Health Care Organization/Delivery

Primary care doctors had a high rate of job turnover in the late 1980s and early 1990s

Job turnover among primary care physicians (PCPs) was a substantial problem in the late 1980s and early 1990s, according to a study supported by the Agency for Healthcare Research and Quality (HS08984). It revealed that more than half (55 percent) of a group of PCPs younger than age 45 left at least one practice between 1987 and 1991. In fact, 20 percent of the group studied left two practices. Not surprisingly, PCPs who were dissatisfied with their jobs were more than twice as likely to leave as satisfied doctors. However, other personal and organizational factors also influenced doctors to leave practices, explains Sharon Buchbinder, R.N., Ph.D., of Towson University.

Dr. Buchbinder and her colleagues examined national survey responses in 1987 and 1991 of 507 nonfederally employed PCPs younger than 45 years who had completed their medical training between 1982 and 1985. They examined the relationship of personal and organizational characteristics, as well as overall job satisfaction, to PCP turnover. Two personal characteristics were particularly significant. PCPs who believed that third-party-payer influence would decrease in 5 years were 1.3 times more likely to leave than those who did not. Also, PCPs who were not board certified were 1.3 times more likely to leave than those who were board certified. The data available for this study did not indicate whether a PCP left a practice voluntarily or involuntarily. Thus, it was not possible to determine whether lack of board certification caused PCPs to be terminated or to seek employment elsewhere.

Only one organizational factor, perceived overuse of standardized protocols for patient care, significantly affected PCP job turnover, with PCPs who perceived overuse being 1.18 times more likely to leave. Overall, PCP job satisfaction was the most powerful predictor of PCP turnover, with dissatisfied PCPs 2.4 times as likely to change jobs. In the case of PCPs who completed training in the 1970s, the encroachment of third-party payers and managed care into their lives could have had a major effect on their job satisfaction. The researchers note the need for a standardized physician job satisfaction instrument to improve measurement and management of PCP job satisfaction and turnover.

More details are in "Primary care physician job satisfaction and turnover," by Dr. Buchbinder, R.N., Ph.D., Modena Wilson, M.D., M.P.H., Clifford F. Melick, Ph.D., and Neil R. Powe, M.D., M.P.H., M.B.A., in the July 2001 American Journal of Managed Care 7(7), pp. 701-713.

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