The recruitment and retention of well-trained, motivated health care providers in underserved communities is a longstanding problem that has led researchers and policy-makers to study providers' motivations for work among the underserved. This study compares the way that 49 providers from a sample of six Christian Community Health Fellowship (CCHF)-affiliated faith-based community health centers (CHCs) and those from four otherwise similar secular CHCs explain their decisions to work among the underserved. In interviews, providers from both settings balance costs, such as the frustrations and difficulties of meeting overwhelming demands with inadequate sources, with rewards, including flexible work schedules and exposure to a variety of clinical issues. In faith-based CHCs, providers explain the decision to work in underserved settings as a response to a religious calling and see a benefit in working with colleagues who share their explicitly faith-based vision of caring for the underserved. They explain how they synthesize rewards and costs and find meaning in their decisions to remain at CHCs in religious terms. Most providers from secular CHCs refer in nonreligious terms to intrinsic rewards of the work.

The authors hypothesize that CHCs will improve provider motivation and satisfaction (and subsequent recruitment and retention) to the extent that they provide environments that invite and provide opportunities for providers to craft their work into callings. For faith-based CHCs this may mean fostering environments that are explicitly organized around their religious vision. Future studies are needed to test these hypotheses using quantitative methods and broader representative sampling.