MARCH 2016
STAFFING THE SAFETY NET:
Building the Primary Care Workforce
at America’s Health Centers
Community, Migrant, Homeless, and Public Housing Health
Centers are non-profit, community-governed preventive and
primary care providers with over 50 years of experience
expanding access and eliminating barriers to care.
Now serving over 24 million patients
as the health care system transforms and
nationally, Community Health Centers have
demand for care increases, the challenge of
more than doubled the number of patients
recruiting and retaining a strong clinical work-
served since 2000. Health center patients
force has become particularly acute among
are predominantly low income, uninsured or
the nation’s health centers, which are located
insured through Medicaid, and members of
in and serve communities with few alterna-
racial/ethnic minority groups. They also experi-
tives for primary and preventive care.
1
ence high rates of complex and chronic conditions.2 Research consistently demonstrates
This brief presents results from a recent
that health centers effectively manage the
national survey conducted by the National
care of their patient population and deliver
Association of Community Health Centers
needed savings to the health care system.
(NACHC), and offers a snapshot of health
3
center clinical workforce needs and priorities.
If all health
center
clinical
vacancies
were filled
today,
health
centers
A key ingredient to Community Health
Even though findings demonstrate that health
Centers’ success in expanding access to
centers are often able to innovate and adapt
high-quality, cost effective care is their
to address clinical workforce challenges, find-
workforce—in particular, the medical, mental
ings also reveal an unequivocal need for more
health, substance addiction treatment, oral,
focused attention and support for Community
and other clinical staff at health centers, as
Health Centers in their consistent efforts to
well as the interdisciplinary health profession-
bring high-quality, committed primary care team
als who facilitate access to care and improve
members to their patients and communities.
more
centers now employ over 170,000 staff,
Workforce challenges are one of the primary
the majority of whom directly deliver need-
barriers to health center patient growth. If
patients.
ed health and wellness care services. The
all health center clinical vacancies were filled
number of health center clinical care staff has
today, health centers could serve 2 million
approximately doubled since 2005.4 However,
more patients.
health outcomes for their patients. Health
could serve
2 MILLION
1
CARE TEAMS AT HEALTH CENTERS
Each health center employs a unique mix of health professionals to expand
access to comprehensive, coordinated, continuous, and accountable
primary and preventive care. The health center care team model includes
clinical and non-clinical, as well as traditional and non-traditional,
HEALTH CENTERS’
CURRENT CLINICAL
VACANCIES
Clinical vacancies are important indicators of
capacity challenges because they represent
existing and funded positions for which a
health center is actively recruiting but cannot
fill. While some vacancies represent new
health and wellness professionals to meet patients’ complex medical,
positions or natural turnover, others may be
behavioral, oral, and other health care needs. For example, health centers
symptomatic of overall national workforce
are hiring new nurse practitioners, physician assistants, and certified
nurse midwives at faster rates than they are hiring new physicians, and
they are twice as likely to hire these non-physician providers than other
practice settings.5 Most health center care teams make extensive use
of medical assistants and community health workers/promotoras. In
challenges. Health centers, however, are at a
particular disadvantage because they serve
isolated or otherwise underserved communities that face challenges in recruiting and
retaining high quality staff.
6
addition, more than 10% of health centers’ total workforce include staff
whose daily jobs enable patients to obtain health and social services, from
community health workers/promotoras, care managers, health educators, transportation staff, and interpreters.7
Almost all health centers (95%) are experiencing at least one clinical vacancy today.
