RURAL PHYSICIAN SATISFACTION - ITS SOURCES AND RELATIONSHIP TO RETENTION

This study uses survey data to identify areas of satisfaction and diss atisfaction for primary care physicians working in rural areas across the country. It also identifies the specific areas of satisfaction ass ociated with longer retention within a given rural practice, as well a s the characteristics of individuals, practices, jobs, and communities associated with the areas of satisfaction that predict retention. Stu dy subjects comprised a sample of 1,600 primary care physicians who mo ved to nonmetropolitan counties nationwide during the years 1987 throu gh 1990, with oversampling of those who moved to federally designated health professional shortage areas (HPSAs). Physicians serving in the National Health Service Corps (NHSC) were excluded. Sixty-nine percent of the eligible subjects returned completed mail questionnaires in 19 91. Analyses for this study were limited to the 620 primary care physi cians who worked more than 20 hours per week in towns of fewer than 35 ,000 population; who were neither in the military nor the NHSC; and wh o were not in urgent care, emergency room, or full-time teaching posit ions. Analyses revealed that the areas of rural physicians' greatest s atisfaction were their relationships with patients, clinical autonomy, the care they provided to medically needy patients, and life in small communities. Physicians were least satisfied with their access to urb an amenities and the amount of time they spent away from their practic es. Retention was independently associated only with physicians' satis faction with their communities and their opportunities to achieve prof essional goals. Retention was also marginally related to physicians' s atisfaction with their earnings. Among the areas of satisfaction not r elated to retention were satisfaction with autonomy, access to medical information and consultants, and the quality of doctor-patient relati onships. In a subsequent series of analyses of the factors that predic t the three areas of satisfaction that were associated with retention (satisfaction with the community, professional goal attainment, and ea rnings), a variety of physician, work, and community factors were iden tified. These findings reveal that specific features of rural physicia ns, their work, and their communities predict each of the various aspe cts of satisfaction and that only certain aspects of satisfaction pred ict rural physicians' retention. There are no magic bullets to make ru ral physicians satisfied in all ways. Nevertheless, there are identifi ed approaches to elevate the specific aspects of rural physicians' sat isfaction important to their retention. Programs to improve the satisf action of rural physicians should focus on those areas of satisfaction that predict longer retention and other important outcomes.