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.

Impact of state nurse practitioner scope-of-practice regulation on health care delivery: Systematic review

“…Rural hospitals located in states granting prescriptive authority to NPs were 30% more likely than rural hospitals in states without this authority to establish a provider-based rural health clinic, which are designed to stimulate the use of NPs and PAs to improve access to primary care in underserved rural areas (Krein, 1999 (continued on next page) N u r s O u t l o o k 6 4 ( 2 0 1 6 ) 7 1 e 8 5 (continued on next page) N u r s O u t l o o k 6 4 ( 2 0 1 6 ) 7 1 e 8 5 (continued on next page) N u r s O u t l o o k 6 4 ( 2 0 1 6 ) 7 1 e 8 5 providers for medically underserved populations, were more likely to hire additional NPs if located in states with more positive practice environments (Shi & Samuels, 1997). This finding was confirmed in a recent study by Ku, Frogner, Steinmetz, and Pittman, (2015) who found that SOP regulation was one of the most important determinants of staff composition in federally funded community health centers. Community health centers located in states with full SOP regulations used slightly fewer physicians and slightly more advanced practice staff including NPs, PAs, and certified nurse-midwives.…”

“…Community health centers located in states with full SOP regulations used slightly fewer physicians and slightly more advanced practice staff including NPs, PAs, and certified nurse-midwives. Community health centers benefited from full SOP regulation by having more flexibility in staffing choice, which is especially significant given these centers are located in areas with a short supply of PCPs (Ku et al, 2015).…”

The Impact of Establishing a Full Scope of Practice for Advanced Practice Registered Nurses in the State of Indiana

“…A report by Westat (2015) found that NPs were 3 percentage points more likely to work in direct patient care, and no more likely to work in primary care, in states with full SOP (both practice and prescription authority) compared with states that had reduced SOP. Ku et al (2015) found that states with full practice and prescription authority had 2 percent more advanced practice staff (NPs, physician assistants, and CNMs) in community health centers and 2 percent fewer physicians. We cannot determine the specific effect for any particular APRN (NPs and CNMs) in this study because all APRNs were combined with other advanced practice clinical staff (for example, physician assistants).…”

Patient Perception and Choice Factors Related to International Hospitals: A Study in Ho Chi Minh City, Vietnam

“…The findings should be interpreted cautiously and broader generalizations may not be made. That said, regional factors and diversity across patient samples aside, the findings should be able valid to other population groups [13,[46][47][48][49].…”