The most common clinical position health
centers report to be currently vacant is family physician (Figure 1).8 More than two-thirds
(69%) of health centers indicate that they are
Health centers will continue to make greater use of diverse care teams as
they progress to meet rising demand for care, further improve community health, and make greater gains in system efficiency goals. Innovations
currently recruiting for at least one family
physician, while about half are recruiting for
a nurse practitioner or medical assistant
(Figure 1). Additionally, 56% of health centers
in care team design are based on each health center community’s specific
report experiencing at least one opening for
needs, preferences, and resources. Increasingly, these innovations are
a behavioral health staff member, such as a
strengthened by health centers’ engagement in interprofessional health
professions training opportunities. As the health center workforce continues to expand and evolve, this brief offers a snapshot of their current
staffing priorities.
licensed clinical social worker, psychologist,
or other mental health/substance abuse
professional (not shown in figure).
Health centers on average have 13% of their
clinical workforce staff positions currently
vacant. This average vacancy rate is higher
for family physicians (25%) and licensed
clinical social workers (17%) (Figure 2). Health
centers also have higher average vacancy
rates for physicians than those experienced
by hospitals (21% vs. 18%).9
NACHC.ORG
STAFFING THE SAFETY NET: Building the Primary Care Workforce at America’s Health Centers
FIGURE 1
PERCENT OF HEALTH CENTERS REPORTING A VACANCY FOR SPECIFIC CLINICAL POSITION
100%
ANY CLINICAL VACANCIES
FAMILY PHYSICIAN
90%
NURSE PRACTITIONER
MEDICAL ASSISTANT
REGISTERED NURSE
80%
LICENSED CLINICAL SOCIAL WORKER
DENTIST
70%
LICENSED PRACTICAL NURSE/LICENSED
VOCATIONAL NURSE
60%
INTERNIST
PEDIATRICIAN
50%
PSYCHIATRIST
DENTAL HYGIENIST
OTHER LICENSED MENTAL HEALTH
AND/OR SUBSTANCE ABUSE STAFF
40%
PHYSICIAN ASSISTANT
30%
OBESTETRICIAN/GYNECOLOGIST
PSYCHOLOGIST
20%
NON-LICENSED MENTAL HEALTH
AND/OR SUBSTANCE ABUSE STAFF
PHARMACIST
10%
0%
CERTIFIED NURSE MIDWIFE
95% 69% 50% 48% 41% 38% 37% 31% 23% 19% 18% 16% 16% 16% 13% 9%
FIGURE 2
8%
7%
6%
6%
VISION SERVICES STAFF
AVERAGE HEALTH CENTER CLINICAL VACANCY RATES
30%
FAMILY PHYSICIAN
LICENSED CLINICAL SOCIAL WORKER
ALL CLINICAL VACANCIES
NURSE PRACTITIONER
PSYCHIATRIST
REGISTERED NURSE
DENTIST
INTERNIST
20%
PEDIATRICIAN
OTHER LICENSED MENTAL HEALTH
AND/OR SUBSTANCE ABUSE STAFF
MEDICAL ASSISTANT
DENTAL HYGIENIST
LICENSED PRACTICAL NURSE/LICENSED
VOCATIONAL NURSE
10%
OBSTETRICIAN/GYNECOLOGIST
PHYSICIAN ASSISTANT
PSYCHOLOGIST
VISION SERVICES STAFF
PHARMACIST
NON-LICENSED MENTAL HEALTH
AND/OR SUBSTANCE ABUSE STAFF
0%
25% 17% 13% 13% 13% 12% 12% 10% 8%
8%
7%
7%
7%
6%
5%
5%
4%
3%
3%
3%
CERTIFIED NURSE MIDWIFE
3
HEALTH CENTERS’ CURRENT CLINICAL VACANCIES (CONTINUED)
Health centers have particular difficulty
family physician, and internist vacancies.
their highest priority to fill, health centers
recruiting certain provider types. Family
On average, respondents spend over a
overwhelmingly identified family physician,
physician is the most difficult vacancy to fill,
year recruiting for a psychiatrist and
with half of respondents selecting it (Figure 5).
with 66% of health centers indicating it as
nearly a year recruiting for family physicians,
“very difficult” to fill. Additionally, 30 to 40%
internists, and obstetrician/gynecologists
The next most common responses were
of centers rate internist, psychiatrist, and
(Figure 4).
behavioral health specialist and dentist
licensed clinical social worker vacancies
as “very difficult” to fill (Figure 3).
