Advancing Primary Care

Grantee Name

Community Health Care Association of New York State, Inc.

Funding Area

Advancing Primary Care

Publication Date

September 2017

Grant Amount

$350,000

Grant Date:

October 2015 – March 2017

The Affordable Care Act greatly increased the number of New Yorkers served by federally qualified health centers (FQHCs).

To provide care for the newly insured and to create a strong safety net for those who remained uninsured, FQHCs needed to increase their capacity to provide quality primary care. An NYSHealth-funded report, developed by the Community Health Care Association of New York State (CHCANYS) in 2013, was the first-ever New York State plan to identify ways for existing health centers to increase productivity and fill vacancies among clinical provider staff. One of the report’s key findings was that expanding established provider recruitment and retention programs to fill existing vacancies could produce 720,000 more visits for more than 155,000 patients. NYSHealth awarded CHCANYS a subsequent grant to take action on the report’s findings and address workforce shortages identified in the statewide plan by increasing FQHCs’ use of State and federal scholarship and loan repayment programs and improving their ability to recruit and retain providers.

State and federal scholarship and loan repayment programs exist to encourage primary care providers to make service commitments to and practice in low-income and federally designated Health Professional Shortage Areas (HPSAs) in exchange for medical school loan forgiveness. In New York State, it is conservatively estimated that more than 4 million people live in HPSAs. Use of these programs has been low, though; prior to this grant, only 263 providers in New York State were participating. To bolster recruitment and retention at their sites, FQHCs can also apply to these loan repayment programs for open slots and hire providers to fill them. However, most FQHCs in the CHCANYS network were either unaware of or lacked the resources to take advantage of these programs.

 

Outcomes and Lessons Learned

  • Provided technical assistance to 63% of FQHCs in the State to help them take advantage of recruitment and retention programs (exceeding its goal of 50% of all FQHCs);
  • Increased FQHC participation in scholarship and loan repayment programs by 68% (exceeding its goal of 10%). As a result, FQHCs were offered an additional 443 slots to recruit new providers in exchange for loan forgiveness. CHCANYS estimated that filling all of these slots would help serve an additional 200,000 patients a year;
  • Conducted a workforce survey, in collaboration with the Center for Health Workforce Studies, to identify recruitment/retention needs and trends, as well as use of and challenges to service-oriented programs;
  • Released a report in August 2017, “FQHC Utilization of State and Federal Loan and Scholarship Programs to Support Clinician Recruitment,” with recommendations for improving FQHC recruitment and retention strategies; and
  • Used report recommendations to provide one-on-one technical assistance to 11 high-need FQHCs in Central and Western New York to create and implement new recruitment and retention processes. As a result, 90 licensed providers were recruited to these sites during 2016–17, including medical, behavioral health, and dental providers.

CHCANYS will follow up with the sites served by this project in May 2018 (one year after the grant closed) to assess how many of the 443 slots offered to the FQHCs have been filled by providers.

As FQHCs are often understaffed and have to balance many competing priorities, some of the project activities were difficult to carry out. For example, scheduling time with the FQHCs for coaching calls, meetings, and on-site visits to provide technical assistance was challenging. CHCANYS was not able to receive as many completed workforce surveys from the FQHCs as it had sought. Some health centers were also resistant to new recruitment strategies; most FQHCs focus on recruiting mission-driven candidates for employment. Although important, this focus sometimes excludes attention to the possibility of new compensation options.

Prior to this grant, many FQHCs were unaware of or had been unclear about repayment programs’ application guidelines, deadlines, and funding limitations. For example, the application cycle for the State’s loan repayment program, Doctors Across New York (DANY), was inconsistent and its requirements changed, making it difficult for FQHCs to take advantage of this opportunity. To address this issue, CHCANYS provided DANY with recommendations for improvements intended to make it easier for FQHCs to apply in the future.

Co-Funding and Additional Funds Leveraged: N/A