Door County Medical Center (DCMC) is an incredible place to work, and it is unique in that it is a top-notch medical facility located in a relatively small, rural American town of around 9,000 people. “I think Door County Medical Center is a jewel—I really do,” says Dr. Dan Tomaszewski, Orthopedic Surgeon with DCMC’s Door Orthopedic Center. “Small towns like Sturgeon Bay don’t normally have hospitals of this quality,” he remarks, adding, “For the size of this community, what we can do here is remarkable. We have unbelievable primary care doctors, physical therapists, a great surgery suite—we have many amenities that are often found in larger medical centers. And, I think a lot of the people take great pride in the fact that we do offer those sorts of services.”
“We pay competitive wages, but our true competitive advantage is our culture,” adds Brian Stephens, Door County Medical Center CEO, “we have created an environment at Door County Medical Center where employees are empowered to give our patients the extra time and attention that they deserve, and we provide our caregivers the tools that they need to provide quality care.”
Staffing challenges ahead
Despite the many benefits of working at Door County Medical Center and living in Door County, several ongoing trends are affecting recruitment and hiring at DCMC. Two of these trends, which affect the entire United States, are contributing to staffing shortages at DCMC to a lesser degree. More pressing, is a third countywide and county-specific trend, which is currently creating significant barriers to hiring new hospital staff.
Nationwide trends: a general lack of available workers nationwide
According to the US Bureau of Labor Statistics, in August of 2021 there were approximately 10 million job openings in the US and only 8.6 million unemployed workers. There have been numerous articles over the course of the last year that address the recent nation-wide labor shortage, but whatever the reasons—be it a mass reassessment of work/life priorities or concerns over on-the-job exposure to COVID-19 (to name a few)—the general lack of prospective employees across the country is directly affecting businesses throughout Door County right now.
Door County Medical Center has not been immune to the effects of a general lack of available workers. In fact, the nation-wide labor shortage has impacted all areas of the hospital workforce. Housekeepers, Patient Access and Patient Service Representatives, Logistics Technicians, Human Resources Generalists, Parking Attendants—these are the non-medical staff that work behind the scenes everyday to keep DCMC running smoothly so that the hospital’s healthcare professionals can provide each patient with the care they need. This is truly important work, but the coronavirus pandemic and the subsequent recession and labor shortage have made hiring non-medical staff at DCMC in the past year more difficult.
Nationwide trends: a shortage of skilled healthcare workers
Shortages of skilled healthcare workers are causing issues across the American healthcare industry. There are numerous reasons for the shortage of healthcare workers, two of which include an aging population (there are more Americans over the age of 65 than any other time in history) and an aging workforce (nearly one-third of the nursing workforce in the United States will be at retirement age within the next 10 to 15 years).
Despite the urgent need for additional healthcare workers, more of these workers are currently leaving the healthcare industry than joining it. “There are structural shortages right now across the healthcare industry,” Stephens comments. “In particular,” he adds, “there simply are not enough nurses, respiratory therapists, occupational therapists, and laboratory medical technicians to fill all of the needs in the United States. Two of the biggest reasons for the current nursing shortage,” he continues, “are early retirements and general burnout,” and he observes that while the current shortage of nurses and other healthcare workers was predicted over a decade ago, it has been “accelerated by the pandemic.”
Nevertheless, Stephens remarks that DCMC has “actually had one of our better years in recent history with regard to recruiting talented clinicians to DCMC and to live in our community.” He continues, “In a way, I think the pandemic has caused many professionals to reevaluate their quality of life in larger, urban centers. Safe communities with great schools, restaurants, and outdoor activities, like those found in Door and Kewaunee Counties are very attractive to our candidates and have given us a real advantage in recruiting.”
A countywide shortage of available and affordable housing
Door County is trending up in positive ways: jobs and the tourism sector are growing, and the housing market has risen 14% since last year. However, these positive trends have come with a downside, and if there is one trend that is responsible for creating a significant barrier to hiring across all positions at DCMC it is the county-specific, and countywide, shortage of available and affordable housing.
