Retention of primary care physicians in rural health professional shortage areas

Objectives. We tested the assumption that average job retention duration is shorter for physicians in rural health professional shortage areas (HPSAs) than for physicians in rural non-HPSAs. Methods. In 1991, we surveyed nationally representative samples of primary care physicians who recently had moved to rural HPSAs and non-HPSAs who were without service obligations. We resurveyed these physicians in 1996 and 1997 to learn of any job changes. Results. Physicians in rural HPSAs (n = 308) demonstrated retention similar to that of the non-HPSA cohort (n = 197) (hazard ratio for leaving = 1.28; 95% confidence interval = 0.97, 1.69; P = .08), even with adjustments for group demographic differences (P = .24). Conclusions. Average retention duration for generalist physicians in rural HPSAs is identical to or slightly shorter than for those in rural non-HPSAs. Poor recruitment is likely to be the principal dynamic underlying local rural shortages.