Why Internal Medicine Program Directors Remain in Their Positions and Are Effective and Thrive: A Qualitative Study

Perspectives Viewpoints•Four positive domains are identified for long-standing Program Directors (PDs): purpose, culture, nature of the work, and sense of achievement.•Nature of the work is associated with long-standing PDs continuing in their role, finding joy, and thriving.•PDs who do not feel effective or thriving consistently describe threats.•Academic medicine leadership should prioritize mitigation of the identified threats because PD retention remains a major area of concern across graduate medical education. •Four positive domains are identified for long-standing Program Directors (PDs): purpose, culture, nature of the work, and sense of achievement.•Nature of the work is associated with long-standing PDs continuing in their role, finding joy, and thriving.•PDs who do not feel effective or thriving consistently describe threats.•Academic medicine leadership should prioritize mitigation of the identified threats because PD retention remains a major area of concern across graduate medical education.