This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (37)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in JAMA  Topic Collections  • Medical Practice  • Health Policy  • Primary Care/ Family Medicine  • Alert me on articles by topic  Social Bookmarking   What's this?

Implications for Planned Expansion

Roger A. Rosenblatt, MD, MPH; C. Holly A. Andrilla, MS; Thomas Curtin, MD; L. Gary Hart, PhD

JAMA. 2006;295:1042-1049.

Context  The US government is expanding the capacity of community health centers (CHCs) to provide care to underserved populations.

Objective  To examine the status of workforce shortages that may limit CHC expansion.

Design and Setting  Survey questionnaire of all 846 federally funded US CHCs that directly provide clinical services and are within the 50 states and the District of Columbia, conducted between May and September 2004. Questionnaires were completed by the chief executive officer of each grantee. Information was supplemented by data from the 2003 Bureau of Primary Health Care Uniform Data System and weighted to be nationally representative.

Main Outcome Measures  Staffing patterns and vacancies for major clinical disciplines by rural and urban location, use of federal and state recruitment programs, and perceived barriers to recruitment.

Results  Overall response rate was 79.3%. Primary care physicians made up 89.4% of physicians working in the CHCs, the majority of whom are family physicians. In rural CHCs, 46% of the direct clinical providers of care were nonphysician clinicians compared with 38.9% in urban CHCs. There were 428 vacant funded full-time equivalents (FTEs) for family physicians and 376 vacant FTEs for registered nurses. There were vacancies for 13.3% of family physician positions, 20.8% of obstetrician/gynecologist positions, and 22.6% of psychiatrist positions. Rural CHCs had a higher proportion of vacancies and longer-term vacancies and reported greater difficulty filling positions compared with urban CHCs. Physician recruitment in CHCs was heavily dependent on National Health Service Corps scholarships, loan repayment programs, and international medical graduates with J-1 visa waivers. Major perceived barriers to recruitment included low salaries and, in rural CHCs, cultural isolation, poor-quality schools and housing, and lack of spousal job opportunities.

Conclusions  CHCs face substantial challenges in recruitment of clinical staff, particularly in rural areas. The largest numbers of unfilled positions were for family physicians at a time of declining interest in family medicine among graduating US medical students. The success of the current US national policy to expand CHCs may be challenged by these workforce issues.

Author Affiliations: WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) Rural Health Research Center, Department of Family Medicine, University of Washington, Seattle (Drs Rosenblatt and Hart and Ms Andrilla); and National Association of Community Health Centers, Bethesda, Md (Dr Curtin).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED ARTICLE

Strengthening Primary Care to Bolster the Health Care Safety Net
Christopher B. Forrest
JAMA. 2006;295(9):1062-1064.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Health IT-enabled Care for Underserved Rural Populations: The Role of Nursing
Effken and Abbott
J. Am. Med. Inform. Assoc. 2009;16:439-445.
ABSTRACT | FULL TEXT  

Improving Diabetes Care: The Model for Health Care Reform
Kahn and Anderson
Diabetes Care 2009;32:1115-1118.
FULL TEXT  

Confronting The Growing Burden Of Chronic Disease: Can The U.S. Health Care Workforce Do The Job?
Bodenheimer et al.
Health Aff (Millwood) 2009;28:64-74.
ABSTRACT | FULL TEXT  

Impact of Title VII Training Programs on Community Health Center Staffing and National Health Service Corps Participation
Rittenhouse et al.
Ann Fam Med 2008;6:397-405.
ABSTRACT | FULL TEXT  

Retail Clinics, Primary Care Physicians, And Emergency Departments: A Comparison Of Patients' Visits
Mehrotra et al.
Health Aff (Millwood) 2008;27:1272-1282.
ABSTRACT | FULL TEXT  

Will Generalist Physician Supply Meet Demands Of An Increasing And Aging Population?
Colwill et al.
Health Aff (Millwood) 2008;27:w232-w241.
ABSTRACT | FULL TEXT  

Grassroots Activism and the Pursuit of an Expanded Physician Supply
Iglehart
NEJM 2008;358:1741-1749.
FULL TEXT  

Spreading the Safety Net -- Obstacles to the Expansion of Community Health Centers
Iglehart
NEJM 2008;358:1321-1323.
FULL TEXT  

Who Is Accountable for Racial Equity in Health Care?
Blustein
JAMA 2008;299:814-816.
FULL TEXT  

Influence of Patients' Socioeconomic Status on Clinical Management Decisions: A Qualitative Study
Bernheim et al.
Ann Fam Med 2008;6:53-59.
ABSTRACT | FULL TEXT  

Primary Care: Can It Solve Employers' Health Care Dilemma?
Sepulveda et al.
Health Aff (Millwood) 2008;27:151-158.
ABSTRACT | FULL TEXT  

Hide and Seek: The Elusive Rural Psychiatrist
Freeman Cook and Hoas
Acad. Psychiatry 2007;31:419-422.
FULL TEXT  

Putting "Rural" Into Psychiatry Residency Training Programs
Nelson et al.
Acad. Psychiatry 2007;31:423-429.
ABSTRACT | FULL TEXT  

Pursuing Equity: Contact With Primary Care and Specialist Clinicians by Demographics, Insurance, and Health Status
Ferrer
Ann Fam Med 2007;5:492-502.
ABSTRACT | FULL TEXT  

Pay for Performance, Public Reporting, and Racial Disparities in Health Care: How Are Programs Being Designed?
Chien et al.
Med Care Res Rev 2007;64:283S-304S.
ABSTRACT  

Do Religious Physicians Disproportionately Care for the Underserved?
Curlin et al.
Ann Fam Med 2007;5:353-360.
ABSTRACT | FULL TEXT  

Title vii: our loss, their pain.
Freeman and Kruse
Ann Fam Med 2006;4:465-466.
FULL TEXT  

Shaping the Future of Academic Health Centers: The Potential Contributions of Departments of Family Medicine
Newton and DuBard
Ann Fam Med 2006;4:S2-S11.
ABSTRACT | FULL TEXT  

Strengthening Primary Care to Bolster the Health Care Safety Net
Forrest
JAMA 2006;295:1062-1064.
FULL TEXT