Background: As the gatekeepers of rural residents' health, teams of village doctors play a vital role in improving rural residents' health. However, the high turnover of village doctors, both individually and collectively, threaten the stability of village medical teams. This research evaluated the influence of job satisfaction, resilience, and work engagement on the village doctors' turnover intention, and explored the mediating role of work engagement and resilience between job satisfaction and the turnover intention of village doctors in China. Methods: A quantitative study using a self-administered questionnaire containing mostly structured items was conducted among village doctors with a sample size of 2693 from 1345 rural clinics in Shandong province, China, during May and June 2019. All variables including demographic characteristics, job satisfaction, resilience, work engagement and turnover intention were based on available literature, and measured on a 5-or 6-point Likert scale. Such statistical methods as one-way ANOVA, bivariate correlation, exploratory factor analysis (EFA), and Structural Equation Modelling (SEM) were used.Results: Up to 46.9% of the subjects had a higher turnover intention and more than 26.3% of them had a medium turnover intention. The job satisfaction of village doctors could not only have a direct negative effect on turnover intention (β = − 0.37, p < 0.001), but also have an indirect effect through work engagement (β = − 0.04,=< 0.001). Meanwhile, work engagement also had a direct negative impact on turnover intention (β = − 0.13, p < 0.001), and resilience had an indirect negative impact on turnover intention through work engagement (β = − 0.09, p < 0.001).The above results of this study strongly confirmed that job satisfaction, resilience, and work engagement were early, powerful predicators of village doctors' turnover intention.(Continued on next page) Conclusion: According to the results, the following should be taken seriously to improve job satisfaction: reasonable and fair income, effective promotion mechanism, fair social old-age security, reasonable workload, and strong psychological coping mechanisms for work stress. The turnover intention of village doctors could be reduced through improving job satisfaction, resilience and work engagement.

Background In China, as the “gatekeepers”of rural residents’ health, the primary-level village doctors, play a very crucial role in ensuring and serving the health level of rural residents. However, the burnout of village doctors is gravely threatening the stability of rural primary medical system step by step. This study systematically evaluated the effects of personality, work engagement and alexithymia on burnout of village doctors, and further measured and assessed the mediating effect of alexithymia and work engagement in the association between personality and burnout. Methods The subjects were 2684 village doctors in Jining, Shandong Province, China, from May to June 2019. Sociodemographic characteristics, alexithymia, personality, work engagement and job burnout were quantitated by self-completed questionnaire and measured by Likert 5–7 scale. One-way ANOVA, Person correlation analysis, and Structural Equation Modelling (SEM) were used for statistical analysis and mediating effect evaluation. Results 2693 questionnaires were collected in total, of which 2684 were valid, with an effective rate of 96.2%. 65.2% of village doctors were diagnosed with burnout, and 54.3% showed moderate to severe emotional exhaustion, 61.6% showed moderate to severe low sense of personal achievement, and 33.9% showed moderate to severe depersonalization burnout. Personality had a direct positive effect on work engagement (β = 0.50, p < 0.001), a direct negative effect on alexithymia (β = − 0.52, p < 0.001) and burnout (β = − 0.50, p < 0.001) respectively. Work engagement had a direct negative effect on burnout (β = − 0.10, p < 0.001), while alexithymia had a direct positive effect on burnout (β = 0.16, p < 0.001). In the path between personality and burnout, both work engagement 95%CI:(− 0.17)–(− 0.08), and alexithymia 95%CI:(− 0.36)–(− 0.09), have significant mediating effects. These results strongly confirm that personality, alexithymia, and work engagement are early and powerful predicators of burnout. Conclusion According to the results, medical administrators should pay attention to the personality characteristics of village doctors in vocational training, practice selection and job assignment, encourage village doctors to reflect on their own personality actively, and to reduce job burnout by obtaining necessary social support, constructing reasonable achievable career expectations, improving time management ability, and participating in psychological counselling programs.

