Family physicians in the National Health Service Corps (NHSC) are more likely than non-NHSC physicians to practice in high-need areas, but retention declines over time. Despite higher retention than non-NHSC physicians, NHSC participants experienced greater declines from 3 to 6 years post-residency (MUA: 85.0% to 60.7%; HPSA: 76.0% 6 to 66.2%; rural: 29.8% to 21.3%), underscoring the need for policies that sustain long-term commitment.