Practice Sights Shows Importance of Community Factors in Physician Retention

Jackie_FannellRural areas are hard pressed to attract and place skilled clinicians, and loan repayment for health care education plays an important role in attracting clinicians to rural or underserved areas. When you recruit a clinician to a small rural or underserved area, and provide no community support, there is a possibility that this individual may not be happy, and ultimately will not stay once their service obligation has been met.

There has to be a partnership. There has to be support. And there has to be buy-in from the entire community so that the clinician feels welcomed as a part of that community from his or her first day on the job.

This is where the Practice Sights Retention Management System comes in.  Currently being utilized by an 11-state collaborative, each of which operates the program independently, data provides states and staff of incentive programs with information to make clinicians’ service experiences as positive and productive as possible.

Practice Sights collects data in the form of questionnaires sent to clinicians and practice administrators via email. The Cecil G. Sheps Center for Health Services Research (Sheps Center) provides expertise on data collection, analysis and dissemination. The questionnaire clinicians receive three months after the start of their service obligation asks about their background, their reasons for applying to the program (needing financial assistance and/or wanting to provide care to an underserved population or area) and their needs, values and expectations of their current position and community.  Annual and end-of-contract questionnaires will ask about their current work, whether the role is meeting their professional goals, etc.  The questionnaires will also ask them to rate their satisfaction with various aspects of their community and practices. Alumni questionnaires are sent periodically and ask clinicians if they are at the same site and, if not, to provide information about their current work.


The rich data collected by Practice Sights allows state program administrators to identify problem areas so that they can work with site administrators to improve overall clinician retention in rural areas. The challenge, notes Jackie Fannell, Program Manager for Practice Sights, comes in getting clinicians to respond to the questionnaires, — particularly program alumni, who are no longer obligated under their contract.  Most states are now seeing over 50% response rates across the board. While this leaves room to grow, it still provides a rich set of data to help improve clinician retention.

Practice Sights plans to bring more states into the collaborative and continue to grow the program. There is no other system that collects data on clinician retention in this manner and it will become more valuable and have even greater impact moving forward and the aggregated data shows trends and reveals what is working and what is not.

Community factors have been shown to greatly impact physician retention. The findings of a 2012 report prepared for the Multi-State/NHSC Retention Collaborative by the Sheps Center calls for programs to help communities learn the important role they play in clinician retention and the things they can do to promote retention, engage community leaders and intervene early — before small problems escalate — when clinicians encounter difficulties with their communities. Efforts to build Accountable Care Communities in North Carolina and other states could be an important step in bringing communities into the health-care conversation. Including community input and participation in health care from the start could help ensure acceptance and support for new providers, rather than waiting until issues arise or only including community voices as an afterthought.

Accountable Care Communities are an important part of clinician recruitment and retention in rural areas. With Accountable Care Communities, the community is involved with all aspects of the health-care environment, and is more vested in supporting and including clinicians and their families in the community. Practice Sights, in turn, plays an important role in helping create Accountable Care Communities, with its data driving the awareness of where community and other support is lacking, as well as allowing communities to become better-equipped to receive and support new clinicians from day one.