Community Health Centers Are Their Own Best Recruiters

The shortage of physicians in community health centers is so great, that if all clinical vacancies were filled today, community health centers could serve an additional two million patients, research shows.

There’s a report out this week that quantifies the chronic staffing shortages at community health centers.

Researchers with the National Association of Community Health Centers found that 95% of community health centers are coping with at least one clinical vacancy at any given time, and that 70% of the time these centers are recruiting for at least one family physician. The report also found that:

• 56% of health centers report at least one behavioral health staff vacancy, such as a licensed clinical social worker, psychologist, or other mental health/substance abuse professional.
• Health centers have higher average vacancy rates for physicians than hospitals.
• More than half of all National Health Service Corps participants are providing care at a health center.
• Health center providers make up 53% of current NHSC participants and 61% of currently listed NHSC vacancies are at health centers.

These pervasive shortages of clinicians come as 24 million people—more people than ever before—rely upon community health centers as a care access point. If all clinical vacancies were filled today, community health centers could serve an additional two million patients, according to estimates cited in the report.

(If I were writing for a general readership, this is about the point where I would segue into a few paragraphs about the inspired work that community health centers have done for more than 50 years to provide cost-effective care for vulnerable, underserved populations. We already know that. Let’s move on.)

Nothing in the report was terribly surprising to anyone paying attention, although it’s good to have the numbers in hand so that we can get a sense of staffing challenges that health centers face.

The Challenges
It’s also good to remind ourselves what community health centers are up against when it comes to recruiting and retention. For starters, primary care physicians, nurse practitioners, physician assistants and behavioral health specialists are in high demand everywhere.

Community health centers generally cannot offer the same salary and benefits as hospitals, physician practices, retail clinics, and other settings. Beyond that, community health centers are often located in remote rural areas or struggling urban neighborhoods, healthcare information and medical technology and clinic support systems are often lagging, work schedules are brutal and language barriers are rife.

Those are all daunting challenges, which makes you wonder why staffing shortages at community health centers aren’t far worse. “We are really fortunate that the providers we are able to recruit really want to be at the health centers,” Jana Eubank, associate vice president of Public Policy and Research at NACHC. “You have to be a special kind of person to want to work with underserved populations. They are incredibly committed to their communities and their patient populations.”

There are also palpable benefits that come with the job. “A lot of providers are open to it because they can be providers. They’re not having to deal with the administrative hassles you have in private practice,” Eubank says.
“Another thing they really appreciate is that our model of care is very comprehensive compared to most private practices, and even group practices. We address all of the needs of the patient, as well as special service needs. They are working in a care team, not only on the medical side, but there are behavioral and social services providers who can help with care coordination.”

Mission-driven Providers
When asked to “check all that apply,” community health centers told researchers that 58% of clinical staff hired over the past two years had trained at that same health center, 30% had worked in another health center, 30% were veterans, 18% were patients or former patients of health centers, 10% were former Community Health Corps/AmeriCorps/Vista volunteers, and 4% were Peace Corp volunteers.

Clearly, the people who work in community health centers are mission-driven, and when you take that into consideration, it’s not so surprising that the biggest single recruiting tool for bringing clinicians into community health centers, is the time these clinicians spend in community health centers.

“It’s the exposure to how important the work of the health center is,” Eubank says. “The providers that are attracted to centers tend to be more open-minded toward that anyway. Once they get exposed to that and see the good work they can do and the difference they can make in people’s lives, that makes a huge difference.”

Where residents do their training has a direct relation to where they practice. “It’s critical that they get out there in the community and get exposed to our types of practices,” Eubank says. “When they do we have a better chance of recruiting and retaining them.”

The obvious solution is more residency programs in community health centers. Unfortunately, it’s more complicated than that.

“It is definitely challenging,” Eubank says. “A lot of health centers don’t have the types of relationships they need with medical schools and residency programs. It’s costly and it takes space and time, and sometimes health centers don’t have access to those resources. And it does take a lot of time. If they have one supervisor who is taking time away from seeing patients, some health centers can’t afford to have those clinicians not seeing patients.”

No Silver Bullet
On the one hand, clinical trainees who spend time in community health centers have a far greater likelihood of practicing in a health center. On the other hand, community health centers frequently do not have the resources to provide adequate training. How is this dilemma resolved?

“There is not really one silver bullet to address all of these issues,” Eubank says. “In terms of community-based training, one thing we are going to be pushing in Congress is to continue to support the Teaching Health Center program that provides seed money and support for community based training and community health centers. We are also supporting additional residency dollars for nurse practitioner training programs. There are some programs in the books that could be funded more robustly to help training opportunities at the community level.”  

Medical professionals who choose to practice in community health centers go into the job with eyes open, understanding that they’ll face hurdles they likely won’t see in private practice. Indeed, that is likely the attraction for many. At the same time, it’s unrealistic and unfair to ask these mission-driven clinicians to sacrifice their financial well-being in the service of society’s most vulnerable people.

Community health centers generally can’t match salary and benefits, but restructuring or forgiving outstanding medical school debts for medical and nursing school graduates, and providing medical trainees with the experience of working in community health centers will go a long way toward helping them fulfill their worthy mission.