mission_employee_2013An email sent out to all Mission Health employees, and then deleted, caused some commotion on Thursday. The missive came in response to Mission CEO Ron Paulus‘ recent announcement that he was cutting the jobs of 68 employees (Mission employs some 9,000) and cutting the pay of another 150 or so employees.

Paulus said he would take a 26 percent pay cut, or a $270,000 to his $1 million pay. Meantime, Mission is moving ahead aggressively with property acquisition, plans to build a new health clinic near Biltmore Park and plans for a massive new tower on its main campus.

Bottom line: there are a lot of disgruntled Mission employees out there. Yesterday’s letter captures some of their sentiment. Here’s the letter, from Mission RN Brett Robertson. (I don’t know if he’s one of the employees losing their jobs):

To Whom It May Concern:

It’s appropriate to find myself writing this on Labor Day. This commentary is in response to the letter we recently received from Mission’s CEO, citing new fiscal adjustments coming our way in the near future. I will begin by saying that this proclamation is disrespectful, and potentially morally corrupt. So begins the vampiric siphoning of our basic benefits back into the Mission vault in a systematic fashion. These cuts stem from unsubstantiated financial losses that the corporation has projected it will incur beginning in 2014. Despite it’s designation as a Not for Profit Organization, Mission Health is a corporation like any other. And as with most corporations, the wealth of the few is forged on the backs of the many.

Now Dr. Paulus mentions that it is his duty as the leader, to fall first on his proverbial sword, in reference to these cutbacks. He cites arbitrarily cutting 26% of his salary for the coming year. Firstly, this plays as a gesture of solidarity, when he knows that his head would be bitten off if he didn’t take such preemptive action. Secondly, I would bet that he will make back at very least his reported loss over the next few years through incentivized bonuses alone. And thirdly, losing 26% of around $1,000,000 for a single year’s compensation is laughable. Hopefully he can still support his kids, and pay the bills while earning such a pittance. These changes do significantly affect the majority of us. I’ve placed an empty coffee can at the Bean Shop for donations toward the Executive Discretionary Fund for anyone who feels differently.

So what other options does Mission have? You might believe that a Top 15 Health System with all its accolades, may want to take better care of the employees who helped in that achievement. We are the engine which drives this hospital. Despite this, Mission has pledged to continue with all nonessential building projects, real estate acquisitions, and the assimilation of area medical and surgical practices under its banner. You can’t throw a stone anywhere near Asheville without hitting a Mission Health sign. Their directive is to effectively monopolize health care in this region. And it is so easy for them to justify this decision by simply citing their altruism to the community. Paulus says that we can’t “retreat into a shell” in this situation. In the military there exists the concept of a strategic withdrawal. It allows for time to regroup, take care of each other, assess the situation, and find a more viable route toward achieving an objective. Perhaps this alternative shouldn’t be discounted so readily.

Fear can be a very powerful tool. Senior administration is using the instillation of fear to quell any real reaction to our discontentment regarding these policies. The comment that “at least we still have jobs” is too pervasive. Granted, Western North Carolina is an economically depressed region of the country. We are generally under-compensated for our labor at this facility and elsewhere locally. I call for truly competitive wages. I urge you to voice your thoughts, feelings, and ideas openly. By doing this, we can begin the restore some balance to the situation. If things continue to deteriorate, you can start weighing your options. You aren’t forced to work for an institution which doesn’t support you. There are better alternatives out there, where your contribution is more aptly recognized and appreciated. Asheville is a beautiful place, but if you aren’t socially fettered to Mission, consider experiencing the beauty of other locales.

Some will disregard all this, believing me jaded or cynical. There is truth in what I say. We don’t have unions to help protect us from exploitation, so we must advocate for ourselves. Tolerance of the situation only makes it easier for them to continue with similar actions in the future. I’ve had the pleasure of experiencing goodness in many people here. Don’t let them mistake goodness for weakness! Take care and good luck!

For those of you willing to endure the enevitible shafting if we do not foment change, we stock plenty of lube in the O.R..
Brett Robertson, RN



  1. I fell & hit my head while landing on the floor. Took the paramedics advice & went to hospital trauma center hospital. Just paid my bill for overnight stay in hospital. Thank G-d I have Medicare & secondary insurance or I would have had to sell my home.
    The C.E.O. of that hospital group makes over 1 million dollars a year in salary and bonuses yet they have to fire many of the Nurses and nurses aids.
    Seems these non profit hospitals are money hungry corporations!

