Employment in healthcare settings remains below pre-pandemic levels, according to a report released in March. The number of healthcare workers dropped dramatically during the start of the coronavirus pandemic and peaked in 2022.

While the last two years provided a sharp increase in employment, report findings share that the country has not yet returned to pre-pandemic levels—especially in skilled nursing. The nation’s aging population will require more healthcare services, and while inflation has affected the economy, healthcare has historically been a safe choice for employees.

To thwart further turnover and increase job opportunities, health centers and free clinics are approaching workforce development by building career pathways and encouraging career literacy. These federally and privately funded institutions have advocated for programs that teach, train, and mentor the incoming and current healthcare workforce to support the nation’s safety net population.

In Florida, a state that has not elected to expand Medicaid, health centers serve 1.7 million patients. According to the National Association of Health Centers, the organizations created over 25,000 jobs in 2021. Steven Bennett, Director of Workforce Development Programs at the Florida Association of Community Health Centers, said the position with the highest turnover rate within Florida health centers is the entry-level position of medical assistant, followed by dental assistant.

FACHC surveys the 54 health centers across the state every six months to learn and analyze the workforce. The latest survey, which dates to December of 2023, reported an increase in the number of unique open positions. Including medical interpreters, which are necessary given nearly 25% of health center patients do not speak English as their first language.

“I think we now sort of see what happens when the house is on fire, and we don’t have all the things in place,” Bennett said.

Community Health Center of Florida, Inc., or CHI, operates nine health center sites and 35 school-based sites for patients in Florida’s 28th congressional district. The district was created after the 2020 census results showed an uptick in the rural area’s population. Over half of the district’s census respondents identified as two or more races, and the majority of respondents identified as a minority race.

Peter Wood, Vice President for Planning and Government Affairs at CHI, said the health center has a commitment to strengthening the overall primary care sector, specifically by serving underserved communities. Patients within the communities that CHI serves are more likely to be adversely and disproportionately affected by the social determinants of health and have a higher rate of chronic conditions.

Given CHI’s commitment to the community, the health center operates a teaching program that encourages providers to take on additional educational opportunities and to use their new skills in the same location. The teaching center is the first of its kind, nationally, and includes residency programs in family medicine and psychiatry. CHI is developing the program to include a dentistry residency and an internal medicine residency program.

“A higher percentage of them would end up taking jobs and staying in those areas, as opposed to working in a hospital and then finding another job that was not serving the underserved neighborhoods or areas of the country,” said Wood.

While medical staff at any workplace must adhere to specific guidelines and educational criteria, Bennett says there are “foundational similarities, but different types of competencies,” among health center and private practice employees. They require a highly qualified workforce that is also representative of the community they serve. Health center staff are more likely to work with patients who may not have insurance, have insurance through Medicaid, do not speak English as a first language, and may not trust or have had prior experience with providers, making them less trusting of the medical process.

“It’s the whole gambit of human complexity that arrives at our front doors, and we have to staff and build a workforce that is able to not only deal with healthcare challenges but able to manage and articulate responses to those complexities as well,” Bennett said.

While recruiting a qualified workforce is important, Bennett says it’s equally important to retain current employees. The director said health centers must take a holistic approach in their efforts and consider what career pathways look like in the long term. He encourages career literacy so that potential and current employees can better understand their career options and suggests that every employee has, at minimum, a two-year plan for their career and mentoring support. He also suggests that health centers have partnerships with local organizations, faith-based centers and schools to engage more people.

Several health centers and free clinics throughout Florida have partnered with MAVEN Project, a national nonprofit that supports primary care providers, for its mentoring program. Retired physicians volunteer to mentor current providers on clinical and or leadership skills in a trusted environment.

“I was like, ‘please, sign me up’,” said Hillary Glenn, doctor of nursing practice and co-founder of Point Washington Medical Clinic in Florida.

Glenn began working with MAVEN Project pre-pandemic and requested a mentor during the height of Covid. She said there was mixed messaging throughout the state regarding the pandemic, and she wanted to confer with another medical professional. She participated in the organization’s weekly Covid update and had bi-weekly calls with her mentor to make sure that she was up-to-date on best practices and that her organization was providing the most accurate medical advice.

“It helped me a lot professionally and to guide the organization in the right direction and (to) do things that were best practice,” Glenn said.

Glenn said that it can be difficult, especially in rural and or underserved parts of the country, to find specialists who will see patients from health centers and free clinics. She said that with the Maven Project, that access is less difficult. She called the mentor program “brilliant” and “an incredible resource for the charitable sector.”

Dr. Lo-Ann Nguyen, is a volunteer mentor for MAVEN Project and finds value in the “thought partnership” it provides to current health center employees. Like Bennett, she says medical professionals must consider the full trajectory of their careers. Nguyen has worked with a physician at a health center in Florida to support their leadership capacity and their long-term career goals for the past year.

Nguyen said that the physician expressed feeling burnt out and they have worked together on how to delegate tasks and rejuvenate their enthusiasm for their work. Nguyen said it’s common for providers to experience exhaustion. She said that she reminds her mentees of their “why” so that they think about their career trajectory and are less likely to quit.

“If you have that basic value of why you went into medicine, why you spend so many years studying and training, what is it that drew you here?” she said. “And so, how do you find joy in the work?”

Both Bennett and Nguyen emphasized the need for recognition on the job. Nguyen said providers need to know that they can be leaders within the organization and that, as leaders, they should express gratitude and create a culture of positive feedback.

“Make your staff feel empowered, feel valued, and they tend to stick with you,” she said. “They will help you more, and they’ll take better care of your patients for you. So, it’s all Win-Win all around.”

One misconception about health center employment is low salary.

“Meeting market rates for compensation is essential for not only building and retaining staff but for delivering the quality care that patients deserve,” Bennett said.

According to FACHC salary reports, most health center staff earn more than the statewide average if they work the same role at a different medical practice. However, it’s not true for every role. Bennett says that’s why having career pathways is important—it prevents employees from quitting every other year for similar roles with slightly higher pay.

“The truth is, no one’s going to retire rich working at a community health center,” Bennett said. “But the good thing is, no one comes to a community health center to get rich, right? You go into your career at one of these centers because of something deep, the mission and servant of heart.”

Direct Relief has supported health workforce development and training, including through the MAVEN Project, which connects community providers with mentorship and expertise.