Pros and Cons of Community Health Center?

[ettezag]

Hello, I am a new grad who has a couple of interviews coming up with CHCs and I would love input from PAs who have experience working with CHCs. 

What in your opinion were the pros/cons, what are the unique challenges of being a primary care PA at a CHC?

Also, greatly appreciate input on what are some important questions to ask during the interview. 

Thanks for your time!

 

[sas5814]

You will be working with the most unhealthy, uneducated, sick people with no resources for health care who, if you say "healthy lifestyle" will look at you like you are stupid.

If you are angel heart and feel a drive to help poor folks who need a lot it is a good place to be. As a new grad, and I mean no insult, I doubt you are even close to being prepared for this patient population. I was a 25 year PA from the military and rural health under-served area experience and it was a challenge every day. My frustration with people who had  no means to get health care but also wouldn't do basic things to care for themselves burned me out fast.

[BruceBanner]

^Scott nailed it. I have 'indirect' experience with this population--- I havent worked in a CHC but have worked with the demographic, and had a friend who managed a chain of local CHCs. I totally concur with Scott.

They will fill your schedule to the brim with the most demanding, uneducated, unhealthy, often non-English speaking people who have cascades of problems, and as a new grad you will be so overwhelmed I think this is a recipe for disaster.

My friend said the providers in his clinics would typically see 20-30 ppd, which is a huge load for this population. They had a high provider turnover, not surprisingly.

At any job interview I ask them about explicit ppd expectations, double bookings, no show rates, late arrival policies, overtime, inbox load, and the obvious scheduling questions. Ask everyone you interview with these questions and try to talk to a PA who works there over email or the phone if possible. Vague answers are usually a bad sign.

 

[sas5814]

Let me add these places live and die by grants and you, the provider, have to follow the terms of the grant even when it doesn't jibe with current standards of practice.

[ettezag]

Thank you both for replying, appreciate it!   

It's been a difficult market for me as a new graduate so I am thankful for the opportunity to interview but at the same time I want to make sure my first job will provide a strong foundation and support.  One position has a 5 month onboarding process, which is great but I will have to definitely ask all the questions you both brought up.  

Anyone have any positive experiences?

[Randito]

I worked in a large community health group for about a year and agree with much of what was said. It was my first time practicing primary care and I felt very overwhelmed, not entirely with the patient population, but with the volume and lack of meaningful support. The double booking and walkins are what kill you especially when the front office has no idea what triage is. As a provider you can can’t possibly do much for a 10 minute walkin that is new to your clinic with shortness of breath and laundry list of co-morbidities or a domestic abuse victim with a facial lac or many of the other patients that should have gone the ED. But your going to want to do something and your management will expect you to see them. Revenue is base on numbers, not necessarily the quality of care provided. And I was seeing max 24 patients per day, I know many providers who see closer to 30.

The docs that I worked with were great, but they were also seeing patients every 15 -20 minutes and didn’t have time for more than a quick questions or 2. I actually found more support from the other PAs and NPs. It didn’t help that my assigned supervising physician was not at my clinic site. 

I will say that the relationship that I had with many of my patients was by far the best part of the position. I had multiple patients start crying when I told them that I was leaving. The frequent provider turnover is very hard on them as well and only further ingrains mistrust in the medical system. I also felt that I learned a lot of medicine in that year that I can still apply to my current practice. 

[electric130]

Agree with everything stated above.  It may be a really good learning experience, but I would try to get a really good idea of how many patients they expect you to see a day and make sure someone is on site that you can ask questions.  If you are limited in your offers it wouldn't necessarily be terrible to take as a new grad, just make sure you have support.  

That demographic is difficult, I have not done community health but see a very large percentage of that demographic and even for a seasoned provider it wears you down.   

[ettezag]

Thank you everyone for your detailed, honest answers!  I have a better idea of what questions to really ask in detail and consider as I prepare for my interviews.  I appreciate the support!

[ettezag]

1 hour ago, Randito said:

I worked in a large community health group for about a year and agree with much of what was said. It was my first time practicing primary care and I felt very overwhelmed, not entirely with the patient population, but with the volume and lack of meaningful support. The double booking and walkins are what kill you especially when the front office has no idea what triage is. As a provider you can can’t possibly do much for a 10 minute walkin that is new to your clinic with shortness of breath and laundry list of co-morbidities or a domestic abuse victim with a facial lac or many of the other patients that should have gone the ED. But your going to want to do something and your management will expect you to see them. Revenue is base on numbers, not necessarily the quality of care provided. And I was seeing max 24 patients per day, I know many providers who see closer to 30.

