Experiences with Clinical Workforce Vacancies, Recruitment, and - PowerPoint PPT Presentation

1 Community Health Center Experiences with Clinical Workforce Vacancies, Recruitment, and Retention Findings from the 2015-16 National Health Center Clinical Workforce Survey Caitlin Crowley, MPH National Association of Community Health Centers

What are Community Health Centers? 2 • Community, Migrant, Homeless, and Public Housing Health Centers are preventive and primary care providers who: • serve in federally-designated medically underserved areas (MUAs) • are non-profit • offer services on a sliding fee scale to anyone who enters • are governed by a consumer-majority board • employ a broad definition of “health”

Community Health Centers Today 3 • Serving over 24 million patients who are predominantly: • low income (92% <200% FPL) • uninsured (28%) or receiving Medicaid (47%) • members of racial/ethnic minority groups (62%) • suffering from complex chronic conditions • 1,300+ organizations with 9,000+ delivery sites • 170,000+ staff, the majority of whom deliver health and wellness care services • Clinical care staff has nearly doubled since 2005

Survey Overview 4 • GOAL: Assess current clinical vacancies, staffing priorities, perceptions of recruitment and retention challenges, and participation in programs that place or train clinicians in underserved areas • Methods • Online survey fielded to 2014 UDS FQHC CEOs • Fielded Nov 2015 – Jan 2016 • N = 499 (39% response rate) • Representative of health centers national along key characteristics: – Size (total patients) – Patient mix (percent uninsured, Medicaid, etc.) – Geography (urban/rural) – Costs of care

5 Health Centers’ Current Clinical Vacancies

6 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% 56% experiencing at least one opening for a LICENSED PRACTICAL NURSE/LICENSED behavioral health staff member VOCATIONAL NURSE 60% INTERNIST PEDIATRICIAN 50% PSYCHIATRIST DENTAL HYGIENIST OTHER LICENSED MENTAL HEALTH 40% AND/OR SUBSTANCE ABUSE STAFF PHYSICIAN ASSISTANT 30% OBESTETRICIAN/GYNECOLOGIST PSYCHOLOGIST 20% NON-LICENSED MENTAL HEALTH AND/OR SUBSTANCE ABUSE STAFF PHARMACIST 10% CERTIFIED NURSE MIDWIFE VISION SERVICES STAFF 95% 69% 50% 48% 41% 38% 37% 31% 23% 19% 18% 16% 16% 16% 13% 9% 8% 7% 6% 6% 0%

FIGURE 2 AVERAGE HEALTH CENTER CLINICAL VACANCY RATES 7 30% FAMILY PHYSICIAN LICENSED CLINICAL SOCIAL WORKER ALL CLINICAL VACANCIES NURSE PRACTITIONER Health centers have higher average vacancy rates for PSYCHIATRIST physicians that those experienced by hospitals (21% REGISTERED NURSE DENTIST vs. 18%) 20% INTERNIST 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 CERTIFIED NURSE MIDWIFE 25% 17% 13% 13% 13% 12% 12% 10% 8% 8% 7% 7% 7% 6% 5% 5% 4% 3% 3% 3% 0%

FIGURE 3 PERCENTAGE OF HEALTH CENTERS RATING SPECIFIC CLINICAL VACANCIES AS VERY DIFFICULT TO FILL 8 70% FAMILY PHYSICIAN INTERNIST PSYCHIATRIST 60% DENTIST LICENSED CLINICAL SOCIAL WORKER PEDIATRICIAN 50% OBSTETRICIAN/GYNECOLOGIST REGISTERED NURSE PSYCHOLOGIST OTHER LICENSED MENTAL HEALTH 40% AND/OR SUBSTANCE ABUSE STAFF NURSE PRACTITIONER PHARMACIST 30% DENTAL HYGIENIST PHYSICIAN ASSISTANT LICENSED PRACTICAL NURSES/LICENSED 20% VOCATIONAL NURSE 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% 9% 8% 8% 8% 5% 5% 4%

AVERAGE NUMBER OF MONTHS SPENT RECRUITING FOR SPECIFIC CLINICAL VACANCIE S FIGURE 4 9 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 MEDICAL ASSISTANT 12 .7 1 1 .4 1 1 .2 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 0

TOP 5 VACANCIES RATED AS HEALTH CENTERS' HIGHEST PRIORITY TO FILL FIGURE 5 10 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% 51% 10% 8% 6% 5% 0%

