An ethnographic study of the retention of doctors in emergency medicine: materialities, retention work, and strategies

Darbyshire, Daniel and Goodwin, Dawn and Brewster, Liz and Isba, Rachel and Body, Richard (2022) An ethnographic study of the retention of doctors in emergency medicine: materialities, retention work, and strategies. PhD thesis, Lancaster University.

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Abstract

Demand on emergency departments has increased more than staff numbers, contributing to a problem with medical staffing that is politicised and emotive. Research on staff retention is decontextualised and has produced an ever-increasing list of factors of uncertain importance leading to a superficial understanding of retention in healthcare. This study aimed to gain a deep understanding of retention in emergency medicine, elucidate how retention is made possible, and make policy and practice recommendations. I conducted 11 weeks of ethnographic observation in a single emergency department, focusing on contextualised day-to-day practices of emergency physicians of all grades. I interviewed 21 emergency physicians from two emergency departments, ten emergency physicians who had left the profession, and ten individuals holding leadership roles with stakeholder organisations. An ethnomethodological lens allowed me to draw out the day-to-day practices from the data. Reflexive thematic analysis provided structure to the analysis and facilitated incorporating grey literature. The results showed how emergency physicians performed routine work to facilitate their retention. They did this using objects and space, which I called “materialities of retention”, and actions that l labelled “retention work”. Examples of retention work include humour, education, and building communities of practice. Portfolio careers and less than full time working were also employed as retention strategies. Emergency physicians utilised mentors, mostly informally, to navigate their careers and to take steps to facilitate their retention. This thesis has developed novel understandings of the importance of day-to-day objects and practices for retention. Policymakers, managers, and practitioners can enable emergency physicians to make their careers sustainable by facilitating retention work and strategies.