Factors determining intention to leave among physicians in tertiary hospitals in China: a national cross-sectional study

Abstract

ObjectiveThe reasons that physicians leave the institutions have not been extensively studied. We aimed to evaluate these reasons, which include the desire to work at another hospital or the intention to make a career change, among physicians in tertiary hospitals in China and explore the associations between the individual-level and organizational-level factors related to these two reasons for leaving.MethodsWe conducted a national survey of 136 tertiary hospitals across all 31 provinces in China between December 2017 and January 2018. A total of 20 785 physicians were selected to self-report on the two evaluated reasons related to physicians’ intent to leave. A univariate analysis and multilevel regression model were applied to evaluate the factors associated with intention to leave.ResultIn all, 10.4% of the participating physicians had thought about working at another hospital, and 20.5% intended to leave to make a career change. At the hospital level, the government subsidy per bed (OR=0.88, 95% CI: 0.86 to 0.98 and OR=0.91, 95% CI: 0.90 to 0.99), personnel funding per capita (OR=0.86, 95% CI: 0.76 to 0.96 and OR=0.80, 95% CI: 0.73 to 0.88) and the number of physicians per bed (OR=0.83, 95% CI: 0.81 to 0.86 and OR=0.89, 95% CI: 0.81 to 0.92) were negatively associated, while the number of hospital-level medical disputes (OR=1.04, 95% CI: 1.03 to 1.05 and OR=1.06, 95% CI: 1.01 to 1.11) was positively associated with both reasons for leaving. At the individual level, income (OR=0.74, 95% CI: 0.71 to 0.79 and OR=0.88, 95% CI:0.83 to 0.92) and job satisfaction (OR=0.18, 95% CI: 0.17 to 0.20 and OR=0.16, 95% CI: 0.15 to 0.18) acted as preventive factors against both reasons for leaving, while work hours per week (OR=1.11, 95% CI: 1.06 to 1.17 and OR=1.23, 95% CI: 1.19 to 1.28) and medical dispute (OR=1.49, 95% CI:1.35 to 1.65 and OR=1.77, 95% CI: 1.64 to 1.91) acted as promotive factors.ConclusionsAlthough the intention to leave is not prevalent among physicians in tertiary hospitals in China, providing more organisational support and a better occupational environment may promote retention among physicians.

How Perceived Quality of Care and Job Satisfaction Are Associated with Intention to Leave the Profession in Young Nurses and Physicians

“…The association between low job satisfaction and intention to leave the profession has been described in several studies, both for physicians [2][3][4][5][6] and nurses [15][16][17][18][19][20][21]43]. A recent study on physicians in Saxony found an association between low job satisfaction and the tendency to move to other health systems [44].…”

“…The effect of perceived quality of care on intention to leave the profession was partially mediated by job satisfaction. Thus, high perceived quality of care and high job satisfaction are both important factors that tend to prevent young physicians and nurses from leaving their professions.for this include overtime, psychosocial stress, burnout, career aspects and particularly, a low level of job satisfaction [2][3][4][5][6]. In order to improve their balance between work and family, some physicians switch to nontherapeutic work or emigrate, in the hope of finding better working conditions in other countries [7].Although the absolute number of all physicians in Germany has been constantly increasing over the years [8], it is still justified to discuss a "relative lack of physicians" or a "lack of medical working hours".…”

“…for this include overtime, psychosocial stress, burnout, career aspects and particularly, a low level of job satisfaction [2][3][4][5][6]. In order to improve their balance between work and family, some physicians switch to nontherapeutic work or emigrate, in the hope of finding better working conditions in other countries [7].…”

The determinants of burnout and professional turnover intentions among Canadian physicians: application of the job demands-resources model

“…This overload situation and inability to effectively administer optimal patient care, can cause stress and burnout, thereby prompting physicians to consider leaving the profession [ 26 , 32 , 47 ]. Physician shortages have become a pervasive issue worldwide [ 48 ]. Given the significant shortage of physicians and since exit from the profession due to burnout is one of the primary reasons in this regard [ 32 ], it apposite to examine intention to leave the profession as a withdrawal mechanism from experienced burnout.…”

Burnout and Job Satisfaction of Psychiatrists in China: A Nationwide Survey

“…Moreover, in addition to providing specialist mental health services for larger geographical areas than SPHs, TPHs are also responsible for providing guidance and support to all other mental health service providers, including SPHs, in the corresponding areas [12]. Therefore, Chinese psychiatrists working at TPHs are often burdened with much heavier workloads and faced with an even grimmer crisis of burnout [13,14]. Considering the central roles that TPHs play in China's mental health care system, more attention should be focused on burnout and job dissatisfaction among psychiatrists working at TPHs in China.…”