  2. I hear that a ton of nurses have joined Brett in leaving Mission’s OR. Seems they don’t cotton to the new Kool-Aid being served up by the new managers there-come heres from someplace else as usual. Stirring the pot and wreckin things for good people who have been there for more years than those folks have been alive. What a shame.

    • what'shappening? says:

      What has happened to this blog? No comments for months and Mission has a record number of nursing vacancies, is increasing costs to patients which collides with patient’s deductible increases due to the ACA, and we still have 40 something VPs . At least NPR is looking at some issues, if not Ashvegas, ACT or WLOS. But I understand not wanting to lose advertising funding. Rp’s lack of transparency to NPR and the obvious lack of actually kmowing what goes on at the front line rings true for other issues besides nursing injuries. Not that a CEO can know everything but how about being open to setting up a tour to show the reporter the lifting equipment and less of the disingenuious blab about nursing’s importance.

  3. Marshall Mama says:

    Word on the street is that over TWENTY FOUR (and counting) Mission OR employees have quit and joined their friend Brett in seeking employment elsewhere- Apparently they don’t like the Kool-Aid the new management is serving to all the employees… I reckon that bit of news is on the cutting room floor of Paulus’ latest video…

    • FYI – The numbers are now up to 50%. Over 50% of the operating room staff has left to seek employment elsewhere. Things continue to get worse.

  4. careful now, be sparing with the lube, I believe it comes from nursing cost budget.

    • just a lowly RN says:

      A letter from our CEO. Another NEW position created, while the staff have had their PTO suspended, and another year ahead of no raises.

      “To better serve the population of western North Carolina and respond to the need for significant health care transformation, Mission Health has appointed Marc Malloy, a seasoned health insurance and managed care executive, to the newly created position of Senior Vice President, Health Plan Solutions.

      This role will focus on creating the infrastructure and associated product offerings for Mission Health’s at-risk offerings, which have been under development for some time. Reporting directly to me, the role will provide strategic direction and implementation of key goals for risk-bearing provider operations, including collaborative physician- and provider-network development, administration, health and wellness, and sales and marketing. This position will also be critical in preparing Mission to participate in the major overhaul of Medicaid services in North Carolina, federal health insurance exchanges and other key health care reform elements.

      We know that the best way to add value to our community is to deliver improved population health at lower cost with an exceptional patient and family experience. By adding a seasoned executive who has successfully managed multiple insurance and at-risk products together with existing team members who have helped develop value-based provider organizations including Intermountain Healthcare, Cleveland Clinic, the Mayo Clinic and Geisinger Health System, Mission Health is positioning itself to lead the nation in managing health, wellness and total population cost during a time of dramatic health care transformation. Mission’s first concern is always the quality and safety of care that we provide our patients, but doing that alone does not define success; achieving success requires the simultaneous improvement of individual patient care, population health and total cost.

      Marc has more than 20 years of senior leadership experience with several nation-leading companies that provide health care business and insurance solutions. For the last two years, he has been an executive with Healthways, the leader in well-being products and services, leaving that organization as President, Health Plan Markets.

      He began his career at insurance giant Aetna, Inc. in 1994, and ascended through various leadership positions, including Vice President, Georgia Network Operations, and Vice President, Southeast Region Medical Economics. From 2004 to 2009, Marc served in two consecutive C-level positions for Coventry Health Care, a leading managed care organization. After leaving Coventry Health Care, he became President and CEO of Renaissance Medical Management Company, a clinically integrated group of 230 primary care physicians located in suburban Philadelphia.

      Marc holds a bachelor’s degree in business administration in economics and an MBA, both from Kennesaw State University. He will join Mission Health on April 21.”

      • Sunshine List says:

        Can anyone provide a link to Mission Hospital’s IRS Form 990 for 2013? I believe we need to shed some light on Executive Compensation given the current climate of no wage increases, and reduced PTO and 403b Matching. Guidestar provides forms for public inspection but at considerable cost. Can anyone help us out?

      • happytobealiveinWNC says:

        So this new VP position was budgeted for, right? And posted appropriately, right? There should be an expectation of this VP to provide a better than break even ROI, more so than the other VPs. But if the VP expense wasn’t budgeted , nor the decrease in expense this VP could theoretically effect…. more cut backs and lay offs. Was this VP part of a major strategic plan or is Paulus acting “off the cuff”? Perhaps this is a former acquaintance?

  5. Your Compensation says:

    Dr Paulus has announced today that PTO will not be paid in April. June is still up for grabs. Perhaps if each and every employee were to take a Sick Day in April, it would make a statement.

    • MAY 1 would be a statement !

    • feduptohere says:

      congratulations Dr. Paulus on your new TRUCK!!!!

