Do physicians serving as managers influence the turnover of physicians and nurses at primary care centers in Sweden?

Abstract

There is an ongoing healthcare workforce crisis in Europe with large shortages of physicians, nurses, and other healthcare workers. Lowering physician and nurse turnover is essential to address the crisis. The purpose of this study is to examine if a change from a non-physician manager to a physician manager causally impacts subsequent physician and nurse turnover rates in Swedish primary care. Our sample consists of 184 primary care centers (PCCs), some of whom incurred a change from a nonphysician to a physician manager. We view these changes as a ‘treatment’, and physician and nurse turnover rates as outcome variables. We employ an event study design since treatments are staggered over the period. We hypothesize that a change from a non-physician manager to a physician manager would decrease (increase) subsequent physician (nurse) turnover rates. Even though this is priori plausible, we find no consistent evidence to suggest that changing to a physician manager influences physician or nurse turnover rates. If anything, we find modest evidence for a temporary increase in physician turnover, especially in the short run close to the manager change. Our thesis is the first study that examines the causal effect of a manager change on physician and nurse turnover, and we provide valuable insights into the ongoing healthcare workforce crisis by demonstrating that merely ‘shifting’ physicians into manager roles does not translate into lower physician turnover.