The Star Tribune Editorial Board recently questioned Mayo Clinic Health System's stewardship in the communities we serve ("Is Mayo living up to Minnesota mission?" Aug. 26).

As the leader for the health system in the southeast Minnesota region, I speak on behalf of more than 4,000 physicians and allied health staff when I say that we recognize and treasure the trust our patients and communities place in us. They count on us every day for compassionate and high-quality care. But more than that, they count on us to understand the complex health care environment and to take the necessary steps to preserve the availability of that care for current and future generations in the face of a changing landscape. It's a privilege and responsibility we take very seriously.

It is disappointing that the editors chose not to share the challenges facing all of us — health care providers, patients and communities — that are playing out in rural areas across the nation. The provider shortage has reached a critical level, and rural hospitals are often unable to achieve even minimal staffing without the use of locum tenens (contracted, temporary providers).

For instance, to keep both the Albert Lea and Austin campuses of our hospital staffed, we will spend more than $4 million this year in temporary staffing costs. Add to that the continued trend of declining hospitalizations and childbirths — both have dropped by about 50 percent in the past two decades — and the problem is clear: Our rural communities have hospitals that were built for another time, when people were hospitalized for a week following surgeries that are now done on an outpatient basis.

Health care organizations everywhere are spreading increasingly scarce staffing resources across half-filled hospitals, with intensive-care and birthing units that care for a very small patient load (for instance, an average of one birth per day on each campus, in our case) at ever-increasing costs. This situation is not sustainable.

The Editorial Board shared its view that Mayo Clinic Health System should have engaged the Albert Lea community earlier regarding the decision to shift the location of some hospital services in the region. We have acknowledged on several occasions that we could have done better. We own up to that and have made a firm commitment to improve. But the editors disregarded the meaningful steps we've taken to engage the community in the past two months.

In addition to partnering with Albert Lea city leaders to form a community stakeholder panel, we have conducted, and are continuing to schedule, consultative meetings with elected leaders, local business groups, and service clubs to listen and address concerns. These past and future meetings, along with numerous meetings with local officials, number in the dozens. We've also initiated an economic impact study, published letters to the community in the local paper and created online resources to provide better information and reduce confusion. And those efforts will continue.

We are using all of these connecting points as opportunities to listen closely to the community's ideas. Last week, we announced that we would be building short-stay observation beds in Albert Lea to prevent unnecessary transfers and that we are staging the implementation of our inpatient surgery transition across early 2018 and will use the time to work with community leaders to address concerns such as transportation. These initiatives are the direct result of community feedback, and we will continue to seek out additional ideas and input.

I grew up in a small town, where my father was a physician, and I have practiced medicine for nearly 20 years. I know and appreciate the importance of vibrant health care resources to a community's economy and identity. At the same time, we can't neglect the broader challenges facing rural health care in our country. Rural hospitals are closing across America (more than 80 since 2010), and advances in patient care, shifting demographics and a significant physician shortage aren't things we can ignore.

It is indeed a time for stewardship, and a time for action. It will take all of us working together — health care organizations, patients, communities and political leaders — to find creative solutions to the rural health care challenges facing all of us. As our nation's population ages, rural communities are on the leading edge; they are experiencing firsthand the challenges of fewer providers to care for more people, elderly patients and families who lack transportation and other infrastructure. Hospitals must adapt to new realities in order to survive.

Solutions are beginning to emerge, such as the use of technology to deliver "virtual visits" that can allow a patient to interact with a provider over a phone or a computer. But we need to accelerate the efforts to make health care more available and more affordable. Mayo Clinic stands ready to work with legislators, community leaders, and the cities and towns we serve to address these issues. Our stewardship in this regard is unwavering.

Annie Sadosty is regional vice president for Mayo Clinic Health System's Southeast Minnesota Region.