In January 2020, a group of retired medical providers were becoming increasingly alarmed about access to health care at Mercy Regional Medical Center in Durango.
They were hearing from neighbors who lost their primary care physicians. On trips to Walmart and City Market, they’d run into former patients who couldn’t find an available doctor or whose providers kept changing.
“People were using words like ‘primary care crisis.’ They couldn’t find doctors,” said Bill Willson, former consultant and director of managed care and strategy at Mercy from 1998 to 2013.
Mercy has already launched some programs to address its staffing issues, but the provider group says some solutions need to come from the top: Centura Health, itself.
For nearly two years, hospitals around the country have been buffeted by the COVID-19 pandemic, the barbed politicization of health care and the so-called “Great Resignation.” As a result, hospital leadership teams, like at Mercy, have been racing to support staff members and combat increasingly high turnover rates.
But the issues at Mercy, the providers said, have been around longer than the pandemic.
“I truly believe that the decline in the number of providers and adequacy of providers and specialists dates back about five years when there were, I think, conscious financial decisions made by Centura Health, to cut back on services,” said Joe Murphy, a primary care doctor who retired in 2019 after spending about 13 years working at Mercy over the last three decades.
Last week, the provider group went public with its concerns with a “petition to improve health care” published in the Opinion section of The Durango Herald. The petition was signed by 12 people, including community leaders former U.S. Sen. Ben Nighthorse Campbell, state Rep. Barbara McLachlan and City Councilor Melissa Youssef, in addition to 17 “concerned physicians.”
The letter had been in the works since January 2020 and was delayed after the COVID-19 pandemic, Murphy said.
It calls the staff turnover at Mercy “alarming,” says the substitution of permanent providers for traveling physicians is a serious problem, and adds that high-risk patients are the most burdened by the frequent provider changes.
“We are in total, full support of local providers here, every single one. ... We don’t lay blame for this deterioration with the local hospital administrator, the physicians, the nurses, anything like that,” Willson said. “The issue is resources allocated to Durango, and Centura is the resource allocator. They are taking a lot of money out in the way of profits as our health care system is starved. That’s not right.”
Mercy CEO Patrick Sharp said the hospital is facing the issue head-on, acknowledging the turnover rates, hiring issues and resulting community concerns.
“There is no doubt that we have had turnover,” he said. “But as a leader, I have two options: I can either spend my time looking in the rearview mirror, or I can look ahead and say, ‘What can we do?’”
Since 2016, 67 providers left Mercy and 84 new medical providers were hired, according to the hospital.
Over the same time period, 20 primary care providers left Mercy. In 2021, the medical center hired 26 new providers who will begin providing care in 2022. Of those, eight are primary care physicians.
Mercy also has 32 new hires starting in the next month, including 13 registered nurses, five medical assistants, two respiratory therapists and other roles.
“You might lose institutional knowledge. ... That doesn’t mean they (the incoming providers) are not very capable, strong and competent physicians and AAP (advanced practice providers),” Sharp said. “Our commitment to quality is unwavering.”
When Murphy looked at 2018 photos of clinic staff members at Mercy, the turnover was apparent. Of the 52 staff members and providers pictured, 43 of his former colleagues were gone, he said.
In these conditions, sometimes the most high-risk patients are affected the most.
Mercy is the main provider for patients without insurance or with Medicare or Medicaid in the area. When it does not have available providers, those patients have fewer options, the provider group said.
Turnover can also affect continuity of care. It can mean new prescriptions don’t take multiple conditions into account, or the new doctor doesn’t know to follow up on the effectiveness of past prescriptions.
“If you don’t have continuous care, you don’t have quality care. That is demonstrated with empirical studies,” he said.
Sharp disagreed. The hospital’s care has been rated highly by external evaluations. In 2021, Mercy hospital was one of only 13.6% of hospitals to receive Healthgrades CMS 5-star rating for the sixth consecutive year.
Mercy is not becoming a “feeder hospital,” Sharp said. Only 1.9% of about 19,000 emergency room patients were transferred in fiscal year 2021. Most had severe trauma diagnosis, he said.
“The perception is we’re not able to take care of people locally, and that’s just not true,” he said. “Our physicians and our nurses continue to do an outstanding job despite being in a pandemic.”
Across Colorado, 38% of facilities anticipate staff member shortages within the next week, according to the Colorado Department of Public Health and Environment.
“We have pockets of areas where we are short-staffed,” Sharp said. “We have open positions right now.”
Durango’s remote, rural location is one of the top challenges. Some specialists must take more on-call shifts because of the smaller teams in rural settings than in urban locations.
As a Level 3 trauma destination, it must have a trauma surgeon on call 24/7 every day of the year.
“We have staffed up our general surgery department to make sure the call burden does not get overwhelming for them,” Sharp said. “That’s the benefit of being part of a system, that we have the financial resources to make that happen.”
Housing costs are rising, and candidates have to be a good fit for both the clinics and the community. People are also self-selecting out of the health care profession during a time of “tremendous burnout,” Sharp said.
“Physicians, along with our nurses and our front-line staff – they are the heroes of today. With this second wave now, there’s not much left in the tank for them,” he said. “The pandemic has slowed the pipeline for sure. All the challenges of rural health care have not gone away.”
To retain hospital staff members, Centura recently invested more than $66 million to increase wages across its 17 hospitals in Colorado and Kansas. That included a $3.6 million investment in Mercy associates.
The hospital has implemented sign-on bonuses, relocation incentives and in-house educational opportunities.
Even as Mercy acts to address some of the impacts of the pandemic to its staff members, the provider group pointed to Centura Health to address some of the more longstanding issues.
“In discussions with Patrick Sharp, his heart is in the right place. ... He has intentions and ideas of correcting each one of these problems,” said Robert Goodman, a retired orthopedic surgeon who worked at Mercy from 1980 to 2014. “One question: ‘Is Centura going to let him do that?’”
He hoped for assurances that Centura is listening to the local administration and supporting the decisions that are made.
Murphy said people were already leaving in his final years at the hospital.
“I would say the main reason people left was a difficult work environment,” Murphy said. “Physicians usually don’t leave practice due to compensation. They usually leave if their services aren’t valued.”
As outsiders to management decisions, the providers hesitated to offer solutions. But Murphy said a culture change at Centura Health could help.
“The culture of the supervising organizations, Centura and Centura Physician Health Group, I think needs to be changed,” he said. “Ideally, management of physicians and clinics should return to local management, responsive to local issues.”
In the meantime, Sharp and the providers shared support of the health care staff members at the hospital.
“The burnout and the burden that our medical professionals have gone through in the last two years – we need to continue to be there for them,” Sharp said.
Neighbors can make them a meal or help them with fall projects as the front-line workers pull long shifts.
“Help support them,” Sharp said. “Because they are truly the unsung heroes in our community, and they need to be lifted up.”