(10% and 8% respectively, of health
Family physician also rates as the most
centers prioritizing).
highly prioritized clinical position to fill
Similarly, health centers report spending
at health centers. When asked to select one
the most time recruiting for psychiatrist,
currently vacant clinical staffing position as
FIGURE 3
PERCENTAGE OF HEALTH CENTERS RATING SPECIFIC CLINICAL VACANCIES AS VERY DIFFICULT TO FILL
70%
FAMILY PHYSICIAN
INTERNIST
PSYCHIATRIST
60%
DENTIST
LICENSED CLINICAL SOCIAL WORKER
PEDIATRICIAN
50%
OBSTETRICIAN/GYNECOLOGIST
REGISTERED NURSE
PSYCHOLOGIST
OTHER LICENSED MENTAL HEALTH
AND/OR SUBSTANCE ABUSE STAFF
40%
NURSE PRACTITIONER
PHARMACIST
30%
DENTAL HYGIENIST
PHYSICIAN ASSISTANT
LICENSED PRACTICAL NURSES/LICENSED
VOCATIONAL NURSE
20%
VISION SERVICES STAFF
MEDICAL ASSISTANT
10%
NON-LICENSED MENTAL HEALTH
AND/OR SUBSTANCE ABUSE STAFF
CERTIFIED NURSE MIDWIFE
0%
66% 40% 34% 32% 31% 29% 23% 16% 15% 13% 13% 10%
NACHC.ORG
9%
8%
8%
8%
5%
5%
4%
STAFFING THE SAFETY NET: Building the Primary Care Workforce at America’s Health Centers
AVERAGE NUMBER OF MONTHS SPENT RECRUITING FOR SPECIFIC CLINICAL VACANCIES
FIGURE 4
13
PSYCHIATRIST
FAMILY PHYSICIAN
12
INTERNIST
OBSTETRICIAN/GYNECOLOGIST
11
PEDIATRICIAN
10
PSYCHOLOGIST
DENTIST
9
LICENSED CLINICAL SOCIAL WORKER
PHYSICIAN ASSISTANT
8
VISION SERVICES STAFF
7
OTHER LICENSED MENTAL HEALTH
AND/OR SUBSTANCE ABUSE STAFF
6
NURSE PRACTITIONER
CERTIFIED NURSE MIDWIFE
5
PHARMACIST
REGISTERED NURSE
4
DENTAL HYGIENIST
3
NON-LICENSED MENTAL HEALTH
AND/OR SUBSTANCE ABUSE STAFF
2
LICENSED PRACTICAL NURSE/LICENSED
VOCATIONAL NURSE
1
0
MEDICAL ASSISTANT
12.7
11.4
11.2
FIGURE 5
10.8
8.7
7.7
6.5
5.7
5.2
5.0
5.0
4.9
4.8
4..2
3.8
3.6
3.3
3.2
2.9
TOP 5 VACANCIES RATED AS HEALTH CENTERS' HIGHEST PRIORITY TO FILL
60%
FAMILY PHYSICIAN
BEHAVIORAL HEALTH SPECIALIST
DENTIST
INTERNIST
50%
NURSE PRACTITIONER
Note: 10% inclusive of 5% of respondents selecting a
Licensed Clinical Social Worker, 4% selecting
40%
Psychiatrist, and 1% selecting Other Licensed Mental
Health and/or Substance Abuse Staff. 21% of
respondents selected another clinical staff position.
