Business as Usual

March 14, 2023

On February 2nd, my whole rehab unit was laid off. All we got was 6 days’ notice, and no explanation. I started writing this article then, about the concerning trend of layoffs and closures in healthcare, only to find out that it was so much worse than I thought.

You see, I worked in a small for-profit hospital in Southwest San Antonio. You’d be forgiven for thinking that living in a city like this would mean easy access to healthcare. My hospital is the only one in the Southwest area, and only one of two on the entire south side. It’s not an accident that the people living in this area, primarily people of color and largely lower-income(1), need to travel much farther than more affluent folks living on the north side of town to access all the specialty care offered at the larger hospital systems. But now, the very limited resources offered here are being taken away.

A few days ago, the President of Texas Vista Medical Center (TVMC), Jon Turton, announced that they would be closing the whole hospital in only two months’ time(2). What reasons did he give that could justify taking away such a valuable resource while so many neighborhoods depend on it?

Money, of course.

The hospital’s press release lamented that they simply had no choice but to close this hospital, due to the lack of pay coming from patients, combined with the staffing/infrastructure strain of Covid. There was a very interesting line that I’d like to draw your attention to:

“…the facility was struggling financially, as it was choked out by the well-heeled “public” hospital competitor across town.”(2)

This line is referencing University Hospital, a non-profit hospital in the Northwest partnered with Bexar County. I have many criticisms of the non-profit hospital industry as it stands currently, but how can that quote be anything other than an admission that a for-profit model is simply incapable of providing care to patients who need it?

And what about us, the 800+ healthcare workers who staffed this hospital(3)? There are some jobs available in the city at other hospitals, but not that many jobs, to say nothing of the fact that the current trend in so many hospital systems is layoffs, or cutting back care.

Why are so many hospitals struggling to manage their finances all of the sudden? Whenever I’ve tried to research the phenomenon of increasing healthcare layoffs from the hospital’s perspective, I see a lot of hand-wringing from hospital executives. They seem totally taken aback to learn that the consistent undervaluing of core staff has driven them away, and so these unfortunate executives were “forced” to rely on expensive short-term contracts to fill the labor gap(4). Because of these expenses, and the federal government ending additional Covid funding, hospitals are finding themselves unable to return to “business as usual”. The only problem with this narrative is that there isn’t a single healthcare worker in this country who couldn’t have predicted this, and executives refused to listen.

In fact, in this exact instance, there had long been rumblings amongst the staff about the issues inside TVMC. I often heard from nurses and CNAs that they simply did not have the staffing to be able to provide good care to their patients, and in many cases they lacked the necessary resources to do their jobs at all. These conditions led to many staff members leaving, and many more planning their exit. What’s worse, under these conditions there were multiple preventable sentinel events (a patient safety event that results in death, permanent harm, or severe temporary harm).

When IMPACT talks about the failures of profit-driven medicine, this is what we mean. The model has always been unsustainable, and treating healthcare like any other business means consistently making sure that the profit line goes up, regardless of the cost to people. In our current economic system, that means cutting costs, and consistently the largest expense in hospital systems is labor(5). So, when these executives need to make their profit margins go up, they lay people off. The problem with this line of thinking is there are only so many people you can lay off before a hospital cannot function any more. Many hospitals around the country are toeing that line, if not already past it(6), and once that happens the whole hospital shuts down.

With core staff shortages, system-wide layoffs, and hospital shutdowns, is it any surprise that so many healthcare unions are striking over unsafe staffing conditions? Is it actually surprising that so many healthcare workers have left the industry entirely(7)? It’s not surprising to me in the slightest. The only surprising thing in my mind is the attitude of healthcare executives and the politicians they fund, who continue to act as if this was a totally unforeseeable problem, or try to pass the blame onto the workers. But this isn’t really all that surprising, as all the executives need to do is sell their companies to another equity fund. After which, they’ll be able to retire comfortably on, in many cases, a golden parachute of millions.

It doesn’t matter to these executives the real-world harm that is caused to healthcare workers, and it certainly doesn’t matter to these people the harm that is caused to our patients. Nothing is going to change unless we, those in the industry, rise up and make something change. Between the unions and advocacy groups like IMPACT, healthcare workers are beginning to wake up to the fact that we have to stand in solidarity with each other and our patients. We are the only ones who are going to fight for us.

Maybe it’s time for us all to admit that “business as usual” simply isn’t going to cut it anymore.


  1. “Equity Atlas,” City of San Antonio Office of Equity, accessed March 12, 2023,
  2. “Texas Vista Medical Center to Close Barring Take Over or Significant Government Relief”, Steward Newsroom, Steward Healthcare, March 1, 2023,
  3. Houston, Matt, “Texas Vista Medical Center to close May 1,” Local News, KENS5, March 2, 2023,
  4. “Beaumont Spectrum confirms 400 layoffs amid rising cost pressures,” Business, The Detroit News, September 9, 2022,
  5. “The Financial Effects of Hospital Workforce Dislocation,” Kaufman Hall, May 11, 2022,
  6. Johnson, Steven Ross, “Staff Shortages Choking U.S. Health Care System,” Health News, US News, July 28, 2022,
  7. Southwick, Ron, “More nursing strikes are likely, and it’s not solely about pay”, Chief Healthcare Executive, February 27, 2023,

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