Physician retention in a context of workforce shortages: evidence from Portugal’s National Health Service with European policy implications

Physician shortages threaten healthcare system sustainability across Europe. Retaining physicians is critical to maintaining service capacity and quality. Despite its importance, physician retention remains a pressing issue in Europe, including in Portugal, where the Portuguese National Health Service (NHS) continues to face significant retention challenges. We conducted a quantitative, observational, cross-sectional study to identify determinants of physician retention in Portugal. A validated survey was developed using a Nominal Group Technique and Delphi Panel with stakeholders. The questionnaire measured job satisfaction with Likert scales. A stratified sampling strategy ensured representation across Portugal's five mainland health regions, yielding 1398 physicians. Data were collected via self-administered electronic questionnaires. Analyses included descriptive statistics, ANOVA, t-tests, and linear regression to assess predictors of retention. Physicians with longer seniority reported higher intention to remain, with those over 10 years showing the strongest intention (mean = 3.72; SD = 1.05; P < .001). Fixed schedules were linked to higher intended retention than shift work (mean = 3.42 vs. 3.18; P = .015). Job satisfaction was the strongest predictor (β = 0.267; P < .001), followed by age (β = 0.222; P < .001), satisfaction with work characteristics (β = 0.125; P = .002), and career development (β = 0.097; P = .011). Satisfaction with human resources and work-life balance was not significant. Physician retention is shaped by seniority, schedule stability, work environment, and career development. Policies fostering supportive environments, predictable schedules, and professional growth are needed to sustain the workforce, to European systems.