Shortages of Medical Personnel at Community Health Centers Implications for Planned Expansion
By Roger A. Rosenblatt, MD, MPH; C. Holly A. Andrilla, MS; Thomas Curtin, MD; L. Gary Hart, PhD
JAMA
March 1, 2006
Residents of the United States lack universal access to health care, and millions of people have difficulty obtaining medical care. The year 2005 marked the 40th anniversary of one of the nation’s most enduring attempts to remedy this problem: the creation of community health centers (CHCs) as part of the “war on poverty.”
The role and responsibility of CHCs have increased as more people in the United States have difficulty gaining access to medical care. CHCs now provide care to more than 14 million US residents in more than 3500 communities. Governed by nonprofit boards with majority representation from the patient population served, CHCs are different from the private practices and for-profit entities that deliver most ambulatory care in the United States.
A national decision to invest further in CHCs has occurred during a period when access to health care in the United States is limited for more people than ever before in the country’s history.
Our results show that in 2004, CHCs were understaffed and were having difficulty recruiting essential health care personnel. This inability to fill budgeted vacancies could become a rate-limiting factor as they seek to expand their clinical activities to care for needy populations, particularly in rural areas.
The clinical role of CHCs is dependent on primary care clinicians, both physicians and nonphysician clinicians. This is occurring in a national environment in which primary care in general has lost popularity as a practice discipline. For example, the US production of family physicians has decreased rapidly in the last 7 years, with the number of US medical graduates matching in family medicine declining 51.6% from 1997 to 2005. Filling the existing CHC vacancies would absorb 20% of the 2005 output from the family medicine residencies.
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.
http://jama.ama-assn.org/cgi/content/full/295/9/1042#REF-JOC60013-9
Comment: By Don McCanne, M.D.
Expanding community health centers seems to be an almost futile exercise when the primary care workforce is contracting.
What can be done, under our current system of funding health care, to address this problem? On the other hand, what might the public administrator of a single payer monopsony do if presented with this same problem? More importantly, would this degree of deterioration of the primary care workforce have been allowed to happen under a single payer system?