Analyzing Rural Versus Urban Differences in Career Dissatisfaction and Plans to Leave Among Pennsylvanian Physicians.
OBJECTIVE
This study estimates whether physicians in rural Pennsylvania have higher odds of career dissatisfaction and plans to leave patient care in the next 6 years, compared to their urban counterparts. Rural-urban differences were estimated across specific subgroups of physicians (gender, race, and specialty) and with regard to specific sources of career dissatisfaction.


METHODS
The 2012 Pennsylvania Health Workforce Survey of Physicians allowed for analysis of 17,444 physicians younger than 55 years old actively practicing patient care. Multivariate, logistic regression was performed to estimate the associations with 2 outcome areas: career dissatisfaction and plans to leave patient care in the next 6 years. Controls included rural setting, age, sex, race, work hours, specialty, and practice characteristics.


RESULTS
Over 12% of under-55 physicians are dissatisfied with their careers and over 18% report plans to leave patient care in the next 6 years. Rural physicians in Pennsylvania have 18.6% higher odds of reporting career dissatisfaction and 29.5% higher odds of leaving patient care in the next 6 years (P < .01 for each) versus their urban counterparts.


CONCLUSIONS
Rates of dissatisfaction and potential attrition among younger physicians are not insignificant, with a stronger association with rural practice. Given the large number of rural health shortage areas, better understanding this association is important to health care providers and policy makers. Regression results suggest that higher rural odds are related more to physician work (i.e., stress, practice demands, and lack of autonomy) and family situations and less related to income concerns.
Department of Economics, Indiana University of Pennsylvania, Indiana, Pennsylvania.
Brandon
B
Vick
D000328:Adult; D000367:Age Factors; D005260:Female; D006297:Health Services Accessibility; D006280:Health Workforce; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data; D008875:Middle Aged; D010414:Pennsylvania; D010820:Physicians / Q000523:psychology*; D011365:Professional Practice Location / Q000706:statistics & numerical data*; D044469:Racial Groups; D012424:Rural Population; D012737:Sex Factors; D014505:Urban Population
career satisfaction; retention; rural health care; rural physicians; young physicians