30%
20%
10%
0%
51%
10%
8%
6%
5%
5
HEALTH CENTER RECRUITMENT AND RETENTION EXPERIENCES
Health centers face a variety of barriers in
related to challenges varied little when com-
past two years, 58% of health centers said
recruiting and retaining their highest priority
paring the half of health centers that chose
they had hired a health professional who
clinical positions (Figure 6). The most highly
a family physician vacancy as their highest
trained at their health center and 30% said
rated challenges confronting health centers
priority to fill with those that reported other
they had hired a health professional who
speak to the sharp competition for qualified
positions as their highest priority.
trained at another health center (Figure 7).
or impoverished areas. Some health centers
Evidence shows that health centers draw
While departing clinical staff most often leave
report challenges with recruiting candidates
from the network of other health centers
their health centers for private primary care
who have proficient language skills and/or
across the country to recruit their clinical
practices and hospitals, a significant number
cultural competency. Interestingly, responses
staff. When asked about staff hired in the
transfer to other health centers (Figure 8).
staff and health centers’ location in isolated
FIGURE 6
IMPORTANT PROBLEMS FOR RECRUITMENT AND RETENTION
50%
RECRUITMENT
RETENTION
40%
30%
20%
10%
43%
39%
SALARY THAT
0%
IS COMPETITIVE
NACHC.ORG
25%
20%
20%
21%
COMMUNITY
BENEFIT
AMENITIES
PACKAGE
AND OTHER
THAT IS
HEALTH
COMPETITIVE
CENTER LOCATION
FACTORS
9%
5%
CANDIDATES’
LANGUAGE
PROFICIENCY
SKILLS AND/OR
CULTURAL
COMPETENCY
8%
13%
HEALTH
CENTER'S
CURRENT
WORKLOAD
AND/OR
CALL SCHEDULE
4%
4%
HEALTH
CENTER
FACILITY
CONDITION
2%
3%
HEALTH
INFORMATION
TECHNOLOGY
CAPACITY
STAFFING THE SAFETY NET: Building the Primary Care Workforce at America’s Health Centers
FIGURE 7
STAFF HIRED BY HEALTH CENTERS IN THE PAST TWO YEARS
60%
HEALTH PROFESSIONAL WHO
TRAINED AT YOUR FQHC
HEALTH PROFESSIONAL WHO
TRAINED AT ANOTHER FQHC
50%
A VETERAN
CURRENT OR FORMER PATIENT
FORMER COMMUNITY
HEALTHCORPS/AMERICORPS/VISTA
VOLUNTEER
40%
PEACECORPS VOLUNTEER
Note: 18% report “None of the Above” and
30%
6% report “Do Not Know”. Totals do not
equal 100% as repondents were asked
to “Check all that apply.”
20%
10%
0%
58%
FIGURE 8
30%
30%
18%
10%
4%
WHERE HEALTH CENTER STAFF WORK AFTER LEAVING HEALTH CENTER
100%
9%
90%
30%
NEVER
35%
70%
50%
I DON’T KNOW
35%
37%
32%
40%
30%
20%
OCCASIONALLY
RARELY
25%
80%
60%
FREQUENTLY
19%
16%
5%
10%
12%
8%
13%
13%
11%
0%
PRIVATE PRIMARY
CARE PRACTICE
HOSPITAL
ANOTHER HEALTH
CENTER/FQHC
7
IMPORTANCE OF THE NATIONAL HEALTH SERVICE CORPS
The National Health Services Corps (NHSC)
NHSC participants are providing care at a
because of limits in the clinician placement
provides scholarships and loan repayment
health center. More than three-quarters
program’s capacity. Among health centers
to clinicians who commit to serving commu-
of NHSC dentists and dental hygienists,
that indicate they do not currently list posi-
nities federally designated as health profes-
as well as over 60% of NHSC certified
tions with the NHSC, 16% report that they
sions shortage areas, and in doing so serves
nurse midwives, nurse practitioners, and
did not think their qualifying score was high
as an essential pipeline of clinical staff to
physicians are working at a health center.
enough to receive NHSC clinicians.
areas experiencing provider shortages.
