Practicing at a Rural Federally Qualified Health Center

The price of higher education leads many new nurse practitioners to look for ways to pay down the debt quickly while gaining experience. Federally Qualified Health Centers (FQHC) through the Health Resources and Services Administration (HRSA) are a way of doing both. These health facilities can be in both urban and rural settings, typically in underserved areas. The goal of the FQHC is to provide services to people who may otherwise have difficulty accessing care. As a provider working in a rural site for over eight years, I can tell you it is rewarding to serve these communities. However, working in a rural location is not without some challenges. Here are some things you should know when considering a rural FQHC job site.

Staffing

Staff turnover in the FQHCs can be high. Frequently, medical staff seek out these positions solely for the benefit of loan repayment and do not intend to establish roots in the communities. They leave as soon as their service for the repayment is satisfied. This can create a revolving door of providers, nurses, and behavioral health staff. High staff turnover leads to significant patient dissatisfaction. Think about how often you see your provider. If you are healthy, likely just once or twice a year. So imagine if you see your provider a handful of times, then they are gone...again. When there is a lot of staff turnover, the patients constantly have to introduce themselves, explain their conditions, and decide if they like the new person sitting in front of them. For my first few years, patients regularly asked if I was sticking around. Be mindful of this when choosing where you may want to work.

It is not only the medical staff that sees high turnover. Support staff, such as billing, front office, and medical assistants, may be hard to come by, especially in rural settings where people with the qualifications are limited. As a provider, you quickly learn good support staff in place affects how well you can do your job. Don't forget illness among staff. If the clinic only has 2-3 providers and one calls off sick, you are going to have a very busy day. If illness occurs when someone is out on vacation, the clinic may be left with no provider. Does the idea of that trigger a stress response in you? It does in me! When looking at potential rural sites, make sure you are considering how well the clinic is staffed. Talk to everyone you can to get a feel for the turnover.

Specialists

Working at a rural clinic may mean not being connected to a larger hospital system or medical group. These can be stand-alone clinics in remote locations with a two-hour drive for a patient to see specialists. Specialists may be booked out for months. Yes, months. These wait times have worsened following the pandemic due to backlog, ongoing outbreaks of illness, and staffing issues. Providers are left managing potentially complicated patients on their own for months at a time. Another consideration is the patient who is unwilling or unable to see a specialist due to the distance. The boost to telemedicine during the pandemic reduced the need for some long trips just for consultations but not for treatments. The key here for new providers is the ability to forge relationships with colleagues to help guide your work so you can better care for these patients. You are their safety net.

Patients

As the only clinic for many miles, you will see anything and everything that walks through the door. Living in rural Oregon, injuries related to fishing, construction, hiking, and the rogue chainsaw is not unexpected. Patients in these rural areas tend to be hard-working and used to some level of injuries. Many times they may not come in unless things are bad - such as an amputated finger from the slip of a circular saw, or with orthopedic injuries they have long ignored and now have retracted muscles to show for it. As there may not be another clinic for miles, providers in these settings will likely also see many staff members. In these rural areas, you will get to know everyone's business.

Opiates and Addiction

Anyone well versed in the opiate crisis knows rural communities where physically demanding jobs are the norm were hard hit with the opioids. The tide is turning, but many patients still struggle with this. You will find patients are still on some form of opioids for long-term pain management or due to addiction. Knowing how to prescribe treatments and a willingness to do so is still needed in these communities. Alcohol abuse is also common. Pain management clinics and rehab facilities can be hard to come by.

Benefits

The benefits of working in a rural setting go beyond just financial for someone who likes this type of work. The commute is much less stressful than in an urban area. A slower pace comes with living in a rural setting, which can be a change of lifestyle. If your goal in choosing to work in family medicine is to treat whole families, you will not be disappointed. If you are looking for the sense of community gained from providing care to your neighbors, the grocery clerk, and the woman who does your hair, a rural site can be quite appealing. Nurse practitioners are filling the gaps in these communities where doctors have become scarce. The patients appreciate the difference in care nurse practitioners provide. The work presents some challenges but is also satisfying and rewarding.