11 Health Center Recruitment and Retention Experiences

IMPORTANT PROBLEMS FOR RECRUITMENT AND RETENTION FIGURE 6 12 50% RECRUITMENT RETENTION 40% 30% 20% 10% 43% 39% 25% 20% 20% 21% 9% 5% 8% 13% 4% 4% 2% 3% CANDIDATES’ COMMUNITY BENEFIT HEALTH HEALTH HEALTH 0% SALARY THAT IS COMPETITIVE AMENITIES PACKAGE LANGUAGE CENTER'S CENTER INFORMATION AND OTHER THAT IS PROFICIENCY CURRENT FACILITY TECHNOLOGY HEALTH COMPETITIVE SKILLS AND/OR WORKLOAD CONDITION CAPACITY CENTER LOCATION CULTURAL AND/OR FACTORS COMPETENCY CALL SCHEDULE

STAFF HIRED BY HEALTH CENTERS IN THE PAST TWO YEAR S FIGURE 7 13 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 40% VOLUNTEER 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% 58% 30% 30% 18% 10% 4% 0%

FIGURE 8 WHERE HEALTH CENTER STAFF WORK AFTER LEAVING HEALTH CENTER 14 100% FREQUENTLY 9% OCCASIONALLY 90% RARELY 25% 30% NEVER 80% I DON’T KNOW 35% 70% 60% 35% 37% 50% 32% 40% 30% 19% 16% 20% 13% 8% 5% 10% 12% 13% 11% 0% PRIVATE PRIMARY HOSPITAL ANOTHER HEALTH CARE PRACTICE CENTER/FQHC

15 Health Centers and the National Health Service Corps

TOTAL NHSC PARTICIPANTS BY PROVIDER TYPE, AND PERCENTAGE OF PARTICIPANTS AT HEALTH CENTERS FIGURE 9 16 DENTIST 988 225 157 1,617 1,659 972 941 532 171 143 1,127 15 8,547 100% REGISTERED DENTAL HYGIENIST CERTIFIED NURSE MIDWIFE 90% NURSE PRACTITIONER PHYSICIANS 80% PHYSICIAN ASSISTANT LICENSED CLINICAL SOCIAL WORKER 70% HEALTH SERVICE PSYCHOLOGIST PSYCHIATRIST 60% MARRIAGE AND FAMILY THERAPIST LICENSED PROFESSIONAL COUNSELOR 50% PSYCHIATRIC NURSE SPECIALIST TOTAL 40% Source: NHSC data as of September 30, 2015. Retrieved from Bureau of Health 30% Workforce, HRSA, DHHS. 20% 10% ! 79% 78% 68% 66% 62% 60% 37% 29% 25% 20% 16% 13% 53% Percent at health center s 0%

17 Health Professions Education and Training in Health Centers

18 PERCENT OF HEALTH CENTERS REPORTING KEY BARRIERS TO PARTICIPATING IN RESIDENCY TRAINING PROGRAMS FIGURE 10 50% LACK OF FORMAL RELATIONSHIPS WITH AREA MEDICAL SCHOOLS AND/OR TEACHING HOSPITALS LACK OF SPACE 40% BUDGETARY CONSTRAINTS OR INADEQUATE FUNDING LACK OF KNOWLEDGE IN HOW TO SET UP A HEALTH 30% PROFESSIONS TRAINING PROGRAM 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 10% MISSION (E.G. PREFER TO FOCUS ON DIRECT CARE) CONTINUITY OF PATIENT CARE IN LIGHT OF 44% 33% 29% 27% 27% 23% 10% 8% 3% 3% 0% RESIDENT TURNOVER PATIENTS’ PERCEPTIONS OF RESIDENTS Note: Includes respondents who indicate they do not participate in residency training programs MISALIGNMENT OF UNIVERSITY AND HEALTH (N = 151). Totals do not equal 100% as respondents were asked to "Check all that apply." CENTER MISSIONS AND/OR APPROACHES TO CARE

19 ORGANIZATIONS HOLDING THE ACCREDITATION FOR HEALTH CENTERS' RESIDENCY TRAINING PROGRAMS FIGURE 11 80% HOSPITAL/MEDICAL SCHOOL HEALTH CENTER 70% OTHER CONSORTIA 60% Note: Includes respondents who indicate they 50% participate in a residency training program (N = 348). Totals do not equal 100% as 40% respondents were asked to "Check all that apply." 30% 20% 10% 78% 22% 7% 2% 0%

Main Takeaways 20 • 95% of health centers currently experiencing at least one clinical vacancy • Two million more patients could be served if all health center clinical vacancies were filled today. • Family physicians • Recruitment and retention challenges: sharp competition, location • Reliance on national network of health centers for recruitment • Continued relationship with and reliance on NHSC • Many health centers participating in health professions training; lack of formal relationships with area medical schools/teaching hospitals and lack of resources stopping more from doing so

Limitations 21 • Survey = potential for recall bias • 39% response rate • Focused on clinical workforce only • New funding opportunities can influence current vacancies + hiring priorities • e.g. new oral health funding

Questions? 22 Caitlin Crowley, MPH Policy Research Analyst National Association of Community Health Centers ccrowley@nachc.org | 202.331.4617