While health center providers make up
Most NHSC clinicians continue to practice in
53% of current NHSC participants, 61%
While the NHSC loan repayment and
underserved communities after completing
of current NHSC vacancies are at health
scholarship program is the largest federal
their service obligations, with more than
centers, further highlighting how important
program routing clinicians to underserved
half (55%) continuing to practice in these ar-
health centers find this program for their
areas, some health centers also rely on
eas 10 years later.10 Health centers’ broad
recruitment efforts.11
other federal placement programs, such as
reach into underserved areas makes them
ideal settings for NHSC members.
the NURSE Corps and J-1 Visa Waivers, and
The NHSC field strength is only as vast
many rely on state initiatives to fill critical
as federal funding can support. National
workforce gaps. Without these important
As Figure 9 shows, an analysis of NHSC
survey findings reveal that some health
programs, health center vacancy rates
data reveals that more than half of all
centers have given up on utilizing the NHSC
would be much higher.
FIGURE 9
988
TOTAL NHSC PARTICIPANTS BY PROVIDER TYPE, AND PERCENTAGE OF PARTICIPANTS AT HEALTH CENTERS
225
157
1,617
1,659
972
941
532
171
143
1,127
15
8,547
100%
DENTIST
REGISTERED DENTAL HYGIENIST
CERTIFIED NURSE MIDWIFE
90%
NURSE PRACTITIONER
PHYSICIANS
80%
PHYSICIAN ASSISTANT
LICENSED CLINICAL SOCIAL WORKER
70%
HEALTH SERVICE PSYCHOLOGIST
PSYCHIATRIST
MARRIAGE AND FAMILY THERAPIST
60%
LICENSED PROFESSIONAL COUNSELOR
PSYCHIATRIC NURSE SPECIALIST
50%
TOTAL
40%
Source: NHSC data as of September 30,
2015. Retrieved from Bureau of Health
30%
Workforce, HRSA, DHHS.
20%
10%
79%
0%
NACHC.ORG
78%
68%
66%
62%
60%
37%
29%
25%
20%
16%
13%
53%
! Percent at health centers
STAFFING THE SAFETY NET: Building the Primary Care Workforce at America’s Health Centers
HEALTH PROFESSIONS EDUCATION AND TRAINING IN HEALTH CENTERS
Health centers are active participants in the
monly trained at health centers today. Despite
While local hospitals and/or medical schools
education and training of the next generation
this, a number of key barriers prevent more
are by far the most likely entities to hold the
of primary care providers. Nearly all health cen-
health centers from participating in residency
accreditation for the residency programs in
ters are participating in some kind of education
training programs. Lack of formal relationships
which health centers are participating, more
or training—for students, residents, or both.
with area medical schools and/or teaching hos-
than 1 in 5 (22%) health centers report that
They also play a large role in employing pro-
pitals, lack of space, and budgetary constraints
they now hold the accreditation for their own
viders who have trained in the unique health
or inadequate funding are the most commonly
residency programs (Figure 11).
center setting. Family physician and nurse
cited reasons for not participating in such
practitioner are the provider types most com-
programs (Figure 10).
FIGURE 10
PERCENT OF HEALTH CENTERS REPORTING KEY BARRIERS TO PARTICIPATING IN RESIDENCY TRAINING PROGRAMS
50%
LACK OF FORMAL RELATIONSHIPS WITH AREA MEDICAL
SCHOOLS AND/OR TEACHING HOSPITALS
40%
LACK OF SPACE
BUDGETARY CONSTRAINTS OR INADEQUATE FUNDING
LACK OF KNOWLEDGE IN HOW TO SET UP A HEALTH
PROFESSIONS TRAINING PROGRAM
30%
COMPLEXITY OF SETTING UP RESIDENCY PROGRAM
20%
CONCERN ABOUT LOST PRODUCTIVITY OF HEALTH
CENTER’S STAFF DUE TO TEACHING
DISTRACTION FROM HEALTH CENTER’S SERVICE
MISSION (E.G. PREFER TO FOCUS ON DIRECT CARE)
10%
0%
44%
33%
29%
27%
27%
23%
10%
8%
3%
3%
Note: Includes respondents who indicate they do not participate in residency training programs
(N = 151). Totals do not equal 100% as respondents were asked to "Check all that apply."
