Mercy Medical Center, the only hospital in Williston, N.D., had to double the number of seats in its waiting room six weeks ago.
It also had to hire security guards to ensure the safety of incoming patients this year, a precaution that has become necessary: emergency room visits have increased 50% in the last 12 months and wait times now average at least a couple hours.
The explosive growth in the small towns surrounding the Bakken oil formation, has led to a surge in accidents and patients, putting an incredible strain on local medical facilities like Mercy.
"Growth here is happening so fast you really can't stay ahead of it," said Matthew Grimshaw, CEO of Mercy Medical Center. "The best we can do is keep things within our field of view and react as nimbly as possible."
Mercy is the only hospital within a 40-mile radius, so it fills up with people from all over the northwestern corner of North Dakota.
Currently short 70 positions -- from nurses and surgeons to cafeteria workers and janitorial staff -- the hospital is racing to catch up with demand. But on any given day, there are 30% more requests for medical services than it can accept.
More people, more problems: A majority of the patients these days are oilfield workers. So many workers come in with injured -- or missing -- toes, fingers and other appendages that orthopedic extremity surgeries have tripled within the last year, said Grimshaw.
Because of all the new patients, the average wait time is now at least two hours (and often more than three hours), up from less than an hour a year ago.
Beth Hafele, a 40-year-old Williston resident, started getting shooting pains in her foot earlier this year and was unable to book an appointment with a doctor for months. So she went to the emergency room instead, where she waited four hours to be seen.
Even though the issue wasn't life-threatening, Hafele -- who also has a chronic eye problem, acid reflux-induced asthma and a heart condition -- wonders what would have happened if it had been.
"I worry a lot now about whether I would get helped if I really needed it," Hafele said. "Doctors are having to decide what is more important now, so you could have a heart attack in the emergency room, but if an ambulance comes, that's the automatic top priority."
Smaller health care facilities in the surrounding oil boom towns are seeing similar crowds.
"Numbers are off-the-charts busy," said Deborah Thompson-Hall, a registered nurse at the health center on the Fort Berthold Reservation in New Town, less than 100 miles North of Williston. "We only have so many ambulances available ... people have to wait for ambulances to get to them so we've had a big increase in trauma-related fatalities."
And along with longer waits for emergency care, doctor's offices and health care clinics are so booked that people have to wait months for appointments.
"When you have people who are not accessing health care, and people being diagnosed at late stages of diseases -- whether it's diabetes, a malignant type of disease like cancer -- without screening and early detection, you're losing lives," said Thompson-Hall. Even sexually-transmitted diseases have risen to a record high in the area, she said.
Playing catch-up: Along with all the people and problems comes money -- lots of it. And that is allowing hospitals like Mercy to expand and try to catch up with the surge in demand.
"We have a unique opportunity to reinvent ourselves to meet this changing region," said Grimshaw.
The 450-employee hospital is currently undergoing a $25 million expansion, doubling the size of the emergency department and adding a new Express Care unit.
But there are still dozens of jobs that need to be filled. Hiring new workers has been complicated by the fact that there's a housing shortage in the area. The hospital is also competing with the high-paying jobs offered by the oil companies, making it even more difficult to attract -- and even worse, retain -- employees.
Between January and September of this year, the hospital hired 100 new employees; and in that same period of time, it lost 101 employees.
The highest turnover doesn't occur among the doctors (they can earn just as much, if not more, than the oil workers), but among support staff -- like receptionists and maintenance workers -- who can earn a lot more working for the oil companies. In the past 12 months, the hospital has boosted wages for those employees by 10% yet the defections to the oil fields continue.
"What we're seeing is really an inverted labor market," said Grimshaw. "Someone who hasn't chosen a profession is often more able to find a job than someone else who has chosen a profession. If you want to stay in the medical profession here, you're probably going to earn less than someone in an oilfield job."
Sarah Esperum, for example, was born and raised in Williston and returned last year after living in California's expensive wine country for 10 years. She is a registered nurse with four degrees, but the cost of living in Williston has climbed so high (higher than California, she says) that she is finding it difficult to get by on a nurse's salary. Meanwhile, her husband opened a restaurant in the area that has been booming, and his servers earn $100 an hour with tips.
"I could easily make so very much more as a waitress than I do as a nurse, which breaks my heart," said Esperum. "Now that we are expecting our second child and I am looking at maternity leave in the spring, that is a choice I will have to make."