Tailoring Retention Strategies for Public Sector Doctors: Addressing Conflicting Motivations and Sector-Switching Dynamics

The shortage of healthcare workers in the public sector poses significant challenges to achieving universal health coverage in developing countries. In mixed health systems, the switchover of doctors from the public to the private sector exacerbates these challenges, yet it remains an under-researched area. Drawing on a census-type survey of chief medical officers in public health facilities in two districts of Karnataka, India, this study examines how motivational dynamics and employment differences among practitioner groups affect job satisfaction and sector-switching intentions. We find that public sector doctors face motivational conflicts, with extrinsic and intrinsic factors operating both independently and interactively to create complex motivational states, which influence job satisfaction and decisions to switch sectors, often in countervailing directions. The study suggests that these conflicting motivations result in behavioral tensions that require nuanced and group-specific policy interventions. By addressing the diverse motivational configurations of public sector doctors, policymakers can design more effective human resource strategies for workforce retention in public healthcare systems.