title: Community health centers employ diverse staffing patterns, which can provide productivity lessons for medical practices.
abstract: Community health centers are at the forefront of ambulatory care practices in their use of nonphysician clinicians and team-based primary care. We examined medical staffing patterns, the contributions of different types of staff to productivity, and the factors associated with staffing at community health centers across the United States. We identified four different staffing patterns: typical, high advanced-practice staff, high nursing staff, and high other medical staff. Overall, productivity per staff person was similar across the four staffing patterns. We found that physicians make the greatest contributions to productivity, but advanced-practice staff, nurses, and other medical staff also contribute. Patterns of community health center staffing are driven by numerous factors, including the concentration of clinicians in communities, nurse practitioner scope-of-practice laws, and patient characteristics such as insurance status. Our findings suggest that other group medical practices could incorporate more nonphysician staff without sacrificing productivity and thus profitability. However, the new staffing patterns that evolve may be affected by characteristics of the practice location or the types of patients served.
authors.affiliation: Leighton Ku (lku@gwu.edu) is a professor in the Department of Health Policy, Milken School of Public Health, George Washington University (GWU), in Washington, D.C.
authors.forename: Leighton
authors.initials: L
authors.lastname: Ku
authors.affiliation: Bianca K. Frogner is an associate professor in the Department of Family Medicine at the University of Washington, in Seattle. At the time of this research, she was an assistant professor in the Department of Health Services Management and Leadership, Milken School of Public Health, GWU.
authors.forename: Bianca K
authors.initials: BK
authors.lastname: Frogner
authors.affiliation: Erika Steinmetz is a senior research scientist in the Department of Health Policy, Milken School of Public Health, GWU.
authors.forename: Erika
authors.initials: E
authors.lastname: Steinmetz
authors.affiliation: Patricia Pittman is an associate professor in the Department of Health Policy, Milken School of Public Health, GWU.
authors.forename: Patricia
authors.initials: P
authors.lastname: Pittman
mesh_terms: D057179:Advanced Practice Nursing / Q000458:organization & administration; D003151:Community Health Centers; D004526:Efficiency; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration*; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D011216:Practice Management, Medical / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration; D064876:Safety-net Providers / Q000458:organization & administration; D014481:United States; D000078329:Workforce
keywords: Nurses; Physicians; Primary Care; Safety-Net Systems; Workforce Issues