OBJECTIVE: Our objective was to identify factors that sustain family physicians practicing in Milwaukee's underserved urban areas.

METHODS: Family physicians with clinical careers in Milwaukee's urban, underserved communities were identified and invited to participate in a 45-60 minute interview using a literature-based semi-structured protocol. Each interview was transcribed and de-identified prior to independent analysis using a grounded theory qualitative approach by two authors to yield sustaining themes. The project was determined not human subjects research per Aurora Health Care IRB.

RESULTS: Sixteen family physicians were identified; six of 11 who met inclusion criteria agreed to interview. Four general domains central to sustaining family physicians working with underserved populations were identified: (1) cognitive traits and qualities (trouble shooting, resilience, flexibility), (2) core values (medicine as mechanism to address social justice), (3) skills (self-care, communication, clinical management), and (4) support systems (supportive family/employer, job flexibility, leadership opportunities, staff function as team). The formation of these personal attributes and skills was partly shaped by experiences (from childhood to medical training to work experience) and by personal drivers that varied by individual. Common was that the challenges of providing care in urbanunderserved settings was seen as rewarding in and of itself and aligned with these physicians' values and skills.

CONCLUSIONS: Family physicians working with underserved populations described possessing a combination of values, cognitive qualities, skill sets, and support systems. While family physicians face complex challenges in quality care goals in urban underservedsettings, training in the personal and professional skill sets identified by participants may improve physician retention in such communities.