Community health centers on Long Island face rising patient demand, and growing staff vacancies

On a recent Wednesday morning, the waiting area at Harmony Healthcare Long Island in Hempstead was brimming with people waiting for help that may be hard for them to get elsewhere — services ranging from dental treatment to primary care.

But this and other Long Island federally qualified community health centers — clinics that play a vital role in ensuring that millions of low-income people get medical care — face a predicament. They have more patients than ever but need more staff.

Harmony Healthcare is hiring for about 25 positions, including five nurses, a couple of social workers, and medical assistants, according to staff at the center, which has locations that include Elmont, Freeport and Westbury.

"It makes it harder to provide the care without the people to do it," said David Nemiroff, president and CEO of Harmony Healthcare Long Island. "So we have in many instances the space, but not the staff to provide the care."

He added: "So it just makes waiting for some services a lot longer than others based on who we have to provide that care to our patients."

With more than 31 million patients in 2023, community health centers nationally are serving the highest number of people in their roughly 60-year history, according to the U.S. Department of Health and Human Services. 

But many of the roughly 1,370 centers around the country — and many sites on Long Island — say they're facing workforce shortages that can make it more difficult to serve a client base that’s often low-income and uninsured.

More than 70% of these centers nationwide say they face shortages in finding primary care clinicians and some other medical staff in 2024, according to The Commonwealth Fund, which surveyed more than 700 leaders of the facilities.

Vacant positions in LI centers

The workforce shortages also are impacting Long Island's centers, which can't reject a patient because of their inability to pay and are bankrolled through a mix of Medicaid reimbursements and other funding.

Several community health centers told Newsday that their inability to hire to ease workforce shortages is exacerbated by the region's high cost of living and low Medicaid reimbursement rates. The centers also say they're competing for talent against larger health systems such as Northwell Health, which can often outbid them for a position.

"It is just a challenge right now to get people in the door and then, you know, to keep them from going to a larger organization," said Allison Bergmann, interim CEO of Long Island Select Healthcare, a community health center with locations that include Central Islip, Riverhead and Smithtown.

Although no two positions are the same, a full-time registered nurse at Harmony Healthcare Long Island can have a salary range of $75,000 to $90,000 a year, according to a job posting on Indeed.

At Northwell Health, a position for a registered nurse with multiple specialties may have a salary of $68,000 to $115,000 a year, according to the health system's website. 

Experts say better recruitment efforts and salary boosts from the federal government, along with other factors such as wellness programs, are needed to attract more people to work in community health centers. 

In the meantime, the demand for physicians and other people who work at the centers is growing.

Nurses saw one of the biggest increases in demand, with roughly 55% of health centers in the Commonwealth Fund's survey saying they needed them in 2018. By 2024, the percentage had grown to 70%.

Nearly 77% of surveyed health centers said they needed more mental health staff this year, up from 70% in 2018.

Long Island Select Healthcare, also called LISH, saw a 916-patient increase from this time last year to now. The health center, which caters to people with intellectual and developmental disabilities, also saw an increase of 785 visitors.

Bergmann, the interim CEO at LISH, said the company’s growth is driven by its strong behavioral health department, after-hours visits to accommodate patients' schedules and telehealth.

"So I think we're able to reach patients who, even if they can't get to us, can still receive some type of care," she said in a phone interview.

Yet, while more patients are being reached, the health center is still searching for enough people to take care of them. LISH’s website lists 14 vacancies, including a clinical psychologist, a medical receptionist and a neurologist. Recently, the organization has hired two nurse practitioners but is having trouble finding physicians.

The lack of staff sometimes impacts morale, but she added that they are working with temp agencies to fill front desk and other roles.

Possible solutions to shortages

Celli Horstman, senior research associate at the Commonwealth Fund, said it's hard for community health centers to offer competitive wages when Medicaid reimbursement is not keeping up. In 2022, Medicaid made up about 40% of revenue from community health centers, their largest source of income, according to the KFF, a nonprofit health policy organization.

Horstman said one way forward is a value-based case, which involves paying an upfront amount for a potential range of services rather than a fee for every service that often involves dealing with reimbursement levels. 

Value-based care, Horstman said, emphasizes the overall quality of care, like the services already provided at the health centers. Additionally, she said the consistent, upfront payments that come from the model can be a means to support the health center workforce.

Another avenue that shows some promise is a family medicine residency program, in which medical residents receive training from the health center.

Harmony Healthcare currently has 21 residents through the program. The center plans to hire two of them in September. This will be a reprieve from last year, the "hardest year we've ever had with hiring medical providers and maintaining them" because "the salaries that they're asking for is a lot," Nemiroff said.

Nemiroff said they try to find medical providers and others who have a calling to help those in need. "We deal with the people who don't have a lot of money and have some chronic medical concerns," he said. "So the people we look for have to really have a mission in their heart."

Back at the Hempstead location, the waiting room on that Wednesday afternoon kept moving. 

In an exam room, nurse practitioner Daniah Jean-Francois said most days are very busy, particularly in pediatrics and mental health. However, the lack of staff across the medical field is a huge obstacle to care. 

"It’s a big hindrance," she said, "when you don’t have the numbers to kind of meet the volume of care."

By Tiffany Cusaac-Smith

tiffany.cusaac-smith@newsday.com@T_Cusaac

Education: Howard University 

Tiffany Cusaac-Smith came to Newsday in 2023 after being a race and history reporter at USA TODAY, where she wrote enterprise and spot articles examining how the past shapes the present. Previously, she worked as the race and justice reporter at the USA TODAY Network of New York, covering issues such as criminal justice reform, housing, environmental justice, health care and politics. At The Journal News/lohud.com in Westchester County, she covered Yonkers, the state's third-largest city. She also worked at The Associated Press in Atlanta.

Honors and Awards: Criminal justice reporting fellowship with the National Press Foundation;  New York News Publishers Association award for distinguished investigative reporting;  Contributed reporting for Best of Gannett honor; Member of Table Stakes, a program funded by the Knight-Lenfest Local News Transformation Fund and managed by the American Press Institute to transform local news.