Federally Qualified Health Centers Reduce the Primary Care Provider Gap in Health Professional Shortage Counties


Ying Xue, Elizabeth Greener, Viji Kannan, Joyce A. Smith, Carol Brewer, Joanne Spetz

February 13, 2018

Federally qualified health centers (FQHCs) were designed to provide care in medically underserved areas and substantial and sustained federal funding has accelerated FQHC growth. This report examines changes over time in primary care provider supply and whether FQHCs have been successful in reducing the gap in provider supply in primary care health professional shortage areas (HPSAs).


Maldistribution of the primary care workforce has been a persistent barrier in reducing health care disparities and improving the efficiency of the primary care system. The most recent data show that county disparities in U.S. life expectancy are large and have increased from 1980 to 2014. This differential is in part explained by the number of physicians per 10,000 population along with socioeconomic, behavioral, metabolic and other health care factors.

As previously stated, one criteria to be certified as an FQHC is to serve a designated medically underserved area or a medically underserved population, which was defined by the Public Health Service Act as “the population of an urban or rural area designated by the Secretary as an area with a shortage of personal health services, or a population group designated by the Secretary as having a shortage of such services.” This designation criteria overlaps with similar designation criteria for primary care health professional shortage areas (HPSAs), which as yet count only primary care physicians as providers, despite a recommendation in 2011 by the Negotiated Rulemaking Committee to include nurse practitioners (NPs) and physician assistants (PAs).


  • Partial-county HPSAs had the highest average provider supply and the greatest increase, followed by non-HPSA counties and whole-county HPSAs.
  • The growth in NPs and PAs contributed largely to the increase of primary care providers over time.
  • The provider gap was larger in whole-county HPSAs compared to partial-county HPSAs.
  • Counties with a FQHC site had significantly smaller provider gaps than those without. Further, counties that had a greater number of FQHC sites were associated with a bigger reduction in the provider gap.