    • happytobealiveinWNC says:

      There is something wrong when the CEO makes over a mil and $12/ hr staff don’t earn their time off. In addition, is Mission getting ROI on its VPs? Many had little or no experience at the position they have been placed. Some magically became VPs, with no posting of their positions or searches for the best qualifications. Instead of cutting the few perks for the frontline, how about lopping off some top dogs due to poor ROI?

    • lay offs are widespread all the while they are keeping it secret by making laid off workers sign legal agreements to keep it secret. no end in adding more & more VPs but firing directors, managers & frontline staff.
      the worst employer i have ever worked for. the feds need to investigate!

      get your healthcare elsewhere. Mission can’t take care of you.

      leadership are cowards.!!!!

    • We need a union at Mission hospital!!!! And everyone needs to stand together…….how can they get away with all they are doing to their employees that have always made MSJ what it is today.? We, the employees, are the backbone of the hospital. How can they be allowed to treat us like they do. The latest is that they are sending RNs and Aides all over the hospital to work…..and most have never been trained for the units they are sent to!!

      • Sunshine List says:

        Suzi, is there support for a nursing union in your area? I finally believe there is sufficient interest in mine. Wish we could meet…

        • happytobealiveinWNC says:

          So, now the ACT will come out with info to the community about their hospital and its financial challenges this year, (read near future lay offs). Don’t expect real information as the employees are afraid to speak. We have no where to go . Even corporate compliance is ineffective now. Information from whistleblowers is not acted upon. Paulus has again insulted us by his statement of “anyone who is not now or can’t get on board is frankly standing in the way of everyone else….” Then asks for us to submit questions, ideas and barriers. When in the past, we have shared ideas, or critically questioned issues, we have been labeled resistant ( not considered on board). It appears there is no place for creative, critical thinking, just following marching orders. Get ready for layoffs. And by the way what is the new emphasis on charitable giving? Anyone know?

          What exactly is causing the half billion dollar deficit? Anyone know? All we hear is generalitites about decreased reimbursement, no expansion of Medicaid, increased supply costs, etc. Every year the deficit gets bigger even though the estimates are for the “next 10 years”. Did the lay offs from last year not improve the deficit? It is worse!

          It could be that there is a strategy to look very bad, cut a lot of costs, then when reviewed by the ACO reviewers, improvements look better, voila more reimbursement, at the expense of valued employees.

          Or cutting more looks good for negotiating the buyout of the hospital and subsequently Paulus’ big package after that is done, again at the expense of employees.

      • North Carolina employees have the legal right to perform a poll concerning interests in seeking unionization. Mission Hospital Systems policy forbids the employees to seek unionization.
        I once considered performing a nurses union poll, to be conducted on the sidewalk in front of the ER parking deck, on Biltmore Avenue. This sidewalk is NOT Mission Hospital property.

        • happytobealiveinWNC says:

          Hospitals are going through “trying times”, to say the least. Employees (we) are treated as dispensable. However, Mission seems to be at the extreme, and the excuses are the non-expansion of NC Medicaid, the high percentages of Medicare/Medicaid, etc. There is some validity in those excuses and in the fact that Mission was behind in aligning health care in WNC. But to have laid off 10% of all of the health care workers in NC (NC Hospital Association reports that 2000 health care workers have been laid off in NC; Mission laid off 70 last year and 130 this year), seems out of range. In addition, not just employees should be alarmed, but local employers and individuals should be alarmed at the increase in outpatient charges that are on the way. Mission will be able to charge more as they open new outpatient facilities. This may decrease access to care to many patients in this area. If there were to be protests, it should be about this and if there is to be accurate and informative reporting by WLOS and the ACT, it should be about this. This is a travesty, although a good business opportunity for competitors:)
          And as an aside, last year Paulus repeatedly stated that the executives had taken deep salary cuts. This was disingenuious as they only agreed to forgo some of their bonuses. That does not qualify as a definition for a salary cut. This year, he is claiming that they won’t get PTO in one report, but another stated they just won’t get to carry it over to next year. Which is it? If it is that they can’t carry it over, that just means they will take more vacation because if they don’t, they lose it.

  6. Take action by celebrating May Day in America.Are we want different or is something wrong with celebrating our daily labor to support our families like the rest of the world.It is our day to honor our efforts and sacrifices.We Are the job creators. We make the country.We the people

  7. No easy solutions ahead for MMH, this disaster has been years in the making. While its is true , the health care environment has contributed to our current sad state of affairs. It is not the major cause.