Door County’s housing shortage has been a recognized problem for at least a decade. In 2019, the Door County Economic Development Corporation (DCEDC) commissioned the infrastructure consulting firm AECOM to research the root causes of the county’s housing shortage. Their report pointed to three main factors causing the current shortage:
Job growth, which has occurred primarily in entry-level positions in manufacturing, healthcare, and education that generally make less than $35,000 a year. According to the DCEDC study, “Demand growth [in these industries] has unfolded in context with a corresponding lack of new apartment construction since 2010. The lack of apartment construction has created an explicit structural gap in housing markets in the county.”
Expanded tourist activity, which has resulted in an increase in the establishment of tourism-related businesses and a concurrent increase in the need for seasonal employee housing. Additionally, because increases in tourism since 2010 have not resulted in a greater supply of tourism-related housing units (i.e.: hotels, resorts, etc.), demand has “encouraged a growing share of single-family homes and cottages to be pulled into seasonal rental use.” Put differently, short-term, seasonal rentals through online services like Airbnb are being shifted away from year-round rentals that serve the county’s workforce. In fact, the DCEDC study found that in the 7 years between 2010 and 2017, Airbnb rentals had increased from 1,074 to 1,290.
Increase in the purchase of second homes. This trend has occurred chiefly with households in their 50s and 60s who earn higher salaries than the national median average—in other words, among those nearing retirement who have the financial ability to purchase a summer vacation home. Indeed, according to the DCEDC report, in 2019 there were 9,992 “housing units [in Door County that were] in seasonal use, but not rented.” Moreover, the study found that a small proportion of these housing units remain empty year-round, which represents, as the study notes, “an opportunity to be re-positioned to support workforce housing.”
Combined, each of the above factors have created a serious dearth of affordable and attainable housing across the county and across all income levels. In fact, the DCEDC/AECOM study found that in order to address the current shortage, 470 affordable apartment units would need to be built in order to cover the current “structural gap” in housing units for entry-level positions created in the manufacturing, healthcare and education sectors. Additionally, the study found that if employment growth continues at the current rate over the next 5 years, “demand for an additional 110 market-rate rental apartments is estimated [as well as] 70 owner-occupied workforce housing units at pricing below $180,000,” an estimate that the study’s authors admit is conservative.
In the long run, Door County’s housing shortage will become an economic issue. “Currently unfolding housing market constraints,” the DCEDC report concludes, “will ultimately lead to decreases in year-around workforce and a reduced pace of economic activity for Door County.” And, the consequences of not addressing the current housing shortage affects not only the long-term health of the Door County economy, but also its healthcare system.
“The housing shortage has definitely had an impact on recruiting employees from outside of the area,” Stephens remarks, “We have had folks accept positions and then ultimately decline because they could not find a place to live.” Stephens notes that the recent increase in the number of rental units in Sturgeon Bay has helped, “but,” he adds, “sometimes people want to live in a single-family home, and that is very difficult to find right now, and really at every price range. Often, these homes are only on the market for a few days—sometimes hours—and that makes for a difficult situation if someone is trying to relocate to the area.”
“In the short run,” Stephens continues, “our caregivers and those who support them are wonderful at prioritizing our patients, so I do not have any true concerns about shortages impacting the quality of care that we provide. It might slow us down and create longer wait times,” he adds, “but we will make the hard decisions to ensure that those who need us most are able to receive the care that they need.”
Nevertheless, Stephens says that the issues with hiring and recruitment Door County’s housing shortage is creating is not sustainable long-term. With this in mind, DCMC is taking proactive steps to help alleviate the situation. “We are working with the DCEDC and the City of Sturgeon Bay to do what we can to support workforce housing,” he says, adding, “We have voiced support for local housing projects at Sturgeon Bay Common Council meetings and have also met with developers to help connect them with local businesses that might be interested in investing in their projects. Additionally,” Stephens continues, “we are considering investment in a housing project, but do not have the details of that worked out at this time.”
For more than 75 years, Door County Medical Center has been the leader in health and wellness for Door and Kewaunee counties. Our integrated medical center provides a wide range of specialties, including Primary Care, the Women’s and Children’s Center, the Door Orthopedic Center, Behavioral Health, General Surgery, the Door County Cancer Center, a skilled nursing facility, and rehabilitation services facilities among others. With its main campus in Sturgeon Bay and satellite clinics and rehabilitation services facilities in other smaller communities, DCMC provides expert care, close to home.