Physician Retention in Community Hospitals of Thailand

Abstract

The objectives of this study were: (1) to explain phenomena of physician turnover and retention in community hospitals of Thailand; (2) to search for the main factors related to physician retention in community hospitals; (3) to develop a model for physician retention in community hospitals of Thailand. The methodology was divided into 3 steps: (1) review of physician retention phenomena from the past until the present and relevant literatures to develop a theoretical model of physician retention in community hospitals of Thailand; (2) qualitative study through in-depth interviews of existing physicians in April, 2008, and then modifying the model; (3) quantitative study, which tested generalization of the model through existing surveys of physicians in community hospitals all over country. The questionnaire was constructed and mailed to existing physicians after two years of working in community hospitals from March to May, 2009. The path analysis technique was used to analyze the complicated data. It was found that the factors that directly influenced early physician retention in community hospitals (age ≤ 35 yrs) were composed of 4 variables: 1) marital status; 2) physician satisfaction; 3) job content; and 4) community context. All 4 variables accounted for physician retention at 13.3 percent. The factors that indirectly influenced early physician retention were composed of 6 variables: 1) general practice physicians; 2) income characteristics; 3) job context; 4) community context; 5) medical operation management, and 6) district supplement compensation in normal and hardship level communities. The factors that directly influenced late physician retention in community hospitals (age >35 yrs) were composed of 6 variables: 1) sex; 2) marital status; 3) general practice physicians; 4) type of learning; 5) income characteristics; and 6) job context. All 6 variables accounted for physician retention at 38.8 percent. The factors that indirectly influenced late physician retention were composed of 2 variables: 1) medical operation management and 2) district supplement compensation in normal and hardship level communities. Policy recommendations for physician retention strategies in community hospitals include the following: the establishment of effective medical operation management to achieve a suitable work load system; an incentive compensation system to work in community hospitals; hospital accreditation policy support to develop a good work environment; work offers for physician’s spouses and school quotas for physician’s offspring in the same area of community hospitals to develop a work-life balance.