abstract: 'Context The US government is expanding the capacity of community health

  centers (CHCs) to provide care to underserved populations.

  Objective To examine the status of workforce shortages that may limit

  CHC expansion.

  Design and Setting Survey questionnaire of all 846 federally funded US

  CHCs that directly provide clinical services and are within the 50

  states and the District of Columbia, conducted between May and September

  2004. Questionnaires were completed by the chief executive officer of

  each grantee. Information was supplemented by data from the 2003 Bureau

  of Primary Health Care Uniform Data System and weighted to be nationally

  representative.

  Main Outcome Measures Staffing patterns and vacancies for major clinical

  disciplines by rural and urban location, use of federal and state

  recruitment programs, and perceived barriers to recruitment.

  Results Overall response rate was 79.3\%. Primary care physicians made

  up 89.4\% of physicians working in the CHCs, the majority of whom are

  family physicians. In rural CHCs, 46\% of the direct clinical providers

  of care were nonphysician clinicians compared with 38.9\% in urban CHCs.

  There were 428 vacant funded full-time equivalents (FTEs) for family

  physicians and 376 vacant FTEs for registered nurses. There were

  vacancies for 13.3\% of family physician positions, 20.8\% of

  obstetrician/ gynecologist positions, and 22.6\% of psychiatrist

  positions. Rural CHCs had a higher proportion of vacancies and

  longer-term vacancies and reported greater difficulty filling positions

  compared with urban CHCs. Physician recruitment in CHCs was heavily

  dependent on National Health Service Corps scholarships, loan repayment

  programs, and international medical graduates with J-1 visa waivers.

  Major perceived barriers to recruitment included low salaries and, in

  rural CHCs, cultural isolation, poor-quality schools and housing, and

  lack of spousal job opportunities.

  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.'
affiliation: 'Rosenblatt, RA (Corresponding Author), Univ Washington, Dept Family
  Med, Rural Hlth Res Ctr, Box 354696, Seattle, WA 98195 USA.

  Univ Washington, Dept Family Med, Rural Hlth Res Ctr, Seattle, WA 98195 USA.

  Natl Assoc Community Hlth Ctr, Bethesda, MD USA.'
author: Rosenblatt, RA and Andrilla, CHA and Curtin, T and Hart, LG
author-email: rosenb@u.washington.edu
author_list:
- family: Rosenblatt
  given: RA
- family: Andrilla
  given: CHA
- family: Curtin
  given: T
- family: Hart
  given: LG
da: '2023-09-28'
doi: 10.1001/jama.295.9.1042
eissn: 1538-3598
files: []
issn: 0098-7484
journal: JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION
keywords-plus: 'PHYSICIAN WORKFORCE; FAMILY PHYSICIANS; SERVICE-CORPS; FOLLOW-UP;
  CARE;

  AREAS; RETENTION; URBAN; RECRUITMENT; EXPERIENCE'
language: English
month: MAR 1
number: '9'
number-of-cited-references: '61'
pages: 1042-1049
papis_id: cef0d602941975eb78cca77b9226d44d
ref: Rosenblatt2006shortagesmedical
researcherid-numbers: Andrilla, Holly/AAC-6264-2019
times-cited: '218'
title: Shortages of medical personnel at community health centers - Implications for
  planned expansion
type: Article
unique-id: WOS:000235656600024
usage-count-last-180-days: '0'
usage-count-since-2013: '27'
volume: '295'
web-of-science-categories: Medicine, General \& Internal
year: '2006'