Background: In China, grass-roots village doctors, as the gatekeepers of rural residents' health, play an important role in guaranteeing and serving the health level of rural residents. However, the serious burnout and high turnover rate of village doctors threaten the stability of village medical teams. This research evaluated the influence of personality, alexithymia and work engagement on the burnout of village doctors in an in-depth and detailed way, and explored the mediating role of work engagement and alexithymia between personality and the burnout of village doctors in China.Methods: During May and June 2019, 2,684 rural doctors in 1,345 rural clinics in Jining city, Shandong Province, were studied using a quantitative study self-administered questionnaire. The questionnaire included demographic and sociological characteristics, personality, alexithymia, work engagement and burnout, and was measured by 5-7 Likert scale. One-way ANOVA, Person correlation analysis, and Structural Equation Modelling (SEM) were used for statistical analysis.Results: Up to 54.3% of the surveyed rural doctors showed moderate to severe emotional exhaustion, 90.5% of them had moderate to severe sense of low personal achievement and 33.9% of them had moderate to severe depersonalization burnout. Personality has a direct positive effect on work engagement (β=0.50, p<0.001), but has a direct negative effect on alexithymia (β=-0.52, p<0.001) and burnout (β=-0.50, p<0.001) respectively. Work engagement has a direct negative effect on burnout (β=-0.10, p<0.001), while alexithymia has a direct positive effect on burnout (β=0.16, p<0.001). In the path between personality and burnout, both work engagement, 95%CI:(−0.17)–(−0.08), and alexithymia 95%CI:(−0.36)–(−0.09), have significant mediating effects.The above results strongly confirmed that personality, alexithymia, and work engagement were early, powerful predicators of burnout.Conclusion: According to the results, medical administrators should pay attention to the personality characteristics of village doctors in their professional training, practice selection and job assignment and encourage doctors to actively reflect on their own personality and to reduce job burnout by obtaining necessary social support, constructing reasonably achievable career expectations, improving time management and participating in psychological counselling programs.

Background As the gatekeepers of rural residents ‘health, the team of village doctors plays a vital role in improving the health level of rural residents. However, a large number of village doctor’s turnover, or even dozens of them turnover collectively, threatening the stability of the village medical team. This research evaluated the influence of job satisfaction, resilience, work engagement on turnover intention of village doctor and explored the mediating role of resilience and work engagement between job satisfaction and turnover intention among village doctor in China.Methods A quantitative study using a self-administered questionnaire containing mostly structured items was conducted among the village doctors with a sample size of 2693 from 1345 rural hospitals or clinics of Shandong province, China, during May and June 2019. All variables including demographic characteristics, job satisfaction, resilience, work engagement and turnover intention were based on literature and measured on 5- or 6-point Likert scale. Such statistical methods as one-way ANOVA, bivariate correlation, exploratory factor analysis (EFA) and Structural Equation Modeling (SEM) were used.Results As high as 46.9% of the participants had a high turnover intention and no less than 26.3% of the participants had a medium turnover intention. Job satisfaction not only has a direct negative effect on turnover intention(β=-0.37, p < 0.001), but also has an indirect effect on it through work engagement(β= -0.04, p < 0.001), work engagement has a direct negative impact on turnover intention(β= -0.13, p < 0.002), and resilience had an indirect negative effect on turnover intention through the mediating effect of work engagement(β= -0.09, p < 0.001). The results of this study strongly verified that job satisfaction, resilience, work engagement were early, powerful predicators of turnover intention.Conclusion According to the results, reasonable and fair income, effective promotion mechanism, fair social old-age security, reasonable workload, strong psychological coping mechanism for work stress, should be taken seriously to improve job satisfaction. The turnover intention of village doctors could be reduced through improving job satisfaction, resilience and work engagement.

Background: As the gatekeepers of rural residents’ health, teams of village doctors play a vital role in improving rural residents’ health. However, the high turnover of village doctors – both individually and collectively – threaten the stability of village medical teams. This research evaluated the influence of job satisfaction, resilience , and work engagement on the turnover intention of village doctors, and explored the mediating role of resilience and work engagement between job satisfaction and the turnover intention of village doctors in China. Methods: A quantitative study using a self-administered questionnaire containing mostly structured items was conducted among village doctors with a sample size of 2693 from 1345 rural clinics in Shandong province, China, during May and June 2019. All variables including demographic characteristics, job satisfaction, resilience, work engagement and turnover intention were based on available literature, and measured on a 5- or 6-point Likert scale. Such statistical methods as one-way ANOVA, bivariate correlation, exploratory factor analysis (EFA), and Structural Equation Modelling (SEM) were used. Results: As high as 46.9% of participants had a high turnover intention and no less than 26.3% of participants had a medium turnover intention. Job satisfaction not only has a direct negative effect on turnover intention(β=-0.37, p < 0.001), but also an indirect effect through work engagement(β= -0.04, p < 0.001), which has a direct negative impact on turnover intention (β= -0.13, p < 0.002) , and resilience had an indirect negative effect on turnover intention through the mediating effect of work engagement(β= -0.09, p < 0.001). The results of this study strongly verified that job satisfaction, resilience, and work engagement were early, powerful predicators of turnover intention. Conclusion: According to the results, the following should be taken seriously to improve job satisfaction: reasonable and fair income, effective promotion mechanism, fair social old-age security, reasonable workload, and strong psychological coping mechanisms for work stress. The turnover intention of village doctors could be reduced through improving job satisfaction, resilience and work engagement.