A sudden oil boom in North Dakota is turning sleepy little towns into buzzing production centers, and tiny hospitals are getting bombarded with waves of new patients that execs hadn't quite anticipated.

When drilling started to ramp up around 2007, health care leaders in the area had an inkling that their systems might eventually face a strain, but not this quickly and severely. Some predictions say the population of McKenzie County could more than triple in size, to 20,000, compared to its 2010 census count.

"We haven't seen the apex of this," says Daniel Kelly, CEO of the McKenzie County Healthcare Systems and chairman of the North Dakota Hospital Association. "It's a major, major transformation."

The impacts on the health system have been numerous in recent years. It's hard to find unskilled hospital workers when the oil guys down the street are paying twice as much. Plus there's a shortage of affordable apartments and houses in which to put those workers. On top of that, they're seeing an increased number of visits to clinics and the emergency room, communicable diseases, and uncollectable hospital bills.

The boom is showing no signs of slowing, Kelly says, as experts expect it to be at least a 20-year play. They've been scrambling to increase wages, "aggressively" recruit new employees from other states and stretch current facilities as much as possible. But what they really need, he says, are bigger hospitals and more apartment buildings. "All of that is really, quite frankly, a Band-Aid approach," he says.

McKenzie County Healthcare Systems is now searching for grant and loan dollars to develop those new facilities and apartment buildings. And its pushing for cost-based reimbursements from Medicaid for their rural health clinics, which have been swamped with workers who are living in "man camps," some with populations in excess of 2,000, leading to higher cases of everything from chlamydia to the common cold.

But why should the CEO of a 2,000-bed hospital in New York City care about what's happening in rural North Dakota? There may be some parallels between the oil-related patient influx there, and the influx that all hospitals will see if the Affordable Care Act holds up in the Supreme Court. Paul Muraca — a regional executive for the American Hospital Association, who's been in regular contact with Kelly — says hospitals should be ready for the wave of patients with different backgrounds who will be entering the system.

"It was pretty isolated for years, given the weather, but with all the influx of new jobs, you're seeing people from all parts of the country finding the beauty in North Dakota," he says. "And that changes not only the racial makeup, but the culture overall."

Kelly's advice is to stay in touch with your hospital peers, and stay one step ahead of the next challenge.

"Try and be hyper-vigilant about what's happening in your market," he says. "I truly would have done some things differently had I known that I'd be sitting in this situation today."