Many Paths to Primary Care: Flexible Staffing and Productivity in Community Health Centers


  • 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:

    Ku L, Frogner BK, Steinmetz E, Pittman P

  • Journal/Publisher:

    Health Affairs

  • Edition:

    Jan 2015. Vol. 34(1): 95-103

  • Link to Article

    Access the article here: Health Affairs

  • Citation:

    Ku L, Frogner BK, Steinmetz E, Pittman P. Many Paths To Primary Care: Flexible Staffing And Productivity In Community Health Centers. Health Affairs. Jan 2015 Vol. 34(1): 95-103

  • Related Studies:

    Impact of Electronic Health Records on Community Health Center Staffing

Many Paths to Primary Care: Flexible Staffing and Productivity in Community Health Centers


  • 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:

    Ku L, Frogner BK, Steinmetz E, Pittman P

  • Journal/Publisher:

    Health Affairs

  • Edition:

    Jan 2015. Vol. 34(1): 95-103

  • Link to Article

    Access the article here: Health Affairs

  • Citation:

    Ku L, Frogner BK, Steinmetz E, Pittman P. Many Paths To Primary Care: Flexible Staffing And Productivity In Community Health Centers. Health Affairs. Jan 2015 Vol. 34(1): 95-103

  • Related Studies:

    Impact of Electronic Health Records on Community Health Center Staffing