Use of Temporary Primary Care Providers in Federally Qualified Health Centers

Objective This study examines the use of temporary providers in federally qualified health centers (FQHCs) in recent years and identifies associated factors. Methods Using 2013-2017 federal administrative data of 1,028 FQHCs, we describe trends in the number and percentage of FQHCs that used temporary primary care physicians and advanced practice providers (nurse practitioners, physician assistants, and certified nurse midwives). We employed descriptive statistics to compare facility and patient characteristics between FQHCs that used and did not use temporary providers and constructed multivariate linear probability models to identify factors associated with their use. Findings Slightly over one-third of FQHCs used temporary primary care providers during 2013-2017. During this period, fewer FQHCs used temporary family physicians, while more FQHCs used nurse practitioners and physician assistants. Centers that used temporary providers were larger and less rural. Multivariate regression analysis showed that neither Health Professional Shortage Area facility scores (a measure of provider shortage), nor the county primary care provider-to-population ratio, was a predictor of temporary provider usage in FQHCs. Instead, facility regular primary care staff-to-patient ratio was positively associated with use of temporary providers. Conclusion Temporary providers tend to be used in FQHCs where measure of underservice appears to be less severe. Future research should use qualitative interviews or other data sources to explore further the underlying reasons for using temporary providers in FQHCs.