Why do we stay? Factors influencing faculty retention in a Brazilian private medical school: a mixed- methods study

Background Brazil's rapid expansion of private medical schools has created tensions between growth and quality. Recent national examination results revealed that 30.5% of medical courses received insufficient ratings, placing institutions under regulatory pressure. Faculty retention is critical for institutional quality. While international literature suggests intrinsic factors outweigh salary in retention decisions, how these dynamics operate in rapidly expanding private medical schools in middle-income countries remains underexplored. This study investigated factors influencing faculty retention at a Brazilian private medical school, aiming to assess retention intentions, identify motivational factors, and explore sources of job satisfaction and dissatisfaction. Methods This mixed-methods cross-sectional study surveyed 206 faculty members at a private medical school during August 2024 and February 2025. Data collection involved a self-administered electronic questionnaire with multiple-choice and open-ended questions. Quantitative data were analyzed using Mann-Whitney and Fisher's exact tests. Qualitative responses underwent thematic content analysis with iterative double-coding, achieving 88–95% inter-coder agreement. Results High retention intention was reported (82% intend to stay, 16.5% uncertain), despite substantial criticism of working conditions. No demographic or professional differences distinguished committed from uncertain faculty. For 91.3%, teaching was not their primary professional activity; 56.3% earned less than one-quarter of income from teaching. The predominant retention factor was "satisfaction and fulfillment with teaching" (43.1%). Student relationships were the primary satisfaction source (59.3%) but also a demand (14.6% dissatisfaction). Main dissatisfaction sources were remuneration (27.1%), organizational problems (21.4%), and workload (16.1%). Notably, 60.7% desired greater institutional involvement, particularly in research (24.3%) and teaching planning (20.9%). Conclusions Faculty demonstrate strong retention driven by intrinsic motivation despite low salaries and organizational challenges. This reflects a professional profile where teaching is secondary employment, enabling vocational choice over financial necessity. However, this configuration may limit pedagogical engagement and quality improvement. Institutions must simultaneously leverage existing intrinsic motivation while addressing extrinsic concerns and creating structured pathways for those desiring greater involvement. These findings have particular relevance for medical schools in middle-income countries navigating expansion alongside quality improvement demands.