The docs that I worked with were great, but they were also seeing patients every 15 -20 minutes and didn’t have time for more than a quick questions or 2. I actually found more support from the other PAs and NPs. It didn’t help that my assigned supervising physician was not at my clinic site. 

I will say that the relationship that I had with many of my patients was by far the best part of the position. I had multiple patients start crying when I told them that I was leaving. The frequent provider turnover is very hard on them as well and only further ingrains mistrust in the medical system. I also felt that I learned a lot of medicine in that year that I can still apply to my current practice. 

Thank you for this detailed response! As a new graduate, what would you consider a reasonable number of patients to see at the 6 month mark and at the 1 year mark? 

[aimyhtixela]

I'm a new grad almost 6 months in working at a CHC in FM. A lot has been said already but I think it is very dependent on the organization. I interviewed at dozens around the country and I can tell you that CHCs come in different flavors. My two cents:

1. Look into their leadership as that will tell you a lot about how things are run (e.g. I interviewed at a CHC whose CEO was a PA, needless to say that it was a supportive environment for new grads).

2. Read employee and patient reviews. Obviously take it with a grain of salt but read comments online from indeed, glassdoor, or facebook to get an idea of what they are like. 

3. Don't be afraid to ask the hard questions. Ask about turnover rate, who are you replacing and why are you replacing them, ask to speak with your future SP if possible, ask to shadow a PA there, ask about your support staff e.g. do you get MAs and nurses, ask about support from admin e.g. when was the last time a provider had to fire a patient and how did admin respond, etc. etc. 

4. Ask about the make up of their patient population. At the CHC where I work, most are migrant farm workers and for the most part, they are quite grateful for the care that they receive. Each population has a unique set of needs and expectations.

5. Ask about the EMR. Do they have templates or quicktexts? If their EMR is NextGen, run. LOL.

For me, what I dislike the most about my job is dealing with worker's compensation and the lack of continuity of care because our patients move around the country. It's true that compliance is tough in the type of population served by CHCs but I've learned not to take that personally. Lately I've been keeping in mind that my patient's health is ultimately their journey. I can prescribe all the pills available to them but if they don't put it in their mouth, there really isn't much that I can do. 

¯\_(ツ)_/¯

Best of luck to you!

[ettezag]

17 minutes ago, aimyhtixela said:

I'm a new grad almost 6 months in working at a CHC in FM. A lot has been said already but I think it is very dependent on the organization. I interviewed at dozens around the country and I can tell you that CHCs come in different flavors. My two cents:

1. Look into their leadership as that will tell you a lot about how things are run (e.g. I interviewed at a CHC whose CEO was a PA, needless to say that it was supportive environment for new grads).

2. Read employee and patient reviews. Obviously take it with a grain of salt but read comments online from indeed, glassdoor, or facebook to get an idea of what they are like. 

3. Don't be afraid to ask the hard questions. Ask about turnover rate, who are you replacing and why are you replacing them, ask to speak with your future SP if possible, ask to shadow a PA there, ask about your support staff e.g. do you get MAs and nurses, ask about support from admin e.g. when was the last time a provider had to fire a patient and how did admin respond, etc. etc. 

4. Ask about the make up of their patient population. At the CHC where I work, most are migrant farm workers and for the most part, they are quite grateful of the care that they receive. Each population has a unique set of needs and expectations.

5. Ask about the EMR. Do they have templates or quicktexts? If their EMR is NextGen, run. LOL.

For me, what I dislike the most about my job is dealing with worker's compensation and the lack of continuity of care because our patients move around the country. It's true that compliance is tough in the type of population served by CHCs but I've learned not to take that personally. Lately I've been keeping in mind that my patient's health is ultimately their journey. I can prescribe all the pills available to them but if they don't put it in their mouth, there really isn't much that I can do. ¯\_(ツ)_/¯

Best of luck to you!

Wow, thank you for such a detailed response!!  The EMR for one location is NextGen--I don't think I've run across it during clinical year--is it particularly bad? :/

Your last tip was great, thanks!

