Health Care Workplace

Physician retention may depend on preventing their dissatisfaction with pay and community relationships

Until recently, physician satisfaction was studied only among those working in special settings, such as rural and urban underserved areas. With the onset of managed care, many physicians have become employees and have found their autonomy constrained, medicine managed as a business, and incomes falling for some specialties. The result is a growing number of doctors considering a job change, nonclinical work, and retirement.

Dissatisfaction with pay and with community relationships are most likely to prompt physicians to leave their jobs, according to a survey of 1,939 practicing generalists and specialists across the United States. The research was supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00032).

Lead author, Donald E. Pathman, M.D., M.P.H., of the University of North Carolina at Chapel Hill, and colleagues analyzed whether physicians in the top and bottom quartiles of satisfaction for each of ten aspects of work were more or less likely to anticipate leaving their jobs within 2 years compared with physicians in the middle quartiles for satisfaction. Generalists and specialists had similar levels of satisfaction. One-fourth (27 percent) of doctors anticipated a moderate-to-definite likelihood of leaving their practices within 2 years. Relative dissatisfaction with pay and with their relationship to the surrounding community (reflected in survey questions such as "a sense of belonging, respected, and strongly connected") were associated with plans for leaving the current practice for nearly all physician groups surveyed.

How physicians felt about their relationships with patients and how they felt about their autonomy were not related to plans to leave their practices. Perhaps these once-central features of doctoring are no longer as important to physicians, or perhaps physicians believe they cannot find better relationships or more autonomy elsewhere and thus see no need to change jobs, explain the researchers. They suggest that clinical practices could promote workforce stability by providing doctors with opportunities and incentives to participate in local and State professional and service organizations or local volunteer clinics.

More details are in "Physician job satisfaction, job dissatisfaction, and physician turnover," by Dr. Pathman, Thomas R. Konrad, Ph.D., Eric S. Williams, Ph.D., and others, in the July 2002 Family Practice 51(7), pp. 593-601.

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