FIGURE 11
CONTINUITY OF PATIENT CARE IN LIGHT OF
RESIDENTTURNOVER
PATIENTS’ PERCEPTIONS OF RESIDENTS
MISALIGNMENT OF UNIVERSITY AND HEALTH
CENTER MISSIONS AND/OR APPROACHES TO CARE
ORGANIZATIONS HOLDING THE ACCREDITATION FOR HEALTH CENTERS' RESIDENCY TRAINING PROGRAMS
80%
HOSPITAL/MEDICAL SCHOOL
HEALTH CENTER
70%
OTHER
CONSORTIA
60%
50%
Note: Includes respondents who indicate they
40%
(N = 348). Totals do not equal 100% as
participate in a residency training program
respondents were asked to "Check all that apply."
30%
20%
10%
0%
78%
22%
7%
2%
9
POLICY IMPLICATIONS
Over the past 50 years, health centers have grown from two small
care system, and particularly those faced by health centers, there is no
demonstration grantees to become the largest primary care net-
single silver bullet within federal policy to solve this complex crisis im-
work in the United States, thanks to strong support from Congress
mediately. Rather, America’s Community Health Centers are embrac-
and both Democratic and Republican Presidents. That growth has
ing a platform of policy and systems solutions that together can help
led to a remarkable expansion of access to primary care.
move our system toward one that emphasizes access to high-quality
Yet the full potential of health centers’ historic growth continues to
go unrealized, due primarily to the challenges they face in training,
recruiting and retaining a qualified, culturally competent, mission-driven, and dynamic clinical workforce. Vacancies on a health center’s
clinical staff can have a ripple effect, leading to productivity challenges and an inability to meet surging demand, both major barriers to
patient growth. Indeed, with 95% of health centers reporting at least
one clinical vacancy, they themselves collectively report that 2 million
additional people could be served if these vacancies were filled. Yet
despite these challenges, health centers have proven themselves as
innovators in addressing costly chronic illness and addressing the root
causes of poor health. Health centers are reaching beyond the walls
primary care for all Americans, and especially for the underserved:
 Recruitment and retention incentives like the National Health
Service Corps and other programs must be grown, strengthened, and made to work for all Community Health Centers.
 Training and education of all primary care team members
must continue to move towards the community settings
where they will be providing care upon completion of their
program. And, health centers should have a prominent place
in any reform of our current health professions education
and training system.
 Innovative care models must be embraced and incentivized
of traditional medicine and partnering with other organizations to ap-
with a focus on team-based approaches and greater use of
ply bold community-based solutions to treat population health. They
technology to bridge gaps in care.
are starting food banks and community gardens, providing housing
and job training, and integrating behavioral or oral health with primary
care. In doing so, health centers both empower patients to effectively
manage their health and help reduce health care costs.
When it comes to the workforce challenges faced across the health
Solving America’s primary care workforce
challenges will not happen overnight. Yet around
the country, Community Health Centers are leading
the way with innovative solutions in the face of
major challenges. Policies at all levels should
reward, replicate, and strengthen these efforts.
The health of millions depends on it.
NACHC.ORG
Solving America’s primary care workforce challenges will not
happen overnight. Yet around the country, Community Health
Centers are leading the way with innovative solutions in the face
of major challenges. Policies at all levels should reward, replicate,
and strengthen these efforts. The health of millions depends on it.