    The blame lies clearly with the board and the hospital administration. The current leadership has created a nightmare. The board has obviously enriched themselves at the patients , staff and communities expense. Properties and practices are being bought by the hospital at a rapid rate, all in the name of a bigger picture. ” MONOPOLY”

    HR has a powerful weapon called fear, if your the only game in the town any perceived noncompliance is harshly dealt with. I know many former and current employees that have been intimidated and have had no ear or path to justice.

    The current administration has bet everything on the “Bigger Picture” Thier view of the future has major flaws. It was never founded on good business principals. In essence they have bankrupted MMH on the altar of pride and greed. I truly think that most of them don’t see the train wreck that is coming. In the end they will move on with thier golden parachutes, the board will have made millions .

    Hopefully we will be able to pick up the pieces by FOCUSING on caring for patients and each other. I do believe we need over site by Buncombe County and NC State .Contributing to our tax base would be a good idea ,an just maybe ….the monopoly needs to be broke up by the Federal Government.


    • just ask the questions says:

      Your ONLY chance at getting these issues addressed is to take the monopoly/community issue to the Federal Trade Commission or the Department of Justice.

      The main issue here is the increased cost to the community caused by the substantial increases in charges to Mission’s payers. Where do you think these increases in employer premiums are coming from if not from Mission and its employed monopoly practices?

      The local media will not investigate due to their fear of Mission’s board and leadership, and so the only way to make this right is to pursue justice outside of the community.

    • you can bet higher ups will get those coveted bonuses!

      • happytobealiveinWNC says:

        This could be considered a type of crisis management, meaning that management, unethically, uses potential crises as a reason to rally the troops to make change. Using a potential budget crisis could be a reason to reduce staff who are older, and cost more in salary , are matched higher in the retirement program and most importantly are not bullied easily. If these staff were to stay, VP incompetence might be revealed to the detriment of the administrative team illusion. The downside is that wisdom and experience is lost, along with trust; front line staff trusted many of the elders. These staff also brought important perspectives from their experiences that combined with new initiatives due to ACA and other health care changes, would many times foster better solutions and strategies than those presented without the perspectives. Too bad. Now, magically, the budget will turn around (really, in 2-4 months in a billion dollar company?), so that bonuses can be presented. And why not be transparent about senior administration cutting their salaries? They decided to forgo their bonuses only. Why not state this? That action alone, my friends, illustrates the fortitude and integrity of the senior management team.

  8. So this is really interesting to me as someone being recruited by Mission. While I oonly know what I’ve heard and read, I can assure you none of this is unique to Mission. The big difference, from what I can tell, is Mission’s place in the community. I work at Baptist in administration now, and I can promise you the feelings are the same. We just laid off almost a thousand folks over the last year. Hardworking caregivers. Critical staff. And our patient care has suffered greatly. Our management makes decisions in a vacuum and is equally as popular as Paulus and the like. I have been to many hospitals and heard the same story. It’s the nature of healthcare today. Under the ACA and Medicare/medicaid changes, it has become almost impossible to operate a hospital while focusing on what matters. Our CEO, MacDonnell, made more than Paulus, including a 10k allowance for country club dues. We’ve faced cuts in raises, benefits, etc every year for like 3 years. The numberpof VPs and size of the executive team is alarming indeed at Mission. And Paulus certainly sounds suspect. But I would encourage you to read about other similar sized health systems around the country, and I suspect you’ll find a lot of layoffs, a lot of employees being asked to do more, and a lot of what you’re feeling. I promise you are not alone, but take pride in doing what yyou can in your role to provide safe, quality patient care. That’s why I got into and stay in health care. You can make a difference in patient lives every day. Don’t let that suffer because Paulus is a tool and the system is feeling pains. Eyes on the prize. And if nothing else, reading this discussion has helped me as I consider potential opportunities at Mission and given me some hard to find context (the thoughtful responses at least; I’m naturally suspect of petty personal attacks). So thanks and best of luck to those in the trenches.

  9. You want a new view Jason? Come to Missions Child development Center. Now there is a dog and pony show. We are supposed to be a 5 star center. We (the teachers don’t see it) We buy must of our supplies and have no support from our supervisor for out of control children AND parents. Teachers are pulled from classrooms so our director doesn’t have to answer phones. She does not like to deal with problems. (The last 2 supervisors answered their phones).
    Director leaves on open house night, ( not comfortable with parents) And we were not even allowed to tell the parents if we were going to be their child’s teachers.
    I am planning on starting a family, and they absolutely will not attend Missions Child Development while the current supervisor is in place, even if I am still there. Which I pray I will not be. The turnover there has become incredible.

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