ST. PAUL (AP) - A significant number of the roughly 46,000 Minnesotans who lost manufacturing jobs since early 2001 are waving goodbye to the production line for good.

They're starting over with new jobs that almost always earn a smaller paycheck, according to job counselors.

One of those workers is John Psihos, who on a recent Thursday could be found in his scrubs ticking down the list of syringes and IV start kits in the supply cabinet at Methodist Hospital.

There are few clues that Psihos, who started work at the St. Louis Park hospital in July, spent most of the past 30 years in factories working sheet metal. Only his right thumb, sliced off above the knuckle, hints at the past.

Psihos, 48, dismisses the thumb as just part of his metal-bending reality. He figures he was laid off five times throughout that career, although he always managed to land another sheet metal job.

"I've dodged a lot of bullets in manufacturing," said Psihos.

But not the last one.

After getting laid off last year, Psihos said he saw no future in manufacturing. Trading work boots for running shoes, he now works as an emergency center technician.

It's a transition very similar to what Minnesota saw 30 to 50 years ago as dramatic changes in agriculture forced workers off the farm to find other work - frequently in manufacturing at the time, said Steve Hine, labor market research director at the Minnesota Employment and Economic Development Department.

This time, the pickings are different. While some workers score another factory job most are migrating to the service sector, becoming truck drivers, cashiers and emergency medical technicians. The state's health care sector, one of the few sectors posting job growth, is clearly attracting many of them.

"The health area is the biggest area, unquestionably," said Lois King, director of the dislocated worker division at the Minneapolis-based Employment Action Center. "But they do need some training."

Manufacturing workers typically require more job training than other laid-off workers, job counselors say. Training for health care jobs can take about two years. That's a formidable hurdle for someone with bills or a family to feed. And not everyone has the personality for the work.

Even for Psihos, who has long been divorced and whose son is grown, the transition was brutal. He dug deep into a well of determination and prayer, he said, maxing out three credit cards, spending his savings, tapping food shelves at times for groceries, and relying on state and other funding to pay for classes. He has managed to hold on to his one-bedroom apartment in Plymouth and his 1997 Dodge pickup, but not much else.

"I've depleted everything I've ever saved," he said. "But I put enough into my truck so I have reliable transportation."