[sas5814]

28 minutes ago, aimyhtixela said:

I'm a new grad almost 6 months in working at a CHC in FM. A lot has been said already but I think it is very dependent on the organization. I interviewed at dozens around the country and I can tell you that CHCs come in different flavors. My two cents:

1. Look into their leadership as that will tell you a lot about how things are run (e.g. I interviewed at a CHC whose CEO was a PA, needless to say that it was supportive environment for new grads).

2. Read employee and patient reviews. Obviously take it with a grain of salt but read comments online from indeed, glassdoor, or facebook to get an idea of what they are like. 

3. Don't be afraid to ask the hard questions. Ask about turnover rate, who are you replacing and why are you replacing them, ask to speak with your future SP if possible, ask to shadow a PA there, ask about your support staff e.g. do you get MAs and nurses, ask about support from admin e.g. when was the last time a provider had to fire a patient and how did admin respond, etc. etc. 

4. Ask about the make up of their patient population. At the CHC where I work, most are migrant farm workers and for the most part, they are quite grateful of the care that they receive. Each population has a unique set of needs and expectations.

5. Ask about the EMR. Do they have templates or quicktexts? If their EMR is NextGen, run. LOL.

For me, what I dislike the most about my job is dealing with worker's compensation and the lack of continuity of care because our patients move around the country. It's true that compliance is tough in the type of population served by CHCs but I've learned not to take that personally. Lately I've been keeping in mind that my patient's health is ultimately their journey. I can prescribe all the pills available to them but if they don't put it in their mouth, there really isn't much that I can do. ¯\_(ツ)_/¯

Best of luck to you!

NextGen.. *shudder*. That was the EHR they used at the CHC I worked at. Why? Because it let admin generate all the reports they needed for their grant reports. Did anyone ask the providers about their thoughts> No.......

Our CFO started as the receptionist in the lobby. She was promoted over and over and was "working on her degree" for the job of CFO....while being the CFO.

I'm sure there are a lot of variable between organizations. This one was on the bottom of the food chain.

[GoodVibes1313]

Considering I've never used any other EHR program, I didn't think NextGen was particularly bad. It was inconvenient; too much clicking and repetitiveness. 

I agree with everything said above. I just reached my 2nd year working in a CHC out of school. It definitely does wear you down and you will definitely get burnt out. How your experience is will depend on your company, but what has been mentioned is pretty consistent with my experience: complex patients wanting lots of hand holding and none of the responsibility for their health, drug seekers, minimal supervision for multiple reasons (I didn't even work with my SP because he was at another site---my real supervisor was UpToDate), lots of double-bookings, lots of no-shows, lots of booking people into no-show slots (putting you behind), little time for patient care, little control over your schedule, LOTS of paperwork, lots of people asking for disability, overworked and underpaid (honestly, ALL family providers are underpaid with the shit they have to put up with), working over time w/o pay because I'm salaried....

I do recommend that if you work at a CHC that has specialties or multiple clinics, that you ask for a pay that is FAIR for you for that specialty and that site. From my personal experience, finding out much later that I get paid the same as pediatrics PA who sees, for the most part, less complex patients, is very frustrating. Remember: family medicine has a lot of chronic diseases requiring labs, frequent follow-up, paperwork, etc----a lot of the latter will cause you to be working OT if your company does not provide you time for it; peds, for the most part, is pretty straight forward. Site location is also important because I was placed at an extremely busy site. I see 22+ patients per day compared to another family medicine PA at a smaller site who sees 14-16 patients per day, and we are paid the same (new grad salary). I don't see how that is fair except that we're both new. Of course, I found this out at a much later date and was not happy, but too late.

I do want to let you know even though it is VERY hard, you will have some of the most appreciative patients. I have patients that tell me I'm the first person who ever listened to their problems and did anything for them. Oh yea, and if you need it, you can get loan forgiveness from HRSA. And if you survive family medicine in a CHC, albeit somewhat jaded and bitter afterwards, I'm sure you can make it anywhere. :) 

So, yea. Not a lot of pros to working at a CHC. Best of luck, OP.

[ettezag]

On 1/7/2018 at 1:51 PM, sas5814 said:

NextGen.. *shudder*. That was the EHR they used at the CHC I worked at. Why? Because it let admin generate all the reports they needed for their grant reports. Did anyone ask the providers about their thoughts> No.......

