Retention of doctors in emergency medicine: a scoping review of the academic literature

Abstract

IntroductionWorkforce issues prevail across healthcare; in emergency medicine (EM), previous work improved retention, but the staffing problem changed rather than improved. More experienced doctors provide higher quality and more cost-effective care, and turnover of these physicians is expensive. Research focusing on staff retention is an urgent priority.MethodsThis study is a scoping review of the academic literature relating to the retention of doctors in EM and describes current evidence about sustainable careers (focusing on factors influencing retention), as well as interventions to improve retention. The established and rigorous JBI scoping review methodology was followed. The data sources searched were MEDLINE, Embase, Cochrane, HMIC and PsycINFO, with papers published up to April 2020 included. Broad eligibility criteria were used to identify papers about retention or related terms, including turnover, sustainability, exodus, intention to quit and attrition, whose population included emergency physicians within the setting of the ED. Papers which solely measured the rate of one of these concepts were excluded.ResultsEighteen papers met the inclusion criteria. Multiple factors were identified as linked with retention, including perceptions about teamwork, excessive workloads, working conditions, errors, teaching and education, portfolio careers, physical and emotional strain, stress, burnout, debt, income, work–life balance and antisocial working patterns. Definitions of key terms were used inconsistently. No factors clearly dominated; studies of correlation between factors were common. There were minimal research reporting interventions.ConclusionMany factors have been linked to retention of doctors in EM, but the research lacks an appreciation of the complexity inherent in career decision-making. A broad approach, addressing multiple factors rather than focusing on single factors, may prove more informative.

The prevalence of turnover intention and influencing factors among emergency physicians: A national observation

“…It was found that average monthly income was negatively related to turnover intention among physicians in emergency department. It is probably due to the lower average monthly income may not cover living needs for physicians in emergency department, so the physicians who have a lower average monthly income were more likely to leave emergency department, which was in line with previous study [ 30 ].…”

Burnout in hospital healthcare workers after the second COVID-19 wave: Job tenure as a potential protective factor

“…Turnover is considered a negative internal indicator by most organizations and the common belief is that employees leave their jobs due to dissatisfaction and other negative reasons. Several studies describe burnout as a reason or mediator of high turnover rates among healthcare workers that should be kept at low levels to increase employee retention ( Neale, 1991 ; Leiter and Maslach, 2009 ; Mahoney et al, 2020 ; Shields et al, 2020 ; Darbyshire et al, 2021 ; Kim and Kim, 2021 ).…”

Who cares where the doctors are? The expectation of mobility and its effect on health outcomes

“…More recently, investigative focus has turned towards retention, or looking at what conditions support continued employment (e.g. Darbyshire et al., 2021). Ensuring that careers are sustainable, with ‘less than full time’ training, more flexible pathways, and a hard look at some of the more problematic elements of work‐life balance such as rota management have become key elements of the narrative around minimising turnover and keeping doctors in the NHS.…”