The Community Health Center

The Affordable Care Act is providing $9.5 billion for expanded services and $1.5 billion for construction and renovation projects towards community health centers.  Here is the problem. A lot of physicians don’t want to work there.  Researchers analyzed the responses of 129 family physicians working at community health centers and compared them with 764 family doctors practicing in other settings and found that those  who work in community health centers are not as satisfied with their employers as colleagues working in other types of facilities.   Now you can see why other studies have indicated that community health centers have a difficult time recruiting and retaining doctors.  The referenced American Medical News did a great job listing the issues:

  • 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.
  • 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.

They say that the barriers to recruitment include low salaries, cultural isolation and poor-quality schools and housing.  Yeah, that will do it.   These FQHC practices have a tough clientele.  I worked at one for 10 years.   There needs to be an incentive to work there (cash).  Right now, there are a lot of J-1 docs (foreign) or others needing loans that use these jobs as a springboard to move on to to better things.  This in fact may skew these results but the bottom line is that these centers are needed so doctors (YES, DOCTORS) need to be there.  So what is the issue?  I am not sure.   There probably is enough money going to these community centers but there just isn’t enough of it going to the physician to make it worthwhile for them.  The gov’t usually pay about $100 per visit for each patient no matter what the complaint is so this easily could be a lucrative job.  Alas, someone else (administrators?) is getting that cash and paying family docs chump change.   Sure they try to convince them that this is charity work but it can only work for so long.  And so the system is crumbling.


Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  1 comment for “The Community Health Center

  1. Jane Zendarski,D.O.
    July 26, 2012 at 7:44 am

    I worked at a community Health center in Rochester, NY From 1998-2000 during my fellowship and I loved it. I was to come on as a staff physician after fellowship but the Feds placed a job freeze. I was disappointed. I loved the diversity of the patient population. The physicians and staff had a strong commitment to the underserved. The physicians were there to stay and serve. I was sorry I couldn’t stay.

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