title: Predictive accuracy of rural physicians' stated retention plans.
abstract: BACKGROUND
  The retention of rural physicians is a difficult phenomenon to study because job changes--the outcome of interest--take years to unfold. One common way to study retention is to ask rural practitioners through surveys how much longer they expect to remain in their current positions and use these statements of "anticipated retention" as an expedient proxy measure of actual retention.
  
  
  OBJECTIVE
  To test the predictive accuracy of rural physicians' stated retention plans and test the hypotheses that predictions are more accurate for certain physicians, such as those with more experience, more control of their work situations, and at less risk for job burnout.
  
  
  METHODS
  A 1991 mail survey (national stratified random sample) prospectively queried rural physicians' retention plans, and a follow-up survey 5 to 6 years later determined if and when respondents (N = 405, 67.5% combined response rate) had moved.
  
  
  RESULTS
  Retention predictions for the entire cohort corresponded remarkably well to the group's actual retention, with the proportion remaining each year deviating by only a few percentage points from what the group collectively expected. Predictions for individuals were also moderately accurate: 4 of 5 physicians who predicted remaining at least 5 years did so; 2 of 3 who predicted remaining less than 5 years indeed left before 5 years. Predictions of job changes in less than 2 years tended to be more accurate than predictions of 2 to 5 years. Physicians' predictions were more accurate when they worked in practices they owned (greater control) and were on-call 2 or fewer times each week (lower burnout risk). Accuracy was not greater with any of 5 measures of experience.
  
  
  CONCLUSIONS
  Rural generalist physicians are moderately accurate when reporting how much longer they will remain in their jobs, validating the use of anticipated retention in rural health workforce studies.
authors.affiliation: Cecil G. Sheps Center, Chapel Hill, NC 27599, USA. don_pathman@unc.edu
authors.forename: Donald E
authors.initials: DE
authors.lastname: Pathman
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Konrad
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Agnew
mesh_terms: D000328:Adult; D002321:Career Choice; D015331:Cohort Studies; D005260:Female; D005544:Forecasting; D006302:Health Services Research; D006801:Humans; D033182:Intention; D008297:Male; D008507:Medically Underserved Area; D010558:Personnel Loyalty; D010821:Physicians, Family / Q000523:psychology / Q000600:supply & distribution*; D011365:Professional Practice Location; D019035:Rural Health Services; D013995:Time; D014481:United States; D000078329:Workforce