Designing Compensation That Works: Balancing Mission and Market in FQHCs
Why Compensation Strategy Matters for FQHCs
Compensation is more than the paycheck. It communicates your organization’s values, priorities, and commitment to its people. For FQHCs, where budget constraints intersect with mission-driven care, designing competitive, equitable compensation is not optional; it’s essential.
Rising competition for healthcare talent, shrinking candidate pools, and persistent turnover demand a strategic approach that aligns financial stewardship with employee satisfaction. Without it, health centers risk losing not only their people but also their ability to deliver consistent, quality care to the communities they serve.
Understanding Total Compensation
An effective strategy looks beyond salaries. Total compensation includes the full package of financial and non-financial rewards:
Base Salary: Market-aligned and competitive.
Benefits: Health insurance, retirement plans, paid time off.
Incentives: Performance bonuses, CME allowances, licensure reimbursements.
Non-Monetary Rewards: Flexible schedules, professional development, recognition programs.
Educating staff on the full value of this package is just as important as designing it because employees often see only what hits their paycheck.
Trends and Data You Can’t Ignore
The workforce challenge is real. Over 70% of health centers are reporting critical staff shortages, not only in primary care and nursing, but also in behavioral health, dental, administrative, billing, and front desk roles.
Salary trends reflect this pressure:
Physicians: up nearly 20% between 2022–2024
RNs: up 15% in the same period
And yet, turnover remains high. Each departure comes at a steep cost:
Registered Nurses: $61,110 per departure
Physicians: $500,000–$1 million+
CEOs: 100–213% of salary
CFOs: 100–150% of salary
Medical Assistants & Front Desk: 25–50% of salary
These numbers underscore the urgency of retention-focused compensation strategies.
Why FQHC Staff Are Leaving
According to the NWRPCA Region X Salary & Benefits Survey (2024), here are the top five reasons staff leave FQHCs:
Better Pay – 68.6%
Move/Relocation – 62.9%
Personal Issues – 57.1%
Career Advancement – 54.3%
Family Issues – 37.1%
Three of these are beyond an organization’s control. But “better pay” is and the solution isn’t always just increasing salaries. The opportunity lies in designing sustainable, transparent compensation structures and ensuring staff understand the total value of what they receive.
Building a Sustainable Salary Scale
Transitioning to a new salary model requires more than good intentions. It takes structure, transparency, and alignment with organizational goals. Here are ten essential steps:
Define your compensation philosophy.
Build a cross-functional compensation team.
Conduct a baseline assessment.
Design the structure (step scales, pay bands, market-based models).
Ensure compliance (regulatory and grant).
Model the financial impact.
Develop an implementation & communication plan.
Document key processes.
Launch and monitor.
Review annually.
Retention vs. Recruitment: Where Should You Focus?
Ask yourself:
Is your annual turnover rate above 15%?
Are critical roles taking 30+ days to fill?
Do exit interviews highlight compensation?
Are you losing staff to competitors?
Are your salaries below market benchmarks?
If you answer yes to any of these, it’s time to act. Retention strategies (career development, recognition, long-term benefits) and recruitment strategies (competitive entry salaries, signing bonuses) must work hand-in-hand. FQHCs that balance both are better positioned to reduce costly turnover and protect continuity of care.
Join Us for the Webinar
We'll explore these issues in more detail during our upcoming webinar on September 24th at 11:00 AM PST: Total Compensation: Competitive Compensation Packages for FQHCs:
How to assess and build total compensation packages.
Best practices for aligning compensation with financial planning.
Real-world examples and lessons from FQHCs nationwide.
Don’t miss this opportunity to gain actionable strategies that strengthen both your workforce and your financial sustainability.
About the Author
Amy Brisson, Chief Strategy Officer
Community Link Consulting
Phone: 509-226-1393
Email: info@communitylinkconsulting.com
Amy combines over 15 years of progressive financial leadership experience with 11 years of specialized FQHC industry expertise to drive strategic initiatives and deliver solutions for community health centers. Her deep understanding of rural healthcare challenges and federal funding programs positions her as a trusted advisor for FQHCs navigating complex workforce and compensation challenges.
References
NWRPCA Region X Salary & Benefits Survey. (2024). Northwest Regional Primary Care Association.
National Association of Community Health Centers. (2024). Health Center Workforce Survey: Addressing Critical Staffing Shortages.
Healthcare Financial Management Association. (2024). The True Cost of Healthcare Turnover: A Comprehensive Analysis.
