Primary Care Office Annual Technical Assistance Survey

August 2025

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.


In February 2025, ASTHO distributed a national assessment to document PCO’s staffing, governance, responsibilities, and technical assistance needs.

The findings gathered will also support HRSA in responding to technical assistance requests and developing future program guidance.

Let’s jump into the survey results

Who Responded to the Survey?



54 participants from 41 ASTHO member jurisdictions participated in the survey.

How Are PCO Operations Structured?



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

  • Chronic Disease Prevention (36%)
  • Maternal and Child Health (34%)
  • State Offices of Rural Health (SORH) (20%)

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 30.2% 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.

The tenures of the PCO staff who participated in the survey were distributed between 1-10 years, with a noticeably higher percentage (41%) of those who worked for 1-3 years.

PCO Staffing | Duration in Position



50% of respondents have been in their position for 3 or less years.

The newness of half of PCO 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.

For positions that are only partially funded by the HRSA PCO cooperative agreement many states supplement with state general funds (75.6%) or other HRSA funds (31.7%).

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.


Who are Key Partners? | Within Health Agency



Valuable partners to PCOs within the state/territorial health agency:

Medicaid agency staff


Oral health programs

Maternal and child health programs


HIV/Infectious disease programs

Who are Key Partners? | Healthcare Delivery Systems



PCOs have built meaningful connection points with healthcare delivery systems via technical assistance, data collection, information sharing, strategic planning, and regulatory relationships.


Across all of these different types of relationships with clinical healthcare delivery systems, federally qualified health centers (FQHCs), critical access hospitals, and rural health clinics were the most frequently reported connection points.

Key Touchpoints | PCO Relationships with the Healthcare Delivery System


Who are Key Partners? | Desired Partnerships



The majority of participants indicated that they desire working relationships with partners, with Oral Health Programming (64%) and Medicaid staff (50%) being the two most frequently cited.

What top challenges do PCOs face? |


Participants were most likely to be experiencing trouble procuring the data that’s necessary for the completion of their PCO Cooperative Agreement activities (61.7%).

Data Procurement Challenges | Data Sources for PCOs



PCOs receive data from Medicaid agencies, licensure boards, and other entities.1

Licensure board(s) are the most accessed data source, used by 35.3% of PCOs.

Data Procurement Challenges | Data Sharing Processes



Almost a third of PCOs do not have a process in place for enabling data-sharing (26.9%).


For the remainder that do, a formal data sharing agreement is the most common practice (85.2%).

What are PCOs Legislative Priorities? |



The top reported priority area was ● Workforce , with at least 20 participants noting it as a priority, especially around recruiting top talent and increasing the workforce in shortage-designated areas.


Other priority areas included:

■ Population Health
◆ Finance
▲ Infrastructure

Supporting the PCO Workforce



ASTHO, with support from HRSA, offers support to PCO staff and will continue monitoring the needs of this critical workforce.


Join ASTHO’s PCO Peer Network and programming. For more information, please contact an ASTHO staff member at ask@astho.org!

Thanks for reading!

Footnotes

  1. This survey question was programmed as single-choice. Because of the frequency with which participants used the ‘other’ option to indicate that they received data from both Medicaid and licensures boards, that category was pulled out and highlighted in the associated chart.