Factors influencing physicians’ choice of workplace: systematic review of drivers of attrition and policy interventions to address them

Koussa, Maria El; Atun, Rifat; Bowser, Diana; Kruk, Margaret E

doi:10.7189/jogh.06.020403

Cited by 29 publications

(38 citation statements)

References 22 publications

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“…Many health-care providers face challenging conditions, including inadequate and delayed salaries, heavy workloads, ambiguous responsibilities, no opportunities for growth, and poor treatment by colleagues and patients. 276,286,287 Not only do these conditions result in burnout, mental distress, and poor retention for providers, but they also result in poorer quality care. [287][288][289] Motivated providers are less likely to make poor decisions or medical errors and are more likely to be empathic towards patients.…”

Section: Universal Action 3: Transform the Health Workforcementioning

confidence: 99%

“…290 Good working conditions, regular pay, clinical support, and opportunities to learn and grow are essential to maintain a workforce that is motivated and committed to providing high-quality care. 286,291,292 WHO recommended a set 293 of decent employment policies to support providers, including ensuring occupational health and safety, fair terms for workers, merit-based career development, and a positive practice environment. In addition to broader policies, a review 294 published in 2017 recommended a set of steps for facilities to foster joy and engagement in their own work force.…”

Section: Universal Action 3: Transform the Health Workforcementioning

confidence: 99%

See 1 more Smart Citation

High-quality health systems in the Sustainable Development Goals era: time for a revolution

Kruk

Gage

Arsenault

et al. 2018

The Lancet Global Health

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2,260

2,275

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The Lancet Global Health Commission and respecting all workers to deliver the best care possible. Fourth, governments and civil society should ignite demand for quality in the population to empower people to hold systems accountable and actively seek high-quality care. Additional targeted actions in areas such as health financing, management, district-level learning, and others can complement these efforts. What works in one setting might not work elsewhere, and improvement efforts should be adapted for local context and monitored. Funders should align their support with system-wide strategies rather than contribute to the proliferation of micro-level efforts. In this Commission, we assert that providing health services without guaranteeing a minimum level of quality is ineffective, wasteful, and unethical. Moving to a highquality health system-one that improves health and generates confidence and economic benefits-is primarily a political, not technical, decision. National governments need to invest in high-quality health systems for their own people and make such systems accountable to people through legislation, education about rights, regulation, transparency, and greater public participation. Countries will know that they are on the way towards a high-quality, accountable health system when health workers and policymakers choose to receive health care in their own public institutions. Components Quality impacts Better health Level and distribution of patient-reported outcomes: function, symptoms, pain, wellbeing, quality of life, and avoiding serious health-related suffering Confidence in system Satisfaction, recommendation, trust, and care uptake and retention Economic benefit Ability to work or attend school, economic growth, reduction in health system waste, and financial risk protection Processes of care Competent care and systems Evidence-based, effective care: systematic assessment, correct diagnosis, appropriate treatment, counselling, and referral; capable systems: safety, prevention and detection, continuity and integration, timely action, and population health management Positive user experience Respect: dignity, privacy, non-discrimination, autonomy, confidentiality, and clear communication; user focus: choice of provider, short wait times, patient voice and values, affordability, and ease of use Foundations Population Individuals, families, and communities as citizens, producers of better health outcomes, and system users: health needs, knowledge, health literacy, preferences, and cultural norms Governance Leadership: political commitment, change management; policies: regulations, standards, norms, and policies for the public and private sector, institutions for accountability, supportive behavioural architecture, and public health functions; financing: funding, fund pooling, insurance and purchasing, provider contracting and payment; learning and improvement: institutions for evaluation, measurement, and improvement, learning communities, and trustworthy data; intersectoral: roads, transport, wa...

