaching
Research
Drug use management
Administration/business mgmt
Other _________________
median
40.7%
10.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
0.0%
Part 4. Job Search Experience
(does not include temporary visa holders)
27. How long have you been actively searching
or did you search for a position?
(n=40)
48.4%
35.1%
12.3%
2.1%
2.1%
0.0%
Less than one month
1-2 months
3-4 months
5-6 months
More than 6 months
Haven*t looked yet (Go to Q. 34)
28. How many positions have you applied for?
6.3% -0
28.0% -1
16.5% -2
24.2% -3
10.6% -4
10.2% -5
30. How many offers for employment/practice
positions did you receive (excluding fellowships
and other training positions)?
0.0% -0
20.3% -1
12.3% -2
24.2% -3
16.9% -4
14.4% -5
5.9% -6 to 10
5.9% -over 10
0.0% -n/a
31. How much difficulty did you have/are you
having finding a practice position you are satisfied with?
(n=40)
56.3% No difficulty
37.7% Some difficulty
6.1% Severe difficulty
2.1% -6 to 10
0.0% -over 10
2.1% -n/a
29. In which geographic areas have you focused
your search (check all that apply)?
(n=40)
5.0%
75.0%
2.5%
2.5%
7.5%
7.5%
7.5%
7.5%
7.5%
12.5%
0.0%
0.0%
All of Minnesota
Twin Cities metropolitan area
Northeastern Minnesota
Northwestern Minnesota
Central Minnesota
Southeastern Minnesota
Southwestern/South Central
Minnesota
Midwest region (ND, SD, WI, IA,
IL)
Eastern U.S.
Western U.S.
Southern U.S.
Outside of U.S.
(Continued on next page)
79
31a. If you had some or severe difficulty finding a satisfactory position, what was the main
reason? (mark only one)
(n=40)
11.6%
6.4%
43.6%
0.0%
0.0%
6.4%
0.0%
32.0%
Overall lack of jobs (residents - lack of jobs in your specialty)
Lack of jobs in desired geographic location
Lack of jobs in desired practice setting (i.e. hospital, HMO, etc)
Lack of jobs at desired level of ownership
Inadequate salary/compensation
Family/spouse considerations
Limited jobs due to visa status
Other ___________________________
32. Did you change your plans because of limited practice opportunities?
8.5% Yes
91.5% No
32a. If yes, how? (check all that apply)
0.0%
100.0%
0.0%
0.0%
0.0%
0.0%
(n=40)
(n=3)
Broadened search to new geographic area
Broadened search to new settings
Broadened search to include different levels of ownership
Changed salary expectations/requirements
Going on for additional training
Other ___________________________
33. How important were the following factors in your job search and in the selection of your
upcoming practice position?
Very Important
Salary/benefits (n=40)
Ownership level (n=40)
Practice setting (n=40)
Coworkers in the practice (n=40)
Direct patient care opportunities (n=40)
Opportunities for prof. growth (n=40)
Family/spouse considerations (n=40)
Demographics of area (n=40)
Military, visa, or loan obligation (n=40)
Geographic location (n=40)
Other ___________ (n=4)
80
75.0%
10.2%
77.5%
55.1%
61.0%
75.4%
61.0%
34.7%
5.9%
55.1%
100%
Somewhat Important Not Important
25.0%
10.6%
22.5%
44.9%
39.0%
24.6%
33.0%
54.7%
18.6%
44.9%
0.0%
0.0%
79.3%
0.0%
0.0%
0.0%
0.0%
5.9%
10.6%
75.4%
0.0%
0.0%
34. What is your perception of opportunities for practice (for residents, opportunities in your specialty) within Minnesota?
(n=40)
67.4% Many Jobs
14.4% Some Jobs
3.8% Few Jobs
8.1% Very Few Jobs
0.0% No Jobs
4.2% Unknown
2.1% n/a – didn’t search in Minnesota
35. What is your perception of opportunities for practice (for residents, opportunities in your specialty) nationally?
(n=40)
65.7% Many Jobs
16.1% Some Jobs
0.0% Few Jobs
2.1% Very Few Jobs
0.0% No Jobs
3.8% Unknown
12.3% n/a – didn’t search nationally
81
82
Endnotes
1
Minnesota Department of Health, Health Economics Program, “Medical Education and Research
Costs (MERC): a Final Report to the Legislature,” 1996.
2
WWAMI Research Center, University of Washington, “Physician Education and Rural Location:
A Critical Review,” February 1999.
3
Minnesota Department of Health, Office of Rural Health and Primary Care, “Minnesota Dentist
Workforce Profile,” 2002.
4
Kington, Raynard, Diana Tisnado, and David Carlisle, “Increasing racial and ethnic diversity
among physicians: an intervention to address health disparities?” In The Right Thing To Do, The
Smart Thing To Do: Enhancing Diversity in the Health Professions. Summary of the Symposium
on Diversity in the Health Professions in Honor of Herbert W. Nickens, MD, National Academy
Press, 2001.
5
Minnesota Department of Health, Office of Rural Health and Primary Care, “Minnesota
Pharmacist Workforce Profile,” 2002.
6
Minnesota Department of Health, Office of Rural Health and Primary Care, “Minnesota Dentist
Workforce Profile,” 2002.
7
American Academy of Physician Assistants, 2001 Physician Assistant Census.
83
8
Minnesota Department of Health, Office of Rural Health and Primary Care, “Minnesota
Physician Workforce Profile,” 2002.
9
Minnesota State Demographic Center, “2000 Census Shows a More Racially and Ethnically
Diverse Minnesota,” May 2001.
10
An exchange visitor or "J" visa allows the holder to remain in the country so long as he or she is
participating in an educational exchange program. Holders of "J" visas must return to their home
country for at least two years upon completion of training unless they receive a waiver to practice in
an underserved area. An "H" temporary worker visa allows the holder to work in the U.S. for up
to six years.
11
American Association of Medical Colleges, “1996 Medical School Graduation Questionnaire.”
12
American Academy of Physician Assistants, 2001 Physician Assistant Census.
13
Minnesota Department of Health, Office of Rural Health and Primary Care, “Health Demand
Assessment.” 2002.
14
Minnesota Department of Economic Security, Research and Statistics Office, OccupationIndustry Matrix 2000.
15
Minnesota Department of Economic Security, Research and Statistics Office, “1998-2008
Occupational Employment Projections.”
84
If you require this document in another format, such as large print, Braille or cassette
tape, call (651) 282-6314
To obtain additional copies:
Health Policy and Systems Compliance Division
Minnesota Department of Health
PO Box 64075
St. Paul, Minnesota 55164-0975
Phone: 651-282-6314
TDD: 1-800-627-3529