STAFFING THE SAFETY NET: Building the Primary Care Workforce at America’s Health Centers
METHODS
NACHC fielded an online survey to all federally-funded health centers between November 2015 and January 2016 to
assess their current clinical vacancies, staffing priorities, perceptions of recruitment and retention challenges, and
participation in programs that place or train clinicians in underserved areas. Some questions had been previously used
in or adopted from a prior validated instrument, and the full survey instrument was reviewed by a national expert panel
made up of academics, health center leaders, and other subject matter experts. Most surveys were completed by the health
center CEO or Director of Human Resources. The final survey sample (N=499, 39% response rate) is representative of
health centers nationally along key characteristics such as size (total patients), patient mix (percent with Medicaid
and percent uninsured), geography (urban/rural location), and costs of care. Findings reflect a given point in time and
therefore health centers’ priorities could change given capacity-building funding opportunities. Some vacancies reflect
existing positions rather than new positions; therefore, NACHC extrapolated findings to estimate the number of new
patients that could be reached nationally if all new positions were filled. This was done by applying the proportions of
health centers with any clinical vacancies and any new positions (95% and 66%, respectively) to the total number of
federally-funded health center organizations nationally (nearly 1,300), and multiplying that by the average number of
patients reached, as reported by survey respondents.
NACHC, 2015. Includes all patients of federally-funded health centers, non-federally funded health centers, and expected patient growth for 2015. Bureau of Primary Health
Care, HRSA, DHHS. 2000 and 2014 Uniform Data System.
1
NACHC. Health Centers Disproportionately Serve Patients with Costly Chronic Conditions. Snapshot. May 2014. Available at http://www.nachc.com/client/documents/High_Cost_
Conditions_2014.pdf.
2
Mukamel DB, White LM, Nocon RS, et al. Comparing the cost of caring for Medicare beneficiaries in federally funded health centers to other care settings. Health Serv Res. 2015
July. Sharma R, Lebrun-Harris LA, Ngo-Metzger Q. Costs and clinical quality among Medicare beneficiaries: Associations with health center penetration of low-income residents.
Medicare Medicaid Res Rev. 2014 Sep 8;4(3). Ku, L et al. Using primary care to bend the curve: Estimating the impact of a health center expansion on health care costs. Policy
Research Brief No. 14. Sept 2009. Geiger Gibson/RCHN Community Health Foundation Collaborative at The George Washington University. NACHC. Health Centers Provide
Cost Effective Care. Fact Sheet. August 2015. Available at http://www.nachc.com/client/documents/Cost%20Effectiveness_FS_2015.pdf. NACHC. Studies of Health Center Cost
Effectiveness. October 2014. Available at http://www.nachc.com/client/documents/HC_Cost_Effectiveness_1014.pdf.
3
Bureau of Primary Health Care, HRSA, DHHS. 2005 and 2014 Uniform Data System.
4
Proser M, Bysshe T, Weaver D, Yee R. Community health centers at the crossroads. JAAPA. April 2015. 28(4). 49-53.
5
NACHC. Assessment of Primary Care Teams in Federally Qualified Health Centers. December 2014. Available at http://www.nachc.com/Patient%20Centered%20Medical%20
Home.cfm.
6
Bureau of Primary Health Care, HRSA, DHHS. 2014 Uniform Data System.
7
The term family physician is used to refer collectively to general/family physicians.
8
AMN Healthcare. 2013 Clinical Workforce Survey: A National Survey of Hospital Executives Examining Clinical Workforce Issues in the Era of Health Reform. 2013. Available at
http://www.amnhealthcare.com/uploadedFiles/MainSite/Content/Healthcare_Industry_Insights/Industry_Research/executivesurvey13.pdf.
9
HRSA, DHHS. NHSC Clinician Retention: A Story of Dedication and Commitment. December 2012. Available at http://nhsc.hrsa.gov/currentmembers/membersites/retainproviders/retentionbrief.pdf.
10
NHSC data as of September 30, 2015. Retrieved from Bureau of Health Workforce, HRSA, DHHS.
11
11
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301-347-0400 | www.nachc.org| Twitter: @NACHC
© National Association of Community Health Centers | March 2016
For more information please email [email protected].