Over the past quarter century, Deschutes County's population has doubled, but the number of health care workers has not kept up.
Deschutes County's population now exceeds 200,000, nearly double what it was in 2000.
These people will eventually need medical procedures and visits to the hospital, and wait times can stretch into weeks due to provider consolidation, rising costs, and a national shortage of nurses and doctors.
Though the health care job market is expanding, there is a national shortage of nurses and doctors that is impacting Central Oregon. Burnout among medical staff is at an all-time high, and the population over 60 is aging, requiring more care.
“Like nursing, we have a shortage of healthcare workers in the medical field,” said Dr. Mark Hallett, chief clinical officer for St. Charles Health System. “At the same time, a growing population in Central and Eastern Oregon needs access to healthcare. While some specialties are stable, others are seeing a decline in the workforce. We need to be as efficient and productive as possible.”
If staffing shortages aren't enough to put pressure on the health care system, the burden on consumers continues to grow. According to the Oregon Health Authority, consumers will see a 3.6% increase in health care costs between 2021 and 2022. According to the health authority's report, health care costs have risen significantly in Oregon, with 23% of household income being spent on health care, more than the cost of housing, transportation or food.
And yet the health system isn't making much of a profit either: The cost of health insurance has doubled since 2000, while revenues have stagnated, according to the same report.
“Patients' needs and expectations continue to grow,” Hallett said, “and frankly, so does our desire to provide safe, timely, effective, equitable and high-quality care. We expect a lot from ourselves.”
Dr. Sarah Dawson, a Bend internist who opened a direct primary care practice, said if the ratings were to be handed down, the industry would likely receive a C-minus grade, depending on the medical specialty.
“Some specialties are worse than others,” Dawson said. “Population is outpacing physician recruitment.”
Central Oregon's Revenue Challenges
In 2000, there were only two St. Charles hospitals, in Bend and Redmond, and now the health system has four, adding hospitals in Prineville and Madras.
St. Charles Health System, Central Oregon's only hospital system and the region's largest employer, reported revenues of more than $1 billion for 2023, up from the previous year, but the increase came after two years of declining revenues, rising costs, staffing cuts and wage hikes to retain and recruit nurses.
Meeting the needs of the community is a constantly evolving process, Hallett said.
In 2019, the health system closed its Redmond birthing center, saying it was using less than half its capacity in Bend and Redmond. But earlier this year, the health system broke ground on a $90 million cancer center to serve patients who travel from Prineville, Madras and elsewhere for treatment.
The changing health care landscape isn't limited to Bend and Redmond. Growth is also happening in southern Deschutes County. La Pine Community Health Center is in the midst of completing a $16 million expansion project designed to meet the growing needs of the area. For years, La Pine residents have made the 40-minute drive to Bend for dental care, mammograms and behavioral health services.
Also hurting the financial situation are default payments from Medicare and Medicaid: At St. Charles, about 57% of patients paid their bills through Medicare in 2022, compared with 55.9% in 2020, according to the health system's annual report. That affects the bottom line.
Private insurers pay nearly double what Medicare does, according to KFF Health News, formerly known as Kaiser Health News.
“At the end of the day, health care is a service,” said Cat Mastangero, executive director of Volunteers in Medicine. “The biggest costs have always been labor costs and wages, which have risen steadily. Doctors' salaries haven't increased, but patients are still paying much of the cost.”
Central Oregon's Workforce Growth
Nicole Ramos, regional economist for the Oregon Employment Department, said the health services and education job markets in Central Oregon have seen greater job growth than any other sector since 2001. In 2001, the health services and private education sector employed 6,780 people, but by 2023, that number will reach 17,680.
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That represents more than a doubling of jobs in the health and education sectors, which reflects job growth in the state. Ramos said health is the second-largest employment sector in Central Oregon's economy, behind trade, transportation and public works.
Hallett said job growth in Central Oregon will benefit the economy, but overcoming a national shortage of doctors and nurses will require creativity.
Statewide, the hospital industry accounts for 23% of state employment, employing approximately 300,000 people. Total statewide hospital industry payroll in 2022 was $18.4 billion.
Job projections suggest the number of healthcare jobs is expected to continue to grow by 15% through 2032. But that still might not be enough.
It's important for policymakers to ensure the city is prepared for that growth. Because of Bend's geographic isolation, it can be hard to persuade medical professionals to move there, said Tierney O'Dare Booker, a member of the Bend Economic Development Advisory Committee, which provides business development advice to the Bend City Council.
“The city seems concerned,” O'Dair Booker said, “that if we let the market take its course, there will be gaps in the city's medical care. Any efforts by the city to encourage the relocation of specialists and physicians will reduce the need to send people over the mountains for medical care.”
Ben Hemson, Bend's economic development manager, said city policy interventions can help here. Health care is one of the key industries the city wants to nurture and grow, Hemson said. The city council is looking at ways to attract businesses through tax incentives and development fee waivers and reductions.
Medical options around town
Mosaic Community Health Center began in Prineville when a group of community members formed a nonprofit organization to care for patients in their community. In the first year, 700 people were seen by medical professionals. Today, according to the Community Health Center's website, the Community Health Center sees an average of 27,000 patients in Bend, Redmond, Madras, Sisters, Prineville and even schools.
“As a not-for-profit community health center, we are committed to providing access to health care to everyone in our community,” said Megan Haas, CEO of Mosaic Community Health. “Since opening our first clinic in Prineville in 2002, we now have 16 clinics across Central Oregon. We continue to expand to meet the needs of our community, but we know that demand for health care services outstrips access.”
The majority of patients are covered by Oregon Health, Medicaid and Medicare, but the payer mix is not a limiting factor in growth. What is limiting growth, Haas said, is a labor shortage. The workforce argument ties into the high cost of living in Central Oregon, especially housing, Haas said.
In fact, Mosaic is planning to expand its Bend clinic in the coming years, said Elaine Nobs-Seasoltz, director of strategic development for Mosaic Community Health.
“Our strategic plan and needs assessment studies showed that there is a clear need for additional health care facilities in the area,” Nobs-Seasoltz said.
Aging Society
Bend is the most densely populated area in Central Oregon, making it easier to find medical facilities than more remote areas like Prineville and Madras. According to data from the Central Oregon Council on Aging, Deschutes County's population 60 and older currently makes up 28.7% of the total population, but is expected to grow to about one-third of the population by 2047.
Seniors who need more medical care often have problems accessing it, said Cathy Regimbal, executive director of the Central Oregon Aging Council. The Aging Council gets calls almost daily from older residents asking for transportation to get to medical appointments, Regimbal said.
“In La Pine especially, this is a huge barrier to accessing care. Dial-a-Ride is only available within the city limits, not outside of the city limits,” Regimbal said. “We don't provide transportation. We have to refer people to other options and providers.”
Another issue, Regimbal said, is access to specialty care such as behavioral health care. For seniors with physical disabilities, he said, access to affordable in-home care can also be an issue.
Deschutes County's population is set to continue to age, she said, and the council's services, supported by the federal Elders Act, will be increasingly relied upon as the population ages.
“When basic needs aren't met, it impacts health,” Regimbal said. “Nutrition, social engagement, access to affordable medicines — all of these things contribute to overall health. Add housing and transportation to the mix, and our limited programs can't meet the needs. We have waiting lists.”
