Turnover among Australian general practitioners: a longitudinal gender analysis

E Anne Bardoel,Margaret Kay,Susan Mayson,Grant Russell,Jenny Advocat

doi:10.1186/s12960-020-00525-4

Abstract

BackgroundLittle is known about gender differences in general practitioner (GP) turnover. It is important to understand potential divergence given both the feminization of the Australian GP workforce and projected shortages of GPs.ObjectiveThere is increasing evidence that national health outcomes are related to the extent to which health care systems incorporate high quality primary care. Quality primary care is, in turn reliant on a stable general practice (GP) workforce. With the increasing feminization of medical schools, we sought to identify correlates of turnover in the GP workforce, separately for women and men, focusing particularly on part-time employment and child-rearing, and distinguishing effects related to either planned or unplanned turnover.MethodsAnnual responses from cohorts of at least 1900 women GPs and 2000 men GPs are used for up to eight waves of the Medicine in Australia—Balancing Employment and Life (MABEL) longitudinal survey of doctors. Descriptive and bivariate correlations are provided. Random effects ordered logit is applied to dependent variables for turnover intentions measuring intent to “leave direct care” or “leave medicine”. A behavioral measure of turnover is used in random effects logit regressions, with the exclusion or inclusion of the confounding intentions variables revealing correlates of unplanned or planned turnover.ResultsPart-time employment is associated with turnover intentions among both women (84% or 94% increase in the odds ratios or ORs) and particularly men (414% or 672%), and with actual turnover for women (150% or 49%) and for men (160% or 107%). Women GPs engage in more unplanned turnover than men: they are 85% more likely to engage in turnover after controlling for intentions. Unplanned turnover is concentrated among women below 40 years of age and with young children, even though both groups report below average turnover intentions.ConclusionAlthough further studies are needed to identify specific factors associated with GP turnover among women, the analysis highlights the need to focus on women GPs who are either young or have young children. Given the substantial personal and social investment required to produce GPs, it is wasteful to lose so many young women early in their careers.

Highlights

General practitioners (GPs) leaving the profession is costly in terms of societal investments in training new general practitioner (GP) [1], and because of the significant loss of investments of time and money by young GPs
Women GPs engage in more unplanned turnover than men: they are 85% more likely to engage in turnover after controlling for intentions
Unplanned turnover is concentrated among women below 40 years of age and with young children, even though both groups report below average turnover intentions

Summary

Introduction

General practitioners (GPs) leaving the profession is costly in terms of societal investments in training new GPs [1], and because of the significant loss of investments of time and money by young GPs. [3] found that women were more likely than men to report family reasons or workplace harassment as reasons for turnover intentions They called for further research focused on understanding gender differences in relation to intention to leave and leaving general practice. This study aims to help fill this gap by investigating longitudinal data on cohorts of GPs to ascertain differences and similarities across women and men in the correlates of turnover and turnover intentions, focusing on the roles of part-time employment and young children, and their relationship to planned and unplanned turnover. Turnover and turnover intentions vary across women and men [3, 6] This factor is relevant because most young GPs in Australia are women. That possibility appears in qualitative Australian research suggesting that some young women enter the field, and work part-time or with flexible hours, to balance caring for children with paid employment [3]

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