Factors Determining Medical Staff Configurations in Community Health Centers: CEO Perspectives

  • Abstract

    While financial incentives to adopt team-based care are mounting, little is known about how leaders of primary care organizations make decisions regarding medical staff configurations. This study explores perceptions of CEOs of community health centers (CHCs) that have a variety of staff configurations. We used the 2012 Uniform Data System to identify a maximum variety sample of CHCs with unusually high proportions of advanced practice providers, nurses, medical assistants, case managers, or community health workers. We conducted semistructured interviews with CEOs at 19 selected CHCs about factors that influenced their medical staff configuration decisions. We found that CEOs considered two major dimensions in their decisions: choice and balance of providers (physicians versus nurse practitioners [NPs] and physician assistants [PAs]) and configuration of clinical support staff. Across these decision domains, CEOs consider contextual issues (e.g., local labor supply, wage gaps between professions, scope of practice regulations, local payment policies, and institutional history), as well as their own perceptions of individual attributes, the quality of specific professions, and the likelihood of retention. Strong preferences emerged for a balance among physicians and NPs/PAs and the inclusion of nurses with “stackable” degrees. This study provides a preliminary framework for understanding how CEOs at CHCs weigh staffing options in a variety of contexts. This framework can serve to inform research on the comparative effectiveness of different staffing configurations and improve national and state workforce projection models.

  • Authors:

    Pittman P, Masselink L, Bade L, Frogner BK, Ku L

  • Journal/Publisher:

    Journal of Healthcare Management

  • Edition:

    Sep 2016. 61(5):364-377

  • Link to Article

    Access the article here: Journal of Healthcare Management

  • Citation:

    Pittman P, Masselink L, Bade L, Frogner BK, Ku L. Factors Determining Medical Staff Configurations In Community Health Centers: CEO Perspectives. Journal of Healthcare Management. Sep 2016 61(5):364-377