Doctors intention to quit or stay: a multifaceted analysis in Embu County

Abstract

Kenya’s healthcare sector is grappling with a significant shortage of medical doctors, driven by high rates of resignation and emigration in pursuit of better opportunities. Burnout, exhaustion, the need for flexibility, and work-life balance concerns are major factors influencing these career decisions. This study aimed to examine the interplay of financial incentives, working conditions, career progression, and organisational culture on doctors' retention in Embu County, Kenya. Grounded in Herzberg’s Two-Factor Theory, which distinguishes between motivators and hygiene factors, and Adams’ Equity Theory, which highlights the importance of fairness in employment, the study employed a quantitative cross-sectional study approach, analysing data from all practicing doctors in the county. Findings revealed a 73.4% response rate, with a workforce predominantly female (67.2%) and aged between 34-44 years. The absence of doctors with over 15 years of service suggests long-term retention challenges, while the significant number of doctors on study leave highlights the value of professional development. Financial incentives emerged as a critical determinant of retention, with many doctors supplementing their income through private practice, underscoring the need for competitive salaries and benefits. Career progression opportunities, particularly paid study leave and internal promotions, were positively linked to job satisfaction, reinforcing the necessity for structured training and promotion systems. Working conditions significantly influenced retention, with manageable workloads and resource availability enhancing job satisfaction. Organizational culture played a pivotal role, with respondents citing supportive leadership and a conducive work environment as key retention factors. However, retention strategies must be multifaceted, incorporating financial incentives, career development, improved working conditions, and a positive work culture. Based on these findings, increasing salaries, expanding professional development opportunities, ensuring adequate staffing and resources, and fostering a supportive organizational culture is recommended as part of the targeted strategies to retain medical professionals and sustain healthcare services in Kenya.