Professional, personal and community: 3 domains of physician retention in rural communities.

INTRODUCTION: We sought to explore the professional, personal and community domains of physician retention in 4 rural communities in Alberta and to develop a preliminary framework for physician retention. METHODS: We used a qualitative, collective case study design to study 4 rural communities (cases) in Alberta that retained family physicians for 4 years or longer. Participants included physicians, staff members, spouses and community members. Data collected from interviews, documents and observations were analyzed individually, and similarities and differences across all cases were assessed. RESULTS: A range of factors that could influence physicians' decisions to stay in a particular community were described by participants. Within the professional domain, physician supply, physician dynamics, scope of practice and practice set-up were common across all communities, and innovation, and management and support emerged from some communities. The personal factors, goodness-of-fit, individual choice, and spousal and family support were present in all communities. Four community factors--appreciation, connection, active support, and physical and recreational assets--emerged across all communities, and reciprocity was present in 3 communities. From these data, we developed a preliminary retention framework. CONCLUSION: Physicians, policy-makers and community members are encouraged to consider the 3 retention domains of professional, personal and community.