Every decision about how to staff a hospital carries a financial weight. For hospitals serving rural communities, that weight has grown heavier. Rising labor costs have become one of the most significant challenges to long-term stability. Maintaining competitive wages and benefits is essential to attracting and retaining caregivers, yet those investments place increasing pressure on already tight operating margins.
In the final PRS Global Viewpoint video, Miriam Batke, Chief Human Resources Officer at Fisher-Titus Medical Center, speaks candidly about that reality, and why organizations can no longer afford to think about staffing decisions in isolation.
Workforce challenges rarely begin with compensation alone. Many healthcare organizations are managing an aging workforce while working to fill critical caregiver roles in an increasingly competitive labor market. Offering competitive wages and benefits is no longer optional, and the financial implications extend well beyond payroll.
"That extra cost to maintain our workforce and provide competitive wages and benefits erodes our operating margin." — Miriam Batke, CHRO, Fisher-Titus Medical Center
Unlike many industries, healthcare organizations have limited ability to offset higher workforce costs. As Miriam explains, hospitals cannot simply pass those additional expenses to insurance companies or other payers. Instead, they absorb the increased cost of maintaining their workforce, which reduces the operating margin that supports patient care, future investments, and organizational growth.
That challenge is especially pronounced for rural and community hospitals, where recruiting from a smaller labor pool often requires even greater investment.
The financial impact is substantial. Labor accounts for approximately 56 percent of the average hospital's total expenses, according to the American Hospital Association.1 For rural hospitals, the pressure is even sharper. HRSA projects that nonmetropolitan areas will face an 11 percent registered nurse shortage by 2038, nearly six times the shortage projected in metropolitan areas.2 For organizations like Fisher-Titus, that context makes every workforce decision carry more weight.
This is why workforce strategy deserves a longer view. The organizations navigating these pressures most steadily are the ones that plan ahead, anticipating retirements, building pipelines, and making staffing decisions before the gap becomes a crisis.
For rural communities, that stability is what determines whether a family in Norwalk, or a town like it, can still get the care they need close to home.
The workforce challenges discussed throughout the Viewpoint series all point to the same conclusion: healthcare organizations cannot wait until vacancies become critical to build their workforce strategy. The decisions leaders make today around recruitment, retention, workforce pipelines, and integration will shape both financial stability and access to care in the years ahead.
For rural hospitals in particular, international hiring can be one part of that longer-term strategy. When approached as an ongoing workforce program rather than a response to immediate vacancies, it can create a predictable pipeline of experienced healthcare professionals who complement domestic recruitment and support greater workforce stability over time.
At PRS Global, this is how we encourage healthcare leaders to think about international workforce strategy: not as a replacement for the workforce already in place, but as another pipeline that can be intentionally built, integrated, and sustained.
Explore the full Viewpoint series to hear directly from the healthcare leaders and internationally educated professionals behind these conversations.
References
1. "The Cost of Caring: Challenges Facing America's Hospitals in 2025." American Hospital Association, April 2025, https://www.aha.org/guides-and-reports/2026-03-09-2025-cost-caring-report
2. "Health Workforce Projections." Health Resources and Services Administration, 11 Dec. 2025, https://bhw.hrsa.gov/data-research/projecting-health-workforce-supply-demand