East San Francisco Bay Area, USA


Background on La Clinica de la Raza

La Clinica de la Raza, like so many other facilities that offer primary care, faces a severe provider shortage. This issue is only worsening with time. La Clinica de la Raza is a nonprofit federally qualified health center, which means its patient population is already underserved. It provides culturally competent and comprehensive services to its patients, whether or not they are insured, and its role in offering basic access to healthcare to the East Bay of the San Francisco Bay Area is crucial. However, the shortage of providers that La Clinica and many other community health centers face undermines its capacity to provide high-quality care for all who need it. I joined with the Planning team at La Clinica to assist in figuring out how to address this shortage.

Current Situation

The severity of the shortage can be better understood by looking at La Clinica’s current situation. From 2013 to 2014 alone, La Clinica’s patient population grew by 7.3%. Across La Clinica’s 31 service sites, nearly 50% of its patients are uninsured, and most of them live at or below 200% of the federal poverty level. The care that La Clinica provides is commonly the only access patients have to consistent, preventive healthcare, which relies heavily on a consistent staffing of primary care providers.

As the need for primary care grows, the reality remains that the primary care provider workforce is simultaneously shrinking. This includes primary care physicians, nurse practitioners, physician assistants, and medical assistants. Primary care as a specialty brings relatively lower salaries and intense schedules for practitioners. Unfortunately, these factors are only compounded in a community health context. In such settings, where patients are often covered by government insurance or not at all, lower reimbursement rates and over-packed patient panels can lead to high levels of provider burn-out. Many sites employ a variety of creative recruitment and retention strategies to combat these challenges, including La Clinica, but further work to evaluate any strategic gaps and address them will better position community health centers to fulfill their mission.

The Rashell Young Fellowship’s Role

The support from the Rashell Young Fellowship enabled me to pursue this work part-time throughout the summer. After speaking with stakeholders and mapping out potential strategies, we developed a project proposal to present to leadership in the following weeks.

The experience The Rashell Young Fellowship offered has been transformative. As someone who seeks to work in community health settings to facilitate strategic systems improvement, I’ve been able to get real-world experience with the struggles community health centers face. I’ve been privileged to learn from La Clinica staff about how they drive change forward in resource-constrained settings and continue to fulfill their mission. I feel fortunate that they have entrusted me to take part in this work, and I wouldn’t have been able to do so without this fellowship.