An important aspect of primary care physician availability is the retention of physicians once they have located. While retention has been under-researched compared to recruitment, it is especially important in rural areas where physician shortages already exist. This study reports the results of a retention survey completed by 132 primary care physicians in rural eastern Kentucky. The survey sets up an objective, hypothetical retention scenario and asks physicians to respond to structured questions and to an open-ended question about factors not appearing in the survey. In response to the structured portion of the survey, physicians indicate that relief coverage is the most important factor in rural physician retention. A content analysis of 75 open-ended responses reveals that besides the other factors in the survey, "sociocultural integration" is the pre-eminent retention issue for rural practitioners. This article concludes that the role of the local rural community may be more important in retention than in recruitment. Finally, it is suggested that additional in-depth qualitative research be conducted within the local contexts to enhance the understanding of rural physician retention processes.

The accuracy of a novel assessment instrument compared with conjoint family interview derived diagnoses is reported. The assessment instrument consisted of seven illustrations containing disguised depictions of family organizational styles and two distractors. When forty-seven families were requested to select by agreement a favourite among the nine illustrations, twenty-seven chose a pattern concordant with a family therapist's formulation of the family's organizational style ( x z = 16.91, P <0.001). These findings support the feasibility of developing a similar instrument for use in clinical practice. Comments address the rationale of the instrument, the study, and possible implications of the findings.