Turnover among Australian general practitioners: a longitudinal gender analysis.

BACKGROUND Little 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. OBJECTIVE There 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. METHODS Annual 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. RESULTS Part-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. CONCLUSION Although 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.