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Donald E. Pathman, MD, MPH, Thomas R. Konrad, PhD, Rebekkah Dann, MS and Gary Koch, PhD

Donald E. Pathman and Thomas R. Konrad are with the Cecil G. Sheps Center for Health Services Research at the University of North Carolina at Chapel Hill. Donald E. Pathman is also with the Department of Family Medicine at University of North Carolina. Rebekkah Dann and Gary Koch are with the Department of Biostatistics at the University of North Carolina at Chapel Hill.

Correspondence: Requests for reprints should be sent to Donald E. Path-man, MD, MPH, Cecil G. Sheps Center for Health Services Research, University of North Carolina CB#7590, Chapel Hill, NC 27599 (e-mail: don_pathman{at}unc.edu).

Objectives. We tested the assumption that average job retention duration is shorter for physicians in rural health professional shortage areas (HPSAs) than for physicians in rural non-HPSAs.

Methods. In 1991, we surveyed nationally representative samples of primary care physicians who recently had moved to rural HPSAs and non-HPSAs who were without service obligations. We resurveyed these physicians in 1996 and 1997 to learn of any job changes.

Results. Physicians in rural HPSAs (n=308) demonstrated retention similar to that of the non-HPSA cohort (n=197) (hazard ratio for leaving=1.28; 95% confidence interval=0.97, 1.69; P=.08), even with adjustments for group demographic differences (P=.24).

Conclusions. Average retention duration for generalist physicians in rural HPSAs is identical to or slightly shorter than for those in rural non-HPSAs. Poor recruitment is likely to be the principal dynamic underlying local rural shortages.

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