Physicians at community health centers less satisfied than those in other settings

Family physicians who work in community health centers are not as satisfied with their employers as colleagues working in other types of facilities, said a study in the July/August Journal of the American Board of Family Medicine.

Researchers analyzed the responses of 129 family physicians working at community health centers and compared them with 764 family doctors practicing in other settings (link).

Respondents had similar levels of contentment with hours and income, but only 62% of physicians at community health centers were highly satisfied with their employer. Seventy-three percent of doctors in other environments reported high levels of satisfaction.

The authors are concerned about the findings because studies have indicated that community health centers have a difficult time recruiting and retaining doctors. At the same time, the Affordable Care Act is providing $9.5 billion for such centers to expand services and $1.5 billion for construction and renovation projects.

“Community health centers provide really important services for underserved populations, and, if they are going to expand, they have to be successful in recruitment and retention of physicians,” said Allison M. Cole, MD, MPH, lead study author and assistant professor of family medicine at the University of Washington School of Medicine in Seattle.

A survey of 795 federally qualified health centers published May 27, 2010, by the Commonwealth Fund found only 37% reported an adequate physician work force (link).

A separate survey of 856 federally funded community health centers published March 1, 2006, in The Journal of the American Medical Association found 13.3% of family physician and 20.8% of obstetrician-gynecologist positions were vacant (link).

Barriers to recruitment included low salaries, and, for facilities in rural areas, cultural isolation and poor-quality schools and housing.

Physicians working in community health centers say the setting is not for everyone. They said the report in the Journal of the American Board of Family Medicine may be skewed because it looked only at physicians less than three years out of residency. The doctors may have been working at the centers to take advantage of the generous loan repayment programs available for doing so, they said. Surveys of doctors who work at such centers for longer periods may find different levels of satisfaction, say physicians at community centers.

Gary Wiltz, MD, chair-elect of the National Assn. of Community Health Centers, started working at a health center 30 years ago. Initially, he counted down the days on a wall calendar until his student loans were repaid and he could practice elsewhere.

“It’s a very, very difficult patient population with a high rate of uninsurance and high poverty level,” Dr. Wiltz said. “They’re good folks, but they have a lot of problems and limited resources.”

He didn’t leave and grew to like the population and the community health center’s team approach. He is now CEO of the Teche Action Board’s clinic, a community health center in Franklin, La.

“We have lost some physicians,” Dr. Wiltz said. “It takes special people to work here, and there is an adjustment period. But the people are so grateful for the services that they receive.”