West Texas has an energy about it that’s hard to find anywhere else. Maybe that’s because it literally IS “energy”. The oil boom in the Permian Basin has shaped the world’s geopolitics, boosted the state’s economy, and created thousands of high paying jobs. They say everything is bigger in Texas, and all signs in West Texas indicate the sky is the limit.
But even the best types of growth can cause growing pains. With an increasing number of residents comes an increased burden on infrastructure, from roads to health care institutions, that makes up the literal backbone of communities across West Texas. Increased oil production levels bring increased truck traffic and increased traffic fatalities. Population growth brings housing scarcity and runaway housing costs.
For Texas hospitals, the boom brings its own challenges.
“Our economic boom is a huge blessing for the state, and for our region in general, but it does pose some pretty significant challenges for us,” said Russell Meyers, president and CEO of Midland Memorial Hospital. “Access to and affordability of housing present hurdles for physician recruitment, and increased demand on the hospital’s emergency department has strained existing infrastructure. In 2018, we saw a 20 percent increase in emergency visits over the previous year. Our booming economy is dependent on a transient workforce that is well compensated but often uninsured or underinsured. So, we are often doing more work with fewer resources,” said Meyers.
Midland’s unemployment rate is below 2 percent – the lowest in the state and fourth lowest in the nation. While the low unemployment rate correlates with population growth and increased case volume, providers state that their hospitals’ payor mix – whether it’s uninsured, Medicaid or privately insured – largely has remained the same.
Donny Booth, RN, chief nursing officer at Permian Regional Medical Center in Andrews, identified his hospital’s challenges as being twofold: staffing and preventative health care. “Even though the population in Andrews County is about 18,000, we tend to serve about 75,000 patients annually.” Booth attributes this increase to the transient workforce moving in and out of the area to work in the oilfields. The need for more staff to treat the growing population combined with the difficulty of attracting physicians to a rural community is a challenge. Booth also emphasized that providing preventative health care is difficult when many of the patients the hospital serves have primary care providers in different regions or states – making obtaining prior medical history, providing medication and administering care more difficult.
To meet these challenges, hospitals in West Texas are relying on partnerships forged over time with community and business leaders and local lawmakers, and health care leaders are shifting their focus to finding innovative ways to improve provider capabilities, infrastructure and population health.
For example, over the last decade, the Midland Development Corporation, a board appointed by the Midland City Council to promote business expansion, job creation and capital investments, has worked with area hospitals to help meet infrastructure and staffing needs. By covering a significant portion of the upfront costs of recruiting and bringing doctors to the community, Meyers says MDC has “recognized that the community's ability to grow and to make this a livable environment depends on more than just bringing the business here. You must have the infrastructure in place. You’ve got to have physicians and other health care professionals. You need good schools and affordable places to live – all of those things are necessary for the economic miracle to continue.”
And it’s not just in Midland. In Andrews, when the community voted to approve a bond for construction of a new hospital, it also dedicated funding for a publicly accessible fitness center – housed at the hospital itself. Alyssa Tochterman, MD, a FM-OB (family medicine with obstetrics) at PRMC, noted that this investment reaps rewards for the public’s health. “When this hospital was built, the community invested some of the public funds into a wonderful fitness facility. The way the facility is laid out is very accessible even to people who have no idea what they're doing. And it's nice because every time patients walk into our clinic, they have to walk right by the gym. So, it's a constant reminder of what they should be doing.” Other community-led and hospital-driven steps are improving health care in the Permian Basin, and it is clear that partnerships and trust, when forged over time can render great benefits for the entire community.
In Big Lake, the construction of the new Reagan Memorial Hospital wouldn’t have been possible without the donation of property by a local ranching family, the Pembrooks. Ann Schneemann, trustee on the hospital board, explains, "This was my grandfather's land. He came to Texon (an unincorporated community near Big Lake) in 1924 and then ranched this land. We're just all very excited about this." That same spirit of community can be found in Midland, where Midland Health, the Permian Basin Master Gardeners and the Midland Chamber of Commerce worked together to construct and maintain public community gardens – giving residents a chance to grow their own produce and enjoy healthier lifestyles.
Heath Holt is a hospital board member at Reagan Memorial Hospital and a local business leader whose family has lived in West Texas and worked in the oil and gas industry for five generations. When asked how hospital leaders were able to rally the community behind the construction of a new facility (and the property tax increase that would accompany it), Holt credits it to the relationship the hospital built with the community over the years. “People in Big Lake, in all their wisdom saw fit to pass a bond to build this hospital… They just had the foresight to see that we needed something bigger and better. And now, these people come through here and they get some of the best care that they can find.”
Then there’s the TexasAIM initiative. A collaboration of the Texas Hospital Association and the Texas Department of State Health Services, the initiative focuses on reducing preventable maternal mortality and morbidity. In prior years, maternal issues were exacerbated in the rural areas that make up much of the West Texas region. But today, out of the 61 Texas counties with labor and delivery hospitals in the Permian Basin, all but three are active participants in TexasAIM and making strides to improve maternal health in their communities.
Those partnerships are proving to be a valuable investment for the oil and natural gas industry as well. The “Permian Strategic Partnership”, an alliance of 20 energy companies located in the Permian, recently committed $100 million to “safer roads, superior schools, quality health care, affordable housing and a trained work force” and promises to work with health care leaders in West Texas to improve care capabilities. Health care providers are also working with local oil and gas companies to conduct emergency response trainings and better prepare employees to respond to trauma in the field. Chevron, for example, invested $750,000 into emergency services in the region in 2018 alone.
A Health Care Transformation
Texas hospitals are transforming health care in the Permian Basin as they seek to provide affordable and accessible health care to a growing population with its own unique challenges.
To address the housing shortage, Reagan Memorial Hospital in Big Lake provides on-site housing for its nurses and, as a result, currently has a nurse retention rate of 95 percent. Jon-Michael Parker, BSN, Reagan Memorial’s chief nursing officer, credits its high retention rate to competitive pay, compensation for continued education and the ability of the hospital to provide housing and reduce commutes.
Hospitals are also actively embracing technology as an important component of improving access to timely care in rural communities. In Spring 2019, Midland Health rolled out BasinMD.com, a new telehealth service that allows patients to visit with a provider 24/7 using their smartphone, tablet or computer. Other hospitals and health systems are moving in that direction as well. Texas Tech University Health Sciences Center, for example, partnered with the Commission on State Emergency Communications to equip 10 ambulances with digital health tools, including a telemedicine backpack.
Everything is bigger in Texas and the people of West Texas are proving that they’re not done growing yet. As the economy booms, unemployment levels decrease, and the population grows, it’s encouraging to see hospital leaders embrace the changing environment, collaborate with community leaders, and adjust operations and approaches in order to provide high quality care in their local communities.
“You're not going to meet more proud people than Texans much less West Texans. We love it here. We grew up here. We're proud of this place,” said Holt.