Many state-issued, institutional, or other types of programs tend to use their own retention metrics that may be more relevant to local conditions than federal metrics. Generally, the differences lie in the length of time assessed and geographic inclusion criteria.
For example, in evaluating retention in state programs, Pathman et al. (2004(a)) tracked retention at two-year intervals to measure the percentage of clinicians remaining in the index practice at discrete points in time. Of the 69 state programs operating in 1996, the average level of assistance did not differ significantly across the five types of programs reviewed (scholarships, service-option loans, loan repayment, direct financial incentives, and resident support). Four-year and eight-year retention in index practice were used as the primary metrics of retention in the study. Average minimum service term was 12 months in resident support programs, 18 months in scholarship programs, 10 months in service option loan programs, 29 months in loan repayment programs, and 36 months in direct incentive programs (Pathman et al., 2004(a)).
To assess long-term retention of graduates of the Physician Shortage Area Program (PSAP) of Jefferson Medical College, Rabinowitz (2013) defines retention for this program as the percentage of individual graduates practicing in the same rural areas in 2011 as they were initially, 20 to 25 years after they first began practice. Practice location was considered to be the same area if it was in the same rural county or an adjacent county as when the graduate was first located (Rabinowitz et al., 2013). ‘Rural’ was defined as counties that are not designated as standard metropolitan areas.
Other programs aimed at increasing the supply and retention of rural clinicians define retention in varied ways. For example, the term rural is sometimes used without further explanation, or it may refer to a non-Standard Metropolitan Statistical Area county (non-SMSA), or communities of population below a certain threshold. Oftentimes, studies use population under 25,000 or under 50,000 as a benchmark (Rabinowitz et al., 2008). The length of retention may vary across studies as well, ranging from 1 year to 25 years.