Good news for Northwest Minnesota: in 2024, the region's Health Care & Social Assistance employment finally surpassed pre-pandemic levels! As DEED celebrates Health Care month, let's examine the unique recovery patterns across Minnesota's regions, with special focus on Northwest Minnesota's strengths and ongoing challenges.

Regional Recovery at a Glance

Three other regions – four of six total – also now have higher Health Care employment in 2024 than before the pandemic (Figure 1). The Twin Cities led the way, surpassing pre-pandemic employment first in 2022, followed by Southeast in 2023. Central and Northwest Minnesota reached this milestone in 2024, while Northeast and Southwest have yet to regain their pre-pandemic Health Care employment levels.

Statewide Growth with Regional Variations

Minnesota's Health Care & Social Assistance sector now boasts 529,514 jobs in 2024 – an impressive 6.8% higher than the pre-pandemic peak of 499,712 jobs in 2019. The Twin Cities region outpaced all others with a blistering 10.5% growth rate. With 57.5% of the sector's statewide jobs concentrated in the Twin Cities region, it's clearly driving statewide employment growth.

Why the Twin Cities Recovered First

The Twin Cities benefits from a diverse healthcare landscape with a vast array of specialties in the Ambulatory Health Care Services subsector, supported by its large population base. The Twin Cities stands out with Ambulatory Care comprising 31.1% of its healthcare employment. Uniquely, Social Assistance ranks as the second-largest subsector in the Twin Cities, accounting for 27.6% of total Health Care & Social Assistance jobs. This explains the region's quick recovery – Social Assistance rebounded more rapidly than other healthcare subsectors.

Similarly, Southeast Minnesota (home to Mayo Clinic) has the largest share of its Health Care & Social Assistance employment in the Ambulatory Care subsector at 50.9% (Table 1). In contrast, Northwest saw a huge job gain in Social Assistance, against declines in Ambulatory Health Care and Nursing & Residential Care Facilities.

Different Employment Patterns Across Regions

The distribution of healthcare employment looks quite different outside the metropolitan areas:

• The distribution of sector employment is much different in the rest of the state. Northern Minnesota (Northwest and Northeast): Both regions have their highest percentage of Health Care employment in the Hospitals subsector (31% in Northwest, 38% in Northeast), with Nursing & Residential Care Facilities following as a close second (28.9% in Northwest, 27.3% in Northeast).
• Central and Southwest: These regions show similar patterns with Nursing & Residential Care Facilities and Hospitals as their top two subsectors, though Nursing & Residential Care is larger in both.

While Minnesota as a whole shows growth in every Health Care & Social Assistance subsector since 2019, no individual region shares this across-the-board growth. The Twin Cities comes closest, with just a half-percent drop in Hospital employment compared to the slight 0.2% statewide growth.

Growth Champions by Region and Subsector

• Social Assistance is Minnesota's fastest-growing Health Care subsector statewide and leads growth in four of the six regions (except Southeast and Southwest).
• Hospital employment grew fastest in southern Minnesota.
• In Southeast Minnesota, the Ambulatory Care subsector added the most jobs, reflecting its outsized role in the region's economy.

Northwest Minnesota's Health Care Recovery: A Mixed Picture

While Northwest Minnesota has recovered its pre-pandemic Health Care & Social Assistance employment levels, the recovery shows striking differences across subsectors (Figure 2). Social Assistance has been the star performer, growing an impressive 28.2% since 2019 – the fastest growth rate of any Health Care subsector in any Minnesota region.

Looking at the quarterly trend data since 2016 reveals some important patterns:

• Ambulatory Health Care Services is down 3% (-260 jobs) from its peak in Q4 2017
• Nursing & Residential Car Facilities has fallen 4% (-493 jobs) since Q2 2018

It's particularly noteworthy that these declines began well before the pandemic. While the more urban regions of the Twin Cities and Southeast have expanded their ambulatory care services, Northwest Minnesota – along with the Southwest – has struggled to recruit the specialists needed to grow this subsector.

Ambulatory Care declined a slight 1.2% in Northwest Minnesota, while Southwest experienced a much steeper 12% drop. As Minnesota's most rural regions, both face significant challenges recruiting specialists that drive Ambulatory Care growth in regions with Minnesota's larger cities. It is notable that the Twin Cities and Southeast have the lowest job vacancy rates in the state, suggesting these regions have an advantage in recruiting healthcare workers of all kinds from other regions and states.

The Nursing Assistant Crisis in Northwest Minnesota

The challenge is particularly acute in Nursing & Residential Care Facilities, where unfilled positions – especially for Nursing Assistants – are preventing facilities from operating at capacity despite growing demand from the region's aging population.

In Northwest, Social Assistance drove overall healthcare employment growth while Nursing & Residential Care Facilities continue to struggle with hiring challenges. This disparity tells an important story for workforce development efforts.

Vacancy Rates Tell the Real Story

Nursing Assistant has the third largest number of job vacancies of any occupation in the Northwest, just behind Fast Food Workers and Retail Salespersons (Table 2). However, both retail and fast food occupations have significant seasonal demand and are much larger occupations overall.

In fact, Nursing Assistant employment is only about 55% the size of Retail Salespersons and Fast Food Workers yet has nearly comparable vacancy numbers. This translates to a vacancy rate of 19.9% for Nursing Assistants – tied for the highest among the top 15 occupations with vacancies in Northwest Minnesota. This elevated vacancy rate signals intense, unmet hiring demand.

Broader Impact on Healthcare Delivery

Nursing & Residential Care Facilities also employ other occupations with high vacancy rates, including Housekeeping Cleaners, Food Preparation Workers, Registered Nurses, Personal Care Aides, Supervisors of Food Prep Workers and Licensed Practical Nurses – all appearing in the top 15 occupations by number of vacancies.

However, Nursing Assistants play a particularly critical role, providing daily care for nursing home residents. The vacant positions in this occupation are directly preventing facilities from admitting residents to open beds, creating a bottleneck in the Health Care system.

While job vacancy rates for most occupations have been trending downward since the pandemic recovery, Nursing Assistant vacancies were significantly higher than average before the pandemic and have widened the gap even further in 2024 (Figure 3).

Looking Ahead: Addressing the Challenge

This analysis provides a detailed look at current labor market conditions (as of the end of 2024) in Northwest Minnesota's Health Care & Social Assistance sector. For workforce development professionals, the data points to clear priorities: increasing the pipeline of Nursing Assistants should be at the top of regional workforce strategies.

Next month, I'll project future demand conditions in the Nursing & Residential Care subsector and examine the fundamental drivers of the persistent worker shortage. This will provide a data-driven perspective that workforce development agencies, educational institutions, and healthcare providers can use to address this critical need.

For more information about Health Care employment in Northwest Minnesota, contact Anthony Schaffhauser at Anthony.schaffhauser@state.mn.us

For more information

Contact Anthony Schaffhauser at Anthony.schaffhauser@state.mn.us.

If you’d like to find out more about Health Care & Social Assistance career opportunities in Minnesota or if you are an employer looking to hire workers, contact staff at a CareerForce location near you.