Texas Healthcare Digs Out Of Critical Condition Amid Fast Growth, Soaring Demand

Texas ranks near the bottom when it comes to the performance of its healthcare system. Yet booming population growth and changing demographics have created unprecedented demand for services, prompting an urgent need to resolve longstanding staffing shortages and facility deficits. 

Hospital systems across Dallas-Fort Worth are expanding existing campuses, breaking ground on new properties and ramping up recruitment initiatives. Meanwhile, institutions of lower and higher education are investing heavily in programs that feed the workforce pipeline. 

Despite the concerted joint effort, many in the profession worry that growth is happening too fast for the industry to keep up.

“We are doing everything we can to build as rapidly as we can,” Methodist Richardson Medical Center President Ken Hutchenrider said. “The demand for healthcare is not abating. It’s actually growing a lot.” 

Texas added nearly half a million residents between July 2022 and July 2023, making it the No. 1 state for population growth in the nation. Dallas-Fort Worth is home to more than 8 million people, with 453,000 new residents moving into the area between 2020 and 2023.

At the same time, the proportion of Texas’ population that is over 60 years old is growing. The U.S. Census Bureau estimates that more than 1 in 5 of the state’s residents will be included in that cohort by 2030, an increase of close to 25% from 2012.

Population growth is heralded as one of Texas’ strengths and is frequently cited as a driver for economic success.

But for those in healthcare, the trend presents a troubling reality, especially as the industry grapples with a workforce deficit and a pandemic-era trend of retirements.

“Access to health care was challenged, and now it’s further challenged,” said Vandana Nayak, principal in Perkins & Will’s Dallas office.

Texas was short more than 6,000 doctors and 29,000 nurses in 2020, a number that is expected to double by 2032. DFW’s deficit of full-time registered nurses is expected to exceed 15,400 in that same timeframe. Close to 68% of hospitals that responded to a 2022 survey by the Texas Center for Nursing Workforce Studies listed retiring nurses as a consequence of the pandemic.

To make matters worse, more people are dying in Texas from avoidable causes than other states, in large part due to insufficient access to healthcare. Between 2019 and 2021, Texas experienced a more than 35% jump in its avoidable mortality rate, according to The Commonwealth Fund’s 2023 Scorecard on State Health Performance. 

Groups like Perkins & Will have partnered with providers around DFW to help stanch the bleeding, developing new health education facilities that revitalize the pipeline of trained professionals. 

The firm’s internal health practice has existed for many years, but demand has increased dramatically over the last decade, Nayak said. The team is actively working on at least a dozen projects, and expansions are often needed even before an initial undertaking is complete. 

Perkins & Will is partnering with Tarleton State University on its $66M Interprofessional Education Building in Fort Worth, which will eventually house the school’s College of Health Sciences and Human Services. The 102K SF facility will include simulation training and clinical skills suites, teaching and research labs, classrooms and a large multipurpose hall.

Since the project began in March 2022, demand for nursing education has increased, prompting the launch of another facility, Nayak said.

“That project is not even complete and we are already expanding their existing nursing program by building a second building on their Stephenville campus,” she said.

The firm also worked with Collin College on its technical campus in Allen, which opened in 2020. The building supports the school's programs for nursing along with other healthcare pathways. Students are exposed to real-world work experience by doing clinical rotations at area hospitals, many of which offer tuition support and reimbursement programs.

The need for nurses has grown so rapidly that an additional 150 seats were added to Collin College's program in the fall, Associate Vice President of Strategic Initiatives & Partnerships Mary McClure said.

All of this has gone a long way in addressing the region’s workforce shortage, but McClure said it’s still not enough to fix what has become a seemingly insurmountable problem.

“We do realize that we need to expand our program enrollments because, at the current rate, our graduates are not in sufficient numbers to meet the demand,” she said. “Meeting the healthcare employee shortage is very high on our master and strategic plans.”

Collin College is working on forming new partnerships with independent school districts and hospitals, McClure said. The school’s healthcare programs, along with similar initiatives at other ISDs and universities, have been instrumental in getting Methodist Richardson back to its pre-pandemic staffing levels, Hutchenrider said. 

Still, the lack of more seasoned professionals remains an issue.

“We’re starting to get that supply coming in, but the problem is they’re not experienced,” Hutchenrider said. “We have to work very diligently with them to give them the training and knowledge base they need to be a very productive part of caring for our patients.”

MRMC’s service area includes 1.5 million people, Hutchenrider said. A $46M project that will double the size of its emergency department and increase capacity from 45,000 to 75,000 annual visits is scheduled to wrap up in March.

A fifth floor of the hospital is also being built to accommodate more beds, he added.

“In every one of our markets we are seeing absolute, unprecedented growth,” Hutchenrider said, noting that Methodist is also expanding its Midlothian and Mansfield campuses while adding a new hospital in Celina. 

The town of Prosper has also been the benefactor of hospital systems chasing explosive growth in DFW’s northern suburbs. Prosper’s population more than tripled to more than 30,000 residents in the decade leading up to 2020. At full build-out, Prosper officials expect its population to land somewhere around 72,000.

Cook Children’s opened its 23-acre Prosper campus in January 2023. Children’s Health also owns 72 acres at the corner of the Dallas North Tollway and U.S. 380, much of which remains undeveloped and could eventually house services that go beyond pediatrics, executive director of the town’s economic development corporation Mary Ann Moon said.

Healthcare as an industry has had a multiplier effect on Prosper in that it attracts not only new residents but also businesses, Moon added.

“There are a lot of ancillary services that come from having hospitals and medical providers,” she said.

Hutchenrider does not expect MRMC to need another expansion anytime soon, though he said a lot rides on what happens with the economy and whether people continue to move to North Texas. He said he hopes this is the last project for a while, but he isn’t holding his breath.

“There’s a lot of ‘ifs’ in that equation,” he said. “If we start to get to the point where we are full again, we can certainly add on.”