Our CFO started as the receptionist in the lobby. She was promoted over and over and was "working on her degree" for the job of CFO....while being the CFO.

I'm sure there are a lot of variable between organizations. This one was on the bottom of the food chain.

That sounds ridiculous and not a great working environment.  I will have to dig around for more info on admin staff.  Thanks for all your tips!

[ettezag]

On 1/7/2018 at 3:17 PM, GoodVibes1313 said:

Considering I've never used any other EHR program, I didn't think NextGen was particularly bad. It was inconvenient; too much clicking and repetitiveness. 

I agree with everything said above. I just reached my 2nd year working in a CHC out of school. It definitely does wear you down and you will definitely get burnt out. How your experience is will depend on your company, but what has been mentioned is pretty consistent with my experience: complex patients wanting lots of hand holding and none of the responsibility for their health, drug seekers, minimal supervision for multiple reasons (I didn't even work with my SP because he was at another site---my real supervisor was UpToDate), lots of double-bookings, lots of no-shows, lots of booking people into no-show slots (putting you behind), little time for patient care, little control over your schedule, LOTS of paperwork, lots of people asking for disability, overworked and underpaid (honestly, ALL family providers are underpaid with the shit they have to put up with), working over time w/o pay because I'm salaried....

I do recommend that if you work at a CHC that has specialties or multiple clinics, that you ask for a pay that is FAIR for you for that specialty and that site. From my personal experience, finding out much later that I get paid the same as pediatrics PA who sees, for the most part, less complex patients, is very frustrating. Remember: family medicine has a lot of chronic diseases requiring labs, frequent follow-up, paperwork, etc----a lot of the latter will cause you to be working OT if your company does not provide you time for it; peds, for the most part, is pretty straight forward. Site location is also important because I was placed at an extremely busy site. I see 22+ patients per day compared to another family medicine PA at a smaller site who sees 14-16 patients per day, and we are paid the same (new grad salary). I don't see how that is fair except that we're both new. Of course, I found this out at a much later date and was not happy, but too late.

I do want to let you know even though it is VERY hard, you will have some of the most appreciative patients. I have patients that tell me I'm the first person who ever listened to their problems and did anything for them. Oh yea, and if you need it, you can get loan forgiveness from HRSA. And if you survive family medicine in a CHC, albeit somewhat jaded and bitter afterwards, I'm sure you can make it anywhere. :) 

So, yea. Not a lot of pros to working at a CHC. Best of luck, OP.

Those are some really great points and tips, thank you for such a detailed reply!  I love the last line of jaded and bitter but able to survive anywhere else.  Thanks for all your help and good vibes! 

EDIT:  I seriously did not realize until minutes later that your username was literally GoodVibes! :)

[PA-SGuy]

what is the pay like at these CHCs? Wonder how many PAs put they would love to work with less fortunate people, who have little to no resources, in their personal statement.....

[aimyhtixela]

On 1/7/2018 at 1:40 PM, ettezag said:

Wow, thank you for such a detailed response!!  The EMR for one location is NextGen--I don't think I've run across it during clinical year--is it particularly bad? :/

Your last tip was great, thanks!

Before and during PA school, I had the opportunity to work with Cerner, AllScripts, Epic, Centricity, and NextGen. NextGen was without a doubt the worst (too much clicking and repetition as mentioned, no quicktexts/templates). Admittedly I've only worked with it for 5 weeks on an FM rotation at a CHC that operated like a circus. Think: double booking, no shows, 24-32 patients in a day, employees were hired not by merit but because they can speak a foreign language, high turnover rate, locum providers who couldn't care any less and don't finish their charts, etc, etc. 

 

3 hours ago, PA-SGuy said:

what is the pay like at these CHCs? Wonder how many PAs put they would love to work with less fortunate people, who have little to no resources, in their personal statement.....

Count me as one! The ones in the west coast were the most generous from my experience, more so as you go rural. PAs/NPs at our CHC make no less than 150K with base and quarterly bonuses combined plus awesome bennies and support e.g. we each get 2 MAs plus one RN per 4 providers and one RN clinic/pod manager who steps in if the other is busy.

OP, there are good, well-run CHCs out there. Although I think in general they are slowly preferring NPs over PAs now because it's hard to find, retain, and pay docs to "supervise" PAs. Our CHC won't hire PAs anymore as a matter of fact (we outnumber NPs here 3:1). But, that's for another thread....... =/