Despite the importance to policy makers and rural communities of retaining physicians in rural practices, very few studies have explicitly addressed this issue. It is still not even known how long rank-and-file physicians remain in rural practices, nor where they move to when they leave. With little data available, policy makers, practices, and communities have only their intuitions and anecdotal experience on which to base retention initiatives. This study will involve analyses and report writing from unique data collected from nearly 700 rural primary care physicians nationwide through two rounds of surveys from two prior studies in 1991 and 1996-8. Never before have such detailed data from such a large, nationally representative incidence cohort of physicians in rural settings been available to answer questions about retention. The study's aims are to: 1. describe how long primary care physicians remain in rural Health Professional Shortage Areas and non-HPSA rural settings; identify the personal, practice and community factors-including community ethnicity and managed care penetration-associated with longer retention, and characterize where physicians move to when they leave rural practices. 2. characterize the interactions between rural physicians and their local communities, and identify how these relationships predict retention duration. 3. assess the accuracy of rural physicians' estimates of their future practice employment tenure, to validate a refined version of a commonly used survey-derived proxy measure for retention. Retention analyses will use the techniques of mufti-variable survival analysis. Retention will be defined with respect to two locations; within a specific rural practice and consecutive rural practices. Physician-community interactions will be characterized as (1) physicians' assimilation into the community and its organizations, and (2) their involvement in health initiatives in the community (community oriented primary care).
