Physician turnover in primary health care services in the East Zone of São Paulo City, Brazil: incidence and associated factors

Abstract

Background The shortage and high turnover of physicians is a recurrent problem in health care systems; this is especially harmful to the expansion and full operation of primary health care (PHC). The aim of this paper is to analyze incidence and associated factors with physician turnover in primary health care services in the East Zone of São Paulo City. Methods This is a retrospective cohort study of 1378 physicians over a 15 years’ time period based on physicians’ administrative records from two distinct secondary databases. Physicians’ individual characteristics were analyzed including graduation and specialization. Survival analysis techniques such Kaplan-Meier and Cox Regression were used to analyze the termination of contract. Results One thousand three hundred seventy-eight physicians were included in the study of which 130 [9.4%(CI95 8.0–11.1%)] remained in the PHC services. The mean and median time until the occurrence of the physician leaving the service was 2.14 years (CI95% 1.98–2.29 years) and 1.17 years [(CI95% 1.05–1.28 years)]. The probability of contract interruption was 45% in the first year and 68% in the second year. Independent factors associated with TEC were identified: workload of 40 h/week HR = 1.71 [(CI95% 1.4–2.09), p < 0.001]; initial salary ≤1052 BGI HR = 1.87 [(CI95 1.64–2.15), p < 0.001]; time since graduation ≤2 years HR =1.36 [(CI95 1.18–1.56), p < 0.001]; and the conclusion of residency in up to 3 years after leaving the service HR = 1.69 [(CI95 1.40–2.04), p < 0.001]. Conclusions The time of employment of the physician in PHC was relatively short, with a high probability of TEC in the first year. Modifiable factors such as working hours, starting salary, time since graduation from medical school and need to enter in a residency program were associated with TEC. In pointing out that modifiable factors are responsible for long term employment or the end of contract of physicians in PHC services of the Unified Health System in the periphery of a metropolitan area, the study provides support for the planning, implementation and management of policies and strategies aimed at attracting and retaining physicians in suburban, priority or underserved regions.

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“…Burnout among healthcare workers and deteriorating care quality are the immediate effects (De Hert, 2020;Džakula & Relić, 2022). Also, globally, more than 20% of health professionals are located in areas where there are many care gaps and it is a major determinant of job dissatisfaction (Bourget et al, 2022). Some 30%-60% nurses leave their first job in less than a year due to work related stress, job satisfaction and better opportunities elsewhere (Hu et al, 2022;Machitidze, 2022).…”

Effects of individual and organizational factors on job tenure of primary care physicians: A multilevel analysis from Brazil

“…The present study builds on and develops in multiple ways what is known on job tenure of PHC physicians in Brazil’s Southeast [ 13 ]. First, it shows that differences between PHCUs affect the tenure of primary care physicians.…”

“…The percentage of PHC physicians intending to terminate their employment in these fields ranged from 26% in Canada to 70% in China [ 6 ]. In San Francisco, 53% of physicians left their work in PHC within two years [ 8 , 11 ], and in São Paulo, 50% of physicians located in the East Zone terminated their employment in the first year after beginning their employment in PHC services [ 13 ].…”

Healthcare Challenges due to Global Conflict Escalation Amid the Pandemic, Climate, and Economic Dilemmas

“…Burnout among healthcare workers and deteriorating care quality are the immediate effects (Dakula & Reli, 2022). Also, globally, more than 20% of health professionals are located in areas where there are many care gaps and it is a major determinant of job dissatisfaction (Bourget et al, 2022). Some 30-60% nurses leave their first job in less than a year due to work related stress, job satisfaction and better opportunities elsewhere (Hu et al, 2022;Machitidze, 2022).…”