West Virginia Medical Journal - 2022 - Quarter 1 | Página 39

had more time to spend with patients and pursue their own interests than perhaps colleagues in other states . Respondents were very clear that support of leadership in hospital and clinical settings influenced their desire to stay in WV . Many of those same physicians indicated that if the leadership or leadership philosophy changed , they would consider leaving the state . Many spoke of loyalty to their state , community , and practice .

Respondents were also asked which factors may cause them to consider leaving their current site ( s ) in WV . Themes that emerged considered the broader environment as well as practice and personal contexts , including economic plight and social deterioration of WV ; government and political factors , including reimbursement and the malpractice environment ; poor support of leadership in the clinical setting ; and a need or desire for a change in environment . Several respondents indicated that they did leave WV for “ a better job outside WV ; more progressive environment .” Others indicated that they had family that had already moved to other states , and they would consider leaving to be closer to family .

The drug crisis was often listed as a deterrent in many areas of respondents ’ practice and personal lives , including the need to constantly try to find help for their patients and their frustration with the social impact of the crisis on their communities . Socioeconomic and political factors were cited by many physicians as influences that may cause them to leave WV , with one respondent stating that “ the economic plight of WV remains grim with a declining population .” Reimbursement changes and challenges and malpractice / tort reform were also specifically cited . While tort reform was cited by many as a positive due to lowering insurance costs , the malpractice environment was also seen as a hindrance to practice in WV .

The importance of strong clinical leadership was referenced by numerous respondents , and many noted that they considered leaving due to the lack of leadership support they receive . Additional reasons included loss of autonomy and clinical decision-making driven by finances . Others noted that they would consider leaving if support by administration decreased for their practice , teaching , or research . Uncertainty created by hospital mergers and the increased independence of advanced practice providers were listed as influences on decisions to leave the state . Lastly , respondents noted factors that could require a change of environment for their practice including age , disability , children , and grandchildren moving out of state for job opportunities , and changes to their family situation such as a spouse needing to find work outside of the state .

DISCUSSION

Addressing financial incentives , quality of life , community attributes , and work environment are field-tested strategies to recruit and retain rural physicians . ^{2 , 7} Results from this study showed that cost of living and earning potential ( financial considerations ), leisure time and workload ( quality of life ), ability to make an impact through their practice ( community attributes ), and work autonomy ( work environment ) were ranked highest by respondents as influencing their selection of a practice site . Fortyfive percent of respondents were from WV , and 17 % from rural WV . Incentives such as scholarships and loan repayment were important to respondents practicing primary care in WV . Additional quality of life factors included nature , culture , opportunities for children , pace of life , and the quality of colleagues . Community attributes such as the ability to practice in a community like “ home ” and having an established network of family and friends was supported by both quantitative and qualitative data and were more important for individuals from WV .

FIGURE 2

Number of Responses

160 140 120 100 80 60 40 20 0

West Virginia Medical Journal • March 2022 • 37