Dive Brief:

• Community health centers are being hit particularly hard by the twin forces of a competitive labor market and COVID-19 burnout.
• A majority of health centers reported they lost up to a fourth of their workforce in the past six months alone, according to a new survey from the National Association of Community Health Centers.
• The health centers, which provide care to mostly low-income Americans, are losing nurses at a higher rate than any other staff. That attrition poses a direct challenge to patient care, especially as COVID-19 cases once again creep upward amid a new variant.

Dive Insight:

Community health centers have played a key role in the nation's pandemic response. To date, the centers have administered more than 21 million vaccines and conducted more than 18 million tests for COVID-19, according to the NACHC. There's some evidence that work is paying dividends, as one analysis suggests there are fewer COVID-19 infections and deaths in areas with an active community health center.

But the U.S. network of health centers is facing the same turnover that's plagued the operations of other providers during the pandemic. More than a third of nurses in one recent survey said they plan to leave their current jobs by the end of the year, exhausted from burnout, high-stress work environments and tempting pay and benefits from other employers.

The new NACHC survey found 68% of health centers reported a workforce loss of up to 25% in the past six months, and 15% of health centers reported a loss of between 25% to 50%.

Those who left were mostly nurses, though other areas like administrative, behavioral health and dental staff were also hit hard. Urban and larger health centers had higher rates of attrition compared to rural and smaller health centers, the survey of more than 260 federally qualified health centers conducted in February found.

Salary competition from larger healthcare employers was the most common reason for staff departure. Half of health centers said they believed their employees who left received 10% to 25% wage increases.

Pandemic-related stress was the other most common reason for turnover.

The future of the community health workforce — and its readiness to meet public health challenges — is uncertain, NACHC Interim President and CEO Rachel Gonzales-Hanson said in a release.

"We must immediately invest in policies that will retain current health center staff, broaden the pipeline for the future workforce and foster creative strategies at the community level for short and long-term solutions," Gonzales-Hanson said, including continued support for medical education programs and expanding the list of billable providers on integrated care teams.

Despite billions in relief from the American Rescue Plan passed last year, community health centers — which operate on razor-thin margins — also need sustained federal funding, NACHC argued.

Health centers were recently notified that the federal COVID-19 Uninsured Program will stop accepting claims for the vaccination, testing and treatment of coronavirus patients who can't pay their medical bills, NACHC said.

That could leave health centers, which treat large numbers of the uninsured, high and dry without reimbursement and result in service cuts.

In March, Congress allocated roughly $1.7 billion for community health centers in its omnibus spending package for the 2022 fiscal year, though it didn't provide any additional COVID-19 relief. In a letter to congressional appropriators in late March, NACHC called the loss of aid "troubling" and said it would have a disproportionate impact on health centers.

Earlier this month, the Senate reached a bipartisan deal for $10 billion in additional COVID-19 aid. The deal would not replenish the program that covers COVID-19 vaccination, testing and treatment for the uninsured.