Provider Retention in High Need Areas. Other characteristics associated with a higher NHSC Retention


The Multi-State NHSC Retention Collaborative, a consortium of 11 state Primary Care Offices, funded a study on the retention of clinicians within their states who serve in NHSC or in similar state-based programs (Pathman et al. 2012(b)). Using data from two key surveys—the 2012 national NHSC medium and long-term retention study and the survey of clinicians in NHSC and state programs in 11 states participating in the Collaborative, this evaluation sought to identify the circumstances and characteristics of clinicians, service sites, and service experiences that contribute to longer retention. Examining the current and recent NHSC and state-program participants’ plans to remain in their original service sites for one, two, and up to ten years, the authors find that of the 1,558 NHSC and state service program participants surveyed, 69 percent remained or anticipated remaining in their service sites for at least one year beyond their service terms, 48 percent anticipated remaining at least three years, and 20 percent anticipated remaining at least ten years. Consistent with previous studies, a significantly higher proportion of NHSC Loan Repayment Program participants anticipate remaining in service sites beyond contractual terms (70 percent compared to 36 percent at one year, 35 percent compared to 13 percent at five years, and 19 percent compared to 2 percent at 10 years, respectively). Within the NHSC Loan Repayment Program, anticipated retention rates are similar across the eleven states.

After simultaneously controlling for the clinicians’ disciplines and demographics, factors relating to principal reason for service and type of practice account for 16.3 percent of variation across clinicians in their plans to remain in their service sites for at least two years beyond their service term, and for 18.7 percent of the variation at five years (Pathman et al., 2012(b)). The factors that have a positive effect on retention include:

  • Being a physician (as opposed to a nurse practitioner, physician assistant, dentist or mental and behavioral health practitioner);

  • Being age 30 or over, non-Hispanic White race/ethnicity, having children, and serving in a state where one grew up and where one trained;

  • Principally motivated by the chance to work with underserved populations rather than for the programs’ financial support; and

  • Serving in a rural health facility, mental health or substance abuse treatment facility, a prison, or “other” type of facility.

Factors relating to clinicians’ satisfaction with work and practice, family integration into the broader community, and overall assessment of their service program explain 28.6 percent of variation across clinicians in their plans to remain in their service sites for at least two years beyond their service term and for 27.1 percent at five years (Pathman et al., 2012(b). These factors include:

  • Feeling of belonging and safety within the community for the clinician and clinician’s family;

  • Satisfaction with the program administrator, salary, the assessment of the practice overall, and access to specialist consultation; and

  • Overall satisfaction with the service program and the program staff support.

Other findings from the study regarding socio-demographic characteristics that contribute to retention are summarized as follows (Pathman et al., 2012(b)):

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