Navy Medicine must retain experienced physicians after their initial service obligations end. Losing physicians can leave clinical positions unfilled and weaken continuity of care and readiness. GAO’s 2025 staffing review reports a decline in assigned military medical personnel across DOD and expected shortfalls through at least 2027. That is current DOD-wide context, not a measured San Diego Navy primary-care attrition rate. The question here is what could help retain Navy pediatricians, general internists, and family physicians who have a civilian alternative.
The global challenge is sustaining the medical workforce that supports U.S. naval operations in the Pacific. Naval Medical Forces Pacific is headquartered in San Diego and spans commands in Hawaii, Japan, and Guam; its mission includes keeping assigned medical forces staffed, trained, and ready to deploy. San Diego is the local labor-market case for this larger workforce question. This project tests a potential retention mechanism; it does not show that departures among these three specialties have reduced Pacific readiness.
At current pay rates, targeted, accurate communication about available Navy-specific nonfinancial opportunities will increase awareness and may improve agreement acceptance and later retention among eligible San Diego-based primary-care physicians relative to standard information. I expect a smaller retention effect for physicians with a larger verified civilian financial advantage. This is a testable prediction, not a claim that communication can compensate for every pay gap.
The economic concepts are opportunity cost and choice among bundles of financial and nonfinancial attributes. The accompanying model estimates the present-value financial opportunity cost of staying: the difference between a feasible civilian path and continued Navy service over the same horizon. Its starting table uses current Navy compensation and published San Diego specialty benchmarks; the individual lab adds taxes, pension continuation, healthcare, GI Bill transfer, and physician-paid costs when reliable inputs are available. It does not measure how much a physician values the nonfinancial attributes or predict retention from salary data alone.
The proposed chain is: local civilian alternatives affect a physician’s stay-or-leave choice; those choices may affect Navy medical staffing; staffing may affect the force’s ability to provide care and deploy. The model measures only the first link. Testing later links requires specialty-level vacancies, fill times, clinical capacity, deployability, and assignment data rather than assuming a pay gap is a readiness loss.
The hypothesis would be weakened if accurate awareness improved but agreement acceptance and later retention did not improve relative to a comparable group. It would also be weakened if the advertised opportunities were rarely accessible or if physicians already knew about them. A stronger alternative is that changing actual assignment predictability, duty-station choice, family conditions, mentoring, or clinical work matters more than describing opportunities. Survey intentions alone are insufficient: the test should observe acceptance at the next unobligated choice and retention after the agreement, accounting for specialty, career stage, pay agreement vintage, and assignment conditions. A weak effect among physicians with the largest verified gaps would limit the strategy’s reach.
Recent reviews strengthen that test rather than settle it. A health-workforce umbrella review warns that intentions and actual departures differ and that intervention evidence varies by setting. A U.S. rural primary-care review finds financial and educational programs promising where outcomes were reported, but inconsistent follow-up. These are reasons to keep financial and real-opportunity changes as live alternatives and to measure post-obligation retention; neither review estimates a Navy communication effect.