"We've Really Built Something": Why Family Medicine Program Directors Stay in Their Positions-A Qualitative Study.

Background: Program directors (PDs) are essential to more than 12 000 residency and fellowship programs accredited in the United States. Short PD tenure may affect overall program quality. Reasons why PDs leave the position are multifactorial, and little is known about the reasons why PDs stay in the position. Objective: The authors explored factors related to retention and why family medicine PDs have stayed in their positions long term. Methods: This was a qualitative study of PDs in their roles for 12 or more years drawn from a national sample of family medicine residency PDs. Interviews with semi-structured and structured questions about long-term PD experience were conducted in October and November 2020. Multiple cycles of comparative coding and code network analysis produced constructs describing reasons why some PDs stay in the position long term. Results: Among 17 respondents with a mean tenure of 17.4 years, 3 interrelated constructs consistently emerged that supported PDs: developing the program, support systems, and job rewards. Program development reinforces internal and external support systems and enhances experiencing rewards of the job. Strong support systems enable further program development and job rewards. Conclusions: Family medicine residency PDs who have been in the role 12 or more years continuously work to develop the program, benefit from strong internal and external support systems, and describe many important rewards of the position that help sustain them in the role.