PRELIMINARY EVIDENCE ON RETENTION RATES OF PRIMARY-CARE PHYSICIANS INRURAL AND URBAN AREAS

The primary study objectives were to 1) determine how many physicians entered primary care practice in rural and urban counties of North Car olina in the 1981 to 1989 period and 2) estimate their length of tenur e in these areas. The secondary objective was to identify the physicia n's demographic, training, and practice characteristics that influence geographic location of practice and length of tenure. A cohort of 1,9 47 physicians was identified from the North Carolina Board of Medical Examiners database, which included all active, nonfederal primary care physicians who began their initial practice in North Carolina in 1981 or later. The primary outcome was time in practice in a given rural o r urban county. Selected data on physician demographic, training and p ractice characteristics were also available in the database. Approxima tely one third of physicians beginning their initial North Carolina pr actice selected a rural county for the location. Almost half of these primary care physicians were still in the county of their initial prac tice in 1989. An additional 20% of these physicians had changed practi ce location within the State, of which half chose a similar type of co unty to that of their initial practice. Length of tenure was similar a cross geographic locations of the medical practice, with the average l ength of tenure being 4.6 and 4.4 years among physicians in rural and urban counties, respectively. The strongest predictors of tenure were practice organizational characteristics with physicians in either an o ffice-based solo practice or partnership having longer tenures. These findings provide support for continuing programs that encourage physic ians to practice in rural areas; they also suggest the need for progra ms designed to retain rural physicians in their practices.