The following letter to the community was published in the Columbia Gorge News on Wednesday, December 21, 2022.

 To our valued community:

As president and CEO of Mid-Columbia Medical Center, I am honored to serve the Columbia River Gorge community and help ensure the continued health and well-being of our residents.

It is also my responsibility to make sure you always have a clear view of where we are as a hospital, how we got here and where we are going.

To that end, I want to share with you some trends we are facing in the industry, their effect on MCMC and what we’re doing to adapt and continue our mission to provide excellent care to those who need us.

It’s hard to believe that it has been almost three years since the start of the COVID-19 pandemic, which was an extraordinarily difficult time for healthcare organizations. The stressors of the pandemic have since given way to skyrocketing costs, major gaps in staffing, the end of government aid and sicker patients than we have ever seen before. As is often the case, rural hospitals like MCMC feel the effects of these conditions more severely than larger health systems.

A staggering 53% of hospitals nationwide are projected to end the year with negative margins, and expenses are expected to be $135 billion more than 2021, making this the most difficult year since the height of the 2008 financial crisis.

We also face a critical staffing shortage. The pandemic led to an industry-wide mass exodus of key clinical personnel, especially among bedside providers. Hospital employment nationwide is down more than 105,000 employees from pre-pandemic levels as staff experience burnout, compassion fatigue and unsustainable workloads.

Labor costs account for more than 50% of hospitals’ total expenses, and this is expected to grow. The small pool of available applicants makes recruiting and retaining employees increasingly expensive, resulting in an expected $86 billion rise in labor costs over 2021.

Nearly 95% of organizations have turned to travel nurses and temporary providers to fill gaps in their workforce. This contract labor is exceptionally costly, with travel nurses costing on average $5,000 per week and temporary providers as high as $5,000 per day.

Workforce shortages are even more pronounced for rural hospitals like MCMC. An estimated 10% of working primary care providers and 8% of working specialty providers practice in rural areas, meaning patients have diminished access.

Across the country, many patients delayed routine screenings or treatment during the pandemic. Because of this delay, they are now presenting with more acute, resource-intensive conditions that are more complex and costly to treat.

The view from Oregon is not much different. In the first half of 2022, 65% of Oregon hospitals posted a negative margin — far outpacing the 53% nationwide number. The cost of labor is up 16% over 2021, and operating margins are lower than even the earliest days of the pandemic.

At MCMC, we are experiencing the same staffing shortages and revenue challenges as the rest of the country. As a result, we’ve made several concessions, most notably temporarily pausing new medical oncology and malignant hematology referrals to Celilo Cancer Center.

We are having to rely on expensive temporary providers to keep several service lines in operation. We’ve successfully employed new providers and will have more starting throughout 2023, but other circumstances continue to make the use of contract labor necessary.

We’ve proactively consolidated several divisions within our hospital and are sharing support staff across providers and clinics, which has helped. Nevertheless, it will take a significant amount of time to return to where we were pre-pandemic.

Despite the obstacles, we are taking concrete steps to stay focused on our vision for the future. We are responsibly deploying resources to maintain core services and ensuring staff members operate at the top of their license to strengthen their impact. We are reducing expenses with an organized approach so that we can improve efficiency and optimize service to our patients without impacting our commitment to person-centered care.

To address the difficulty in recruiting providers, we have added a dedicated provider recruiter to focus on hiring top physicians and providers who are committed to rural healthcare.

I am privileged to announce that fourteen OHSU providers in primary care, general surgery and orthopedic surgery have chosen to transition to MCMC. Their commitment to their patients and the community as a whole solidifies a powerful provider team in each clinic. In addition, four new clinicians have joined primary care, four more have committed to join MCMC in the coming months and we are thrilled to have three providers join our behavioral health team. We have hired new physicians to join our existing teams in ear, nose and throat, urology and general surgery. We know that, despite the industry challenges, it is possible to make progress, and I feel we are doing so. However, there is still work to be done, and we are committed to improving access and providing quality care.

Our innovative “Grow Your Own MA” program is of enormous benefit in responding to the shortage of support staff for our providers. This program has enabled us to fill ten open medical assistant positions.

We also recognize that the best way to continue our work is by being nimble and willing to evolve. We are therefore extremely excited about our proposed affiliation with Adventist Health. Last week, we announced the finalization of a affiliation agreement for MCMC to join Adventist Health’s Oregon Network, bringing us one step closer to being part of the Adventist Health family.

In addition to a $100 million commitment to strategic capital needs, Adventist Health offers us the opportunity to take advantage of their size and resources. With their help, we will be able to reduce expenses through greater purchasing power and more favorable contract terms. We will also benefit from their commitment to investments in provider recruitment, service line development and healthcare campus improvements.

We are confident that this partnership will have a tremendous impact on our ability to advance our mission and continue providing high-quality, local healthcare to patients and families in The Dalles and the Columbia River Gorge.

This is a challenging time to be a healthcare organization. Across the nation, hospitals, and health systems, including MCMC, are struggling to overcome obstacles and deliver the care patients need and deserve. However, the MCMC culture is defined by our strength and our ability to withstand adverse conditions. Our team of physicians, advanced practice providers, nurses and staff is willing to take on these obstacles, and I very much appreciate their dedication to serving our patients’ needs. With the talents of our incredible team and our partnership with Adventist Health, I know we will persevere and remain a source of hope and healing for our community, now and in the future.

Thank you for your patience, understanding and continued support. I wish you and your loved ones a happy and healthy holiday season.

Dennis Knox

President & CEO, Mid-Columbia Medical Center