Primary Care Office Annual Technical Assistance Survey

August 2024

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Context

Context | What are PCOs?

State and territorial Primary Care Offices (PCOs) play a critical role in identifying communities most in need of healthcare services and managing programs to expand the healthcare workforce.

Context | What do PCOs do?

PCOs track healthcare professional shortage areas in their jurisdiction by collecting data on clinicians and community needs.

PCOs may also administer workforce programs to address those shortages.

PCOs are primarily supported by HRSA cooperative agreement (co/ag) funding.

Context | PCO Survey

The Association of State and Territorial Health Officials (ASTHO) supports state and territorial PCOs by monitoring the state of the workforce through an annual, national survey.

Between January-February 2024, ASTHO, in collaboration with the National Organization of State Offices of Rural Health (NOSORH), distributed a national assessment to document the governance structure, technical support needs, policy priorities, and staffing of PCOs.

The information in this report is used to inform ASTHO and NOSORH programming and raise awareness of how PCOs operate.

Let’s jump into the survey results

Who Responded to the Survey?

40 ASTHO member jurisdictions participated in the survey, including 1 Island jurisdiction.

How Are PCO Operations Structured?

The majority of PCOs sit within the following bureaus and divisions:

> State Offices of Rural Health (SORH) (40%)
> Chronic Disease Prevention (23%)
> Maternal and Child Health (19%)

PCO Governance | Overall

In 24.5% of responding jurisdictions, the PCO Director reports directly to a state/territorial health official or senior deputy.

PCO Governance | Division Chief

In 22.6% of responding jurisdictions, the PCO Director reports to the division chief. Divisions reported include:

PCO Governance | Branch Chief

In 34% of responding jurisdictions, the PCO Director reports to a branch chief within a division. Branches reported include:

PCO Staffing | Duration in Position

The role of PCO staff and directors require a significant time investment for training and onboarding.

While many PCO staff and directors have been in their role for more than a decade, many have been in their role for less than three years, meaning they have yet to be through a full cooperative agreement cycle with HRSA.

PCO Staffing | Duration in Position

51% of respondents have been in their position less than three years.

The newness of more than half of staff indicates a need to continue to orient PCOs to available resources.

PCO Funding

Each PCO receives a five-year co/ag from HRSA to complete shortage designations and other associated tasks.

27 respondents indicated that they use supplemental funding sources in addition to their HRSA/PCO cooperative funding.

State general funds were cited most often as an additional funding source.

PCO Partnerships

PCOs rely on strong internal and external relationships.

PCOs can partner with other programs and divisions within their state/territorial health agency to share data and information, coordinate on needs assessments, build relationships with the healthcare delivery system, and support education on shared policy goals.