Association for Public Policy Analysis & Management

Research Objective: It is recognized that a facility uses temporary staff to fill in the temporal leaving of existing providers or to fill vacancies when they are unable to recruit a regular staff. However, empirical evidence is lacking to understand whether community health centers (CHCs) use temporary staff as a strategy to solve staffing shortages. This analysis tracks the recent trends in the use of temporary staff for primary care services in CHCs and explores key factors associated with the use of temporary staff.

Study Design: Data were from 2013-2017 Uniform Data System that documents grantee-level information of all federally-funded health centers. Study outcome is a binary variable indicating health centers reported use of temporary staff in primary care medical services during 2013-2017, including family physicians, internists, obstetrician-gynecologists, pediatricians, nurse practitioners, physician assistants, and nurse midwives. Descriptive analysis was conducted to track trends in the use of temporary staff in CHCs overall and by rural-urban location and Medicaid expansion status. We compared facility and patient characteristics between centers used and did not use temporary staff and used multivariable linear probability regression to examine the relationship between use of temporary staff and key explanatory variables.

Population Studied: 1,384 unique CHCs (6,446 observation-years) from 2013-2017.

Principal Findings: During 2013-2017, there was a decline in the use of temporary primary care providers in CHCs (36% in 2013 vs. 32% in 2017), and the drop was driven by the decline in the use of temporary family physicians (22% in 2013 vs. 17% in 2017). We observed that the use declined before 2015 but went up after 2015 in urban centers, with an opposite trend observed in rural centers. Centers in Medicaid expansion states had a bigger decline compared to centers in non-expansion states. Centers that used temporary staff are larger, more urban, and more likely to have patients who are Hispanic, non-English spoken, low-income, and covered by Medicaid. We find that higher facility staff FTEs, larger patient flows, location in Medicaid expansion states, increases in federal grant amount, reporting of open position, and a higher percent of uninsured patients are positively associated with the overall use of temporary primary care providers, while rural location, county health outcome ranking, and county preventable hospitalization rate are negatively associated with the use of temporary providers. No association was found between the use of temporary providers and HPSA facility scores and county provider-to-population ratio.

Conclusions: These findings indicate that CHCs may use temporary staff as a strategy to complement the existing workforce, rather than using them to solve staffing shortages.

Implications for Policy or Practice: The downward trend in the use of temporary staff is likely driven by the Medicaid expansion, possibly because centers gained revenue to attract and hire more regular staff. Using temporary staff, especially providers from locum agencies and on-call providers, is expensive and could undermine care quality. CHCs should carefully and strategically make use of this type of providers – efficiently use can increase staff flexibility while inefficiently use can harm patient care capacity.