It’s Not All About Pay: What Data Tell Us About Why Physicians Stay

BY MANDI GINGRAS

Job turnover for physicians is prompted for various reasons, including inadequate administration, difficulties maintaining work-life balance, unfair compensation, feeling undervalued, non-collegial work environment, among others.

Dr. Don Pathman, a researcher with the University of North Carolina Sheps Center used data from 3RNET’s PRISM project to inform a study asking these questions:

• What do physicians think about their jobs?
• How do those opinions differ between physicians planning to stay, and physicians planning to leave soon?
• Does it vary between urban and rural settings?

Not enough is known about the job factors specifically affecting turnover or its converse, retention, for physicians working in urban and rural Health Professional Shortage Areas (HPSAs), where turnover is particularly costly for patients and practices. According to the Bureau of Health Workforce, HPSAs are a federal designation that identify areas, population groups, or facilities experiencing a shortage of primary care, dental, or mental health providers. HPSAs are used to direct resources, often including incentive programs, to areas with the greatest need.

Provider Retention and Information System Management (PRISM) is a collaborative of state Primary Care Offices and other state clinician workforce offices in thirty-six states.

PRISM surveys clinicians when they begin each year, and when they complete loan repayment contracts, and then every second year thereafter. PRISM currently holds data from more than 94,000 complete questionnaires.

Since 2012, PRISM participating states have partnered to collect data to identify issues, document outcomes, and learn how to strengthen loan repayment and related programs and support participating clinicians. In other words, PRISM data can support clinicians currently serving within the incentive programs, measure the success of these programs by looking at how likely the clinicians are to stay (research tells us that if clinicians anticipate they will stay, this is pretty accurate), and more. 

For this study, Dr. Pathman and a team of researchers and staff from 3RNET (the organization which operates PRISM) took PRISM data to ask the above questions. In this instance, they looked at data from 1,102 physicians who were working within a HPSA when their National Health Service Corps program ended, from 2014 to 2024. 

Respondents

Findings

Approximately three-quarters of physicians both in urban and rural HPSAs anticipated they will remain in their current practices more than two years.

Satisfaction scores, rated on a scale from 1 (low) to 5 (high), were comparable for the urban and rural HPSA physicians for four of the six aspects of physicians’ work and jobs evaluated.

As a group, rural HPSA physicians were more satisfied both with having good practice administration and feeling well and fairly compensated.

After accounting for other variables, physicians in both urban and rural HPSAs who expected to stay in their practices for more than two years showed differences compared to those planning to leave sooner.

• They were satisfied with their practice administration. 
• They felt connected and supported at work. 
• They found their work meaningful. 
• They were able to provide the full range of services they desired.

Among rural Health Professional Shortage Area (HPSA) physicians, a positive work-life balance was linked to anticipated retention. In contrast, for both urban and rural HPSA physicians, anticipated retention was not correlated with perceptions of being well or fairly compensated.

Conclusions and Recommendations 

Whether or not these HPSA physicians anticipate remaining in their practices is related to how they feel about some, but not all aspects of their work. These aspects are generally but not always the same for those working in urban versus rural HPSAs. 

• Physicians in both urban and rural HPSAs tend to remain in their positions when they are satisfied with practice management, experience belonging and support at work, view their roles as meaningful, and can provide a broad range of services they value. 
• In rural HPSAs specifically, but not in urban ones, retention is higher among doctors who enjoy a healthy work-life balance. 
• For physicians in either setting, feeling adequately and justly paid does not appear to influence their likelihood of remaining in their positions. 

These findings show that HPSA practices often manage key aspects of physicians’ work that impact retention.  

Practices can ensure the administration is effective and attentive to physicians’ needs, help physicians feel their work’s importance, and support physicians in their needs as people to have a supportive work environment and, in rural HPSAs, a sustainable balance between their personal and professional lives. 

Differing from other studies where salary levels have demonstrated their importance to attracting physicians to HPSA practices, pay in this study found it to be unimportant to retaining them there.  

When pay is sufficient to attract mission-driven physicians to underserved areas, their decision to leave later is influenced by factors other than compensation. ♦

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Author bio:

Mandi Gingras is the Director of Education for 3RNET, the National Rural Recruitment and Retention Network, a nonprofit organization connecting health professionals with careers in rural and underserved communities. She leads recruitment and retention education for 3RNET members and safety net facilities nationwide. 

Mandi has 20 years of healthcare workforce recruitment experience, including prior roles with Bi-State Primary Care Association and McLaren Health Care. Her background spans primary care, oral health, and surgical specialty recruitment, along with workforce consulting. 

Contact: Gingras@3RNET.org

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Sources: 

This article is based on the “Summary Findings” put together by PRISM, which is a summary of the findings from this paper: How physicians' anticipated retention within urban and rural HPSA practices varies with their assessments of their work and jobs, published in The Journal of Rural Health. The full article may be accessed here: https://onlinelibrary.wiley.com/doi/10.1111/jrh.70117