Community Relationships and Physician Retention in Clinician Shortage Areas.

Importance: Physicians' retention in rural underserved areas is known to be affected by how well their communities meet their families' needs and by how well physicians integrate into their communities, yet the relative importance of these 2 dimensions and whether they similarly affect retention in urban underserved practices are unknown. Objective: To examine the associations of community needs fulfillment and community integration with anticipated retention among physicians in rural and urban underserved areas, and assess whether the relative importance of each dimension differs by setting. Design, Setting, and Participants: This cross-sectional study used survey data collected May 2014 through January 2024, with analyses performed July 2025 to March 2026. Participants were physicians serving in rural and urban federally designated Health Professional Shortage Areas (HPSAs) in 33 US states participating in the Provider Retention and Information System Management collaborative. Exposures: Community needs fulfillment (4-item scale; Cronbach α = 0.74) and community integration (2-item scale; α = 0.81). Main Outcomes and Measures: The outcome of interest was anticipated retention beyond 2 years in the current practice. Separate rural and urban logistic regression models estimated independent associations with each exposure scale; z tests compared β coefficients across settings. Results: Of 2163 physicians emailed invitations, 1174 (54.9%) responded; 1074 physicians (mean [SD] age, 40.6 [6.7] years; 648 [61.8%] female) met inclusion criteria and were analyzed (351 physicians [32.7%] in rural HPSAs, 723 physicians [67.3%] in urban HPSAs). Among these, 265 physicians (75.5%) in rural HPSAs and 515 physicians (71.2%) in urban HPSAs anticipated remaining beyond 2 years (P = .14). In both settings, higher community needs fulfillment and community integration scores were independently associated with anticipated retention. Findings were comparable for the 2 scales among rural HPSA physicians (community needs fulfillment: β = 0.612 [SE, 0.192]; community integration: β = 0.578 [SE, 0.156]; Nagelkerke R2 = 0.19) and among urban HPSA physicians (community needs fulfillment: β = 0.565 [SE, 0.130]; community integration: β = 0.687 [SE, 0.110]; R2 = 0.16). The z tests showed no significant rural-urban differences for either scale. Conclusions and Relevance: In this cross-sectional study of 1074 physicians, community needs fulfillment and community integration were independently and similarly associated with anticipated retention among physicians in rural and urban HPSA practices. Practices and communities should pursue strategies to help physicians have their needs of their communities met and become integrated into their communities.