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Section: Universal Action 3: Transform the Health Workforcementioning

confidence: 99%

Section: Universal Action 3: Transform the Health Workforcementioning

confidence: 99%

High-quality health systems in the Sustainable Development Goals era: time for a revolution

Kruk

Gage

Arsenault

et al. 2018

The Lancet Global Health

Self Cite

2,260

2,275

View full text Add to dashboard Cite

show abstract

“…It was noteworthy that factors such as managerial interference or relationship with patients, which have been reported in high-income countries, were not considered by the participants in the present study (42). Moreover, although career development is a recurring factor in most lowincome countries (42), it was not a factor in the Islamic Republic of Iran. This was most likely because there are more opportunities for professional development for specialists in the public sector.…”

Section: Discussionmentioning

confidence: 71%

“…Moreover, the behaviour of specialists is influenced by societal culture and attitudes (41). It was noteworthy that factors such as managerial interference or relationship with patients, which have been reported in high-income countries, were not considered by the participants in the present study (42). Moreover, although career development is a recurring factor in most lowincome countries (42), it was not a factor in the Islamic Republic of Iran.…”

Section: Discussionmentioning

confidence: 74%

Factors influencing medical specialists’ dual practice in the Islamic Republic of Iran

Bayat

Shokri

Khodadost

et al. 2018

East Mediterr Health J

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Background: Dual practice (DP) is performing several different jobs at the same time and has effects on healthcare services delivery. Aims: To identify the causes of medical specialists' tendency towards DP in the Islamic Republic of Iran. Methods: We used a qualitative approach to identify the factors affecting DP in medical specialists in 2016. We used a purposive and outlier sampling method to conduct semistructured deep interviews with 14 key informants. The data analysis was performed simultaneously with data collection using thematic content analysis by MAXQDA (version 10.0). Interviews continued up to data saturation. The quality of the study was ensured by addressing the criteria of Guba and Lincoln. Results: The results of the interviews showed six themes and 16 subthemes for specialists' propensity to DP. Major themes included financial incentives, cultural attitudes about professional identity of physicians, experience and academic level of specialists, controlling approaches in the public sector, available infrastructure for responding to the population needs in the public sector, and regional characteristics of health service locations. Conclusions: Medical specialists' DP is a multidimensional issue, influenced by different factors such as financial incentives, cultural attitudes and available infrastructure. Considering the capacities and conditions of each country, control and management of this phenomenon require regulatory and incentive mechanisms, which in the long term can modify private and public sector differences and increase the willingness of doctors to work in the public sector.

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“…Career intentions of medical students has been studied in qualitative and quantitative studies (16,47,48). This study contributes to this knowledge with the first attempt at interacting self-stated career intention with rural health facility attribute preference.…”

Section: Discussionmentioning

confidence: 99%

Preferences of Medical Students for Rural Medical Internships in South Africa: A Discrete Choice Experiment

José¹,

Obse²,

Zuidgeest³

et al. 2020

Preprint

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Background: Globally the proportion of medical doctors to population in rural areas in low- and middle-income countries remains insufficient to address their health care needs. Therefore, it is imperative to design strategies that attract medical doctors to rural areas to reduce health inequalities and achieve universal health coverage. Methods: This study assessed preferences of medical students for rural internships using a discrete choice experiment. Attributes of rural job were identified through literature and focus group discussions. A D-efficient design was generated with 15 choice sets, each with forced binary, unlabelled, rural hospital alternatives. An online survey was conducted, and data analysed using mixed logit models of main effects only and main effects plus interaction terms. Results: Majority of the respondents were females (130/66.33%) and had urban origin (176/89.80%). The main effects only model showed advanced practical experience, hospital safety, correctly fitting personal protective equipment, and availability of basic resources as the most important attributes influencing take up of rural internship, respectively. Respondents were willing to pay ZAR 2645.92 monthly (95%CI: 1345.90; 3945.94) to gain advanced practical experience (equivalent to 66.15% of current rural allowance). In contrast, increases in rural allowance and the provision of housing were the least important attributes. Based on the interaction model, female respondents and those intending general practise associated higher weight for hospital safety over advanced practical experience. Conclusion: In the context of limited budgets and resource constraints, policy makers and rural health facility managers are advised to prioritise meaningful internship practise environments that offer supervised learning environment, safety from physical and occupational hazards and the provision of basic resources for healthcare system-wide benefits to both staff and rural health facility users alike.

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Factors influencing physicians’ choice of workplace: systematic review of drivers of attrition and policy interventions to address them

Cited by 29 publications

References 22 publications

High-quality health systems in the Sustainable Development Goals era: time for a revolution

High-quality health systems in the Sustainable Development Goals era: time for a revolution

Factors influencing medical specialists’ dual practice in the Islamic Republic of Iran

Preferences of Medical Students for Rural Medical Internships in South Africa: A Discrete Choice Experiment

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