title: Factors Influencing Neurosurgeons' Decision to Retain in a Work Location: A Qualitative Study.
abstract: BACKGROUND
  Physician retention is a serious concern to have an effective and efficient health system; the key challenge is how best to encourage and retain health providers in their work location. There have been considerable studies on factors influencing physicians' retention but little research has been conducted in Iran. This study aims to determine the affecting factors from neurosurgeons' viewpoint to support policy makers in proposing a sort of evidence based retention strategies.
  
  
  METHODS
  We conducted semi structured interviews with 17 neurosurgeons working in 9 provinces of Iran between September and November 2014. We included physicians remaining to work in a particular community for at least 3 years and asked them about the factors influenced their decision to retain in a work place. Data were thematically analyzed using "framework approach" for qualitative research.
  
  
  RESULTS
  Satisfaction with monetary incentives, availability of adequate clinical infrastructure in a community and appropriate working condition were most commonly cited factors mentioned by all participants as key reasons for retention. Furthermore elements which contributed to the quality of living condition, personal background and incentives, family convenience were emphasized by majority of them. A small number of participants mentioned opportunity for continuing learning and updating knowledge as well as supportive organizational policies as important motivators in a workplace.
  
  
  CONCLUSIONS
  Ministry of Health and Medical Education (MOHME) should consider a multifaceted and holistic approach to improve neurosurgeons' retention in their work location. Our findings suggests a combination of financial remuneration, establishment of adequate hospitals and clinical facilities, collaborative working environment with reasonable workload, proper living condition, family support and facilities for professional development to be employed as an effective strategy for promoting physicians' retention.
authors.forename: Sima
authors.initials: S
authors.lastname: Rafiei
authors.affiliation: . arabmoha@tums.ac.ir.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Arab
authors.forename: Arash
authors.initials: A
authors.lastname: Rashidian
authors.forename: Mahmood
authors.initials: M
authors.lastname: Mahmoudi
authors.forename: Vafa
authors.initials: V
authors.lastname: Rahimi-Movaghar
mesh_terms: D003657:Decision Making; D006801:Humans; D007407:Interviews as Topic; D007492:Iran; D009493:Neurosurgery; D010558:Personnel Loyalty; D011365:Professional Practice Location; D036301:Qualitative Research; D066231:Surgeons / Q000523:psychology*; D017132:Workplace