Factors influencing physicians' choice of workplace: systematic review of drivers of attrition and policy interventions to address them.

Maria El Koussa,Diana Bowser,Margaret E Kruk,Rifat Atun

doi:10.7189/jogh.06.020403

Abstract

ObjectivesThe movement of skilled physicians from the public to the private sector is a key constraint to achieving universal health coverage and is currently affecting health systems worldwide. This systematic review aims to assess factors influencing physicians’ choice of workplace, and policy interventions for retaining physicians in the public sector.MethodsFive literature databases were searched. Studies were included in the review if they focused on at least one of the following criteria: (i) incentives or motivators for retaining physicians in the public sector, (ii) pull factors that encouraged physicians to move to the private sector, (iii) push factors that forced physicians to leave the public sector, (iv) policy interventions or case studies that addressed physician retention in the public sector, and (v) qualitative reviews of policy interventions that were implemented in different health system settings.ResultsNineteen articles met the inclusion criteria. Six major themes that affected physicians’ choice of workplace were identified including: financial incentives, career development, infrastructure and staffing, professional work environment, workload and autonomy. The majority of the studies suggested that the use of financial incentives was a motivator in retaining physicians in the public sector. The review also identified policy interventions including: regulatory controls, incentives and management reforms. Regulatory controls and incentives were the two most frequently reported policy interventions.ConclusionWhile factors affecting physicians’ choice of workplace are country specific, financial incentives and professional development are core factors. Other factors are highly influenced by context, and thus, it would be useful for future cross–country research to use standardized data collection tools, allowing comparison of contextual factors as well as the examination of how context affects physician retention in the public sector.

Highlights

Studies were included in the review if they focused on at least one of the following criteria: (i) incentives or motivators for retaining physicians in the public sector, (ii) pull factors that encouraged physicians to move to the private sector, (iii) push factors that forced physicians to leave the public sector, (iv) policy interventions or case studies that addressed physician retention in the public sector, and (v) qualitative reviews of policy interventions that were implemented in different health system settings
Other factors are highly influenced by context, and it would be useful for future cross–country research to use standardized data collection tools, allowing comparison of contextual factors as well as the examination of how context affects physician retention in the public sector
The human resource shortages are acute in low and middle income countries in Africa, Asia and the Pacific and exacerbated by the movement of skilled physicians from the public to the private sector affecting health systems worldwide [2,3]. In both low– and high–income countries, physicians working in government hospitals and clinics often practice privately in order to boost their earnings. This dual practice is common in many European countries including the United Kingdom and is high in low– and middle–income countries such as Egypt, Vietnam and India [4]

Summary

Objectives

The movement of skilled physicians from the public to the private sector is a key constraint to achieving universal health coverage and is currently affecting health systems worldwide

Methods

Results

Discussion

Conclusion