Medical staff shortages threaten planned expansion of nation's community health centers

February 28, 2006

Shortages of physicians may threaten the planned expansion of the nation's Community, Migrant, Public Housing, and Homeless Health Centers, concludes a study released this week in the Journal of the American Medical Association. Health Centers are the centerpiece of the federal government's strategy to provide health care to millions of uninsured Americans.

Health Centers now provide medical, dental, and mental health care to more than 15 million Americans in more than 3,600 communities across the country. There are Community Health Centers in every state and in the District of Columbia.

The study reports that the nation's Health Centers, which serve vulnerable populations including the uninsured, migrant workers, and the homeless, have more than 400 vacant positions for family physicians, the largest physician specialty upon which these clinics depend. The number of unfilled positions is particularly high in rural areas.

The problem may become worse because of recent cuts in federal funding for training family physicians, and recent declines in the number of medical students choosing to specialize in family medicine or in other primary-care fields, such as internal medicine or pediatrics. Compounding the problem is the fact that the number of primary-care physicians is not keeping up with need. According to a recent American College of Physicians report, the number of primary-care physicians who are retiring is greater than the number of primary-care physicians graduating from medical schools.

More than 45 million Americans lack health insurance, and 36 million lack access to basic health care, according to the National Association of Community Health Centers (NACHC). The United States government is investing substantial amounts of money in starting new Health Centers, and in expanding existing ones to address the problem of the medically underserved and the uninsured. Health Centers provide high-quality primary care in out-patient settings, and employ primary-care physicians, obstetricians, psychiatrists, dentists, pharmacists, mental health workers, nurse practitioners, and physician assistants to provide that care.

In addition to facing shortages of family physicians, Health Centers are also having considerable difficulty recruiting obstetricians (doctors who provide prenatal care and deliver babies), psychiatrists, and dentists. More than 25 percent of the funded positions for these three disciplines are unfilled in the nation's rural Community Health Centers. The study also found that Health Centers in general are highly dependent on other federal programs such as the National Health Service Corp, and state programs that re-pay educational loans for physicians who choose to work in medically underserved settings.

Yet federal programs, such as the National Health Service Corp, are in danger of being cut. Cuts in the programs health centers rely on to provide needed medical care, coupled with the shrinking number of primary-care physicians, suggests a bleak future for Health Centers and the patients they serve.

In their article, "Shortages of Medical Personnel at Community Health Centers: Implications for Planned Expansion," the researchers suggest several interventions that could improve staffing of Health Centers. These include increasing Title VII funding, which is the health professions training program that supports the education of primary-care physicians; offering more scholarships and loan repayment programs for clinicians working in Community Health Centers; and expanding other federal and state programs that support practitioners who wish to provide care to vulnerable and uninsured populations. Attracting doctors and nurses to rural areas may require additional measures, such as increases in financial bonuses, already provided by Medicare, to rural physicians.

The study will appear in the March 1, 2006, issue of the Journal of the American Medical Association. The authors are Dr. Roger Rosenblatt, University of Washington (UW) professor and vice chair of the Department of Family Medicine; Holly Andrilla, research scientist at the UW School of Medicine's Rural Health Research Center; Dr. Gary Hart, UW professor of family medicine and director of the Health Workforce Center and the Rural Health Research Center at the UW; and Dr. Tom Curtin, medical director of the National Association of Community Health Centers in Bethesda, Md.

An accompanying editorial by Dr. Christopher Forrest, of the Johns Hopkins Bloomberg School of Public Health in Baltimore, discusses the implications of the shortage of primary-care physicians on the nation's health-care safety net. The editorial comments: "The study by Rosenblatt and his colleagues... provides sobering evidence that recent workforce trends may be adversely affecting access to primary care for the nation's most vulnerable populations ...

University of Washington

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