198734 Struggling to stay afloat with health care reform: A community health center recruitment and retention primary care physician study

Monday, November 9, 2009

Judith Savageau, MPH , Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA
Donna E. Johnson, MSW, LICSW , Division of Primary Care and Health Access, Massachusetts Department of Public Health, Boston, MA
Linda Cragin, MS , MassAHEC Network, University of Masschusetts Medical School, Shrewsbury, MA
Joan Pernice, RN, MS , Clinical Affairs Department, Massachusetts League of Community Health Centers, Boston, MA
Joan Bohlke, MS , MassAHEC Network, University of Masschusetts Medical School, Shrewsbury, MA
Julia Dyck, MPA/H , Division of Primary Care and Health Access, Massachusetts Department of Public Health, Boston, MA
Warren J. Ferguson, MD , Department of Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA
  
Background: When Massachusetts implemented universal health insurance coverage in 2006, community health centers (CHCs) were on the primary care front line. The CHC primary care physician (PCP) shortage heightened as many community-based physicians' practices closed. This study's objective was to characterize Massachusetts' CHC PCP workforce and identify factors related to preparedness, recruitment and retention.

Methods: An on-line cross-sectional survey was emailed to 572 PCPs at 62 CHCs asking about physician sociodemographic and practice characteristics, medical education, and factors related to preparedness, recruitment and retention.

Results: With 58% responding, CHC PCPs are predominantly female, white, non-Hispanic, work full-time, speak 1+ additional non-English language, and have been in practice an average of 13 years. 16% are foreign-trained; 22% had medical education debt over $100,000; and 19% currently participate in visa/loan repayment programs. Recent graduates felt significantly more prepared to work with non-English speaking patients and multi-disciplinary teams. In selecting a CHC, compelling factors were working for an organization whose mission the physician could believe in, working in a severe medical need area, and the geographic region. Primary care compensation was recognized as an important concern. However, once a commitment is made to primary care, other factors emerge as more important to retention: work/life balance, support staff, and professional development support.

Conclusions: With national focus on health care reform, these results indicate opportunities to inform the CHC PCP pipeline. Addressing compensation is one strategy; equally important are PCP-identified priorities to help retain those who plan to remain and those undecided about their future.

Learning Objectives:
1. Describe the key factors related to recruitment and retention of primary care providers within the community health center setting. 2. Assess physician sociodemographic and practice characteristics related to both the recruitment and retention processes in light of health care reform practices ongoing in our state. 3. Identify implications of our survey findings for primary care practice.

Keywords: Community Health Centers, Underserved Populations

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have conducted numerous workforce studies both within the community health center environment as well as in rural health areas and have been a co-author on a number of these projects. I have been a major contributor in the development and conduct of this project and am leading several efforts to disseminate these results.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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