Tuesday, January 18, 2011

The New Deal for Primary Care in Community Health Centers

(Image of Codman Square CHC's proposed expansion under the new federal grants. Founded in 1974, Codman Square is a FQHC located in Dorchester, MA)

2011 marks the 46th anniversary of the creation of community health centers (CHCs), which were originally created as part of the "war on poverty" in 1975. The importance of CHCs has continued to grow over the past 46 years and CHCs have continued to receive increased federal support, in large part due to bipartisan support.

One of the primary aims of community health centers is to provide good, comprehensive primary care to members of the community that it serves. CHCs disproportionately serve low-income, minority populations. 89.4% of physicians at CHCs nationally are primary care physicians and, of PCPs, 53.8% are family physicians (Rosenblatt et al, 2006). Family medicine's service model is uniquely fitted to the aims of community health centers since both aim to provide comprehensive, community-oriented care.

The large role that family medicine plays in CHCs means that the new funding and planned expansions for CHCs in the health care reform bill brings new opportunities for the specialty of family medicine! In the Patient Protection and Affordable Care Act (PPACA) passed in March 2010, $11 billion were appropriated for Community Health Center capital development grants. $9.5 billion are allocated for creation of new CHCs and expansion of existing CHCs. $1.5 billion are allocated to renovation and upkeep of existing aging CHC facilities. Currently, CHCs serve 20 million patients nationwide. By 2015, they are projected to serve twice that number, 40 million patients nationwide.

Since CHCs predominately provide for underserved populations, this increase will expand access to care to many uninsured patients and also insured patients who have been unable to find a regular primary care physician.

The expansion, while bringing increased opportunities for family physicians and other primary care doctors, also brings another question. Will there be enough FM doctors and PCPs to fill the provider positions that will become available at these new and expanded CHCs? Already, in 2006, a study showed that the average CHC has 13.3% of its family physician positions unfilled. This percentage is even larger in rural areas. This number will only increase if current trends in the primary care workforce shortage continue.

What are some effective recruitment techniques that CHCs are using?
  • loan repayment: the National Health Service Corps (NHSC) and some state programs provide student loan repayment to physicians who are willing to work at CHCs. The PPACA adds $1.5 billion to NHSC funding and will add an estimated 15,000 PCPs in shortage areas.
  • J-1 visa exemptions: popular among IMGs who do not have legal residency in the US as a means of staying in the USA after residency training (IMGs who come on a J-1 visa for GME training typically have to return to their home country for 2 years following residency unless they receive a J-1 visa exemption; one of the means of receiving a J-1 visa exemption is by serving at a CHC following residency)

These methods of recruitment and other movements within primary care fields provide hope for provider shortages at community health centers. However, we will need to continue to find solutions to recruit PCPs to CHCs and, more importantly, to retain those we already have, if we are to continue to provide quality care and increased access to care through the community health center model.

Rosenblatt RA, Andrilla CHA, Curtin T, Hart LG. Shortages of Medical Personnel at Community Health Centers. JAMA 2006;295:1042-1049.

National Association of Community Health Centers. Community Health Centers and Health Reform: Summary of Key Health Center Provisions. http://www.nachc.com/client/Summary%20of%20Final%20Health%20Reform%20Package.pdf

Ku et al. Using Primary Care to Bend the Curve: The Effect of National Health Reform on Health Center Expansions. Geiger Gibson/RCHN Community Health Foundation. June 30 2010. Policy Research Brief No. 1.

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