Nursing levels are showing signs of improving in Minnesota hospitals, just in time for health care leaders to fret about another problem: the unavoidable cliff of doctors from the baby boomer generation set to retire.

Both trends emerged in the Minnesota Hospital Association's annual workforce survey released last week that continues to show the ripple effects of the COVID-19 pandemic and the burnout it caused for doctors, nurses and other caregivers.

About 11% of nursing jobs have been vacant this year in Minnesota's hospitals and affiliated clinics, a decline from 15% last year but an increase from 3% before the pandemic in 2019, the survey showed.

"The ranks are growing," said Dr. Rahul Koranne, the hospital association's chief executive. "We see the light at the end of the tunnel, but we have a ways to go."

Hospitals have leaned on flexible scheduling as the share of nurses working part-time has increased from 41% in 2019 to almost 49%. Rapid training programs have helped, and the Minnesota Legislature responded in the past two years with loan-forgiveness programs to make it affordable for students to pursue nursing.

The Minnesota Nurses Association agreed that vacancies have declined, but the president of the union, Chris Rubesch, argued it's partly because hospitals have eliminated positions they can't afford or struggle to fill. The 113 hospitals in the workforce survey collectively employ almost 80,000 doctors, nurses and other caregivers, an increase from 2022 but a decrease from the 83,000 they employed last year.

"It's a short-term gain for the hospitals, but in the long term, I think it's going to end up being a major problem, both for patients and for workers," said Rubesch, noting a recent increase in hospital-reported adverse events that understaffing could have partly caused.

The workforce has become younger: The average age of registered nurses has dropped since 2019 from 45.8 to 45, according to Minnesota's nurse-licensing agency. And the hospital association's survey showed nearly half of health care providers, including nurses, have five or fewer years of experience.

Mallory Farr, 21, completed training this spring at Western Technical College in La Crosse, Wis., and is finishing orientation this summer at Winona Health to work in labor and delivery. She chose the profession after watching Mayo Clinic nurses care for her grandmother at the end of her life, and Farr said she hoped that work in a smaller hospital would give her more responsibilities and opportunities to connect with patients.

Many nurses during the pandemic sought daytime clinic jobs to escape the pressures of inpatient work, but Farr said the challenges of hospital nursing appealed to her.

"In a hospital, you have more time with your patients, and you're able to get to know them better on a deeper and more personal level," she said.

One analysis ranked Minnesota second-highest for nursing wages among states when adjusted for cost of living. Rubesch said there are practical barriers to the career, though. The Duluth cardiac nurse isn't working full-time, for example, because child-care options are dwindling and don't sync well with typical 12-hour hospital shifts.

"It's very hard to find a child-care facility that will take a drop-off at 6:30 a.m.," he said.

Aging is taking its toll on the doctor ranks, causing the vacancy rate for physician jobs to increase from nearly 12% last year to almost 15%. A quarter of the physician workforce will be 65 or older in the next decade, but many doctors aren't waiting for traditional retirement. Burnout and other factors caused the number of working physicians in Minnesota to drop by 9% last year, the workforce report stated.

Koranne said the industry needs state and federal investments to confront this trend of doctors leaving practice, which can particularly hurt smaller, rural communities. Mayo's hospital in New Prague, Minn., had to stop scheduling baby deliveries this year after one doctor retired and another went on leave.

Solutions include a $750,000 federal grant so Lakewood Hospital in Staples, Minn., can train the next generation of family medicine doctors in obstetrics. A campus of the University of Minnesota Medical School is opening in St. Cloud and taking its first class of 24 students in fall 2025.

Students from rural Minnesota don't pursue physician careers as much, but the presence of a medical school will give them more opportunities and hopefully inspiration, said Dr. Jill Amsberry, a CentraCare pediatrician and assistant dean for the new medical school campus.

"If you train students in rural Minnesota," she said, "they are much more likely to stay in rural Minnesota."