The prevalence of turnover intention and influencing factors among emergency physicians: A national observation

Abstract

Background High turnover among physicians in emergency department is a great challenge in China. However, the rate and the reasons why physicians intend to leave have not been extensively studied yet. Therefore, this study aimed to identify the risk factors of turnover intention among physicians in emergency department. Methods A national cross-sectional survey was conducted from July to August 2018 in China. A total of 10 457 physicians in emergency department were investigated using a structured self-administered questionnaire, which included demographic characteristics, work-related factors, turnover intention, the Patient Health Questionnaire and Positive and Negative Affect Scale. The stepwise logistic regression analysis was applied to identify the risk factors of turnover intention among physicians. Results A total of 55.18% of the physicians in emergency department reported turnover intention in China. Turnover intention were more likely to be reported among physicians who were male (odds ratio (OR) = 1.25, 95% confidence interval (CI) = 1.13-1.38); who perceived medical errors (OR = 1.35, 95% CI = 1.23-1.47); who had a lower average monthly income; who provided out-of-hospital resuscitation services; who experienced physical violence (OR = 1.39, 95% CI = 1.26-1.54) and who reported higher score on negative affect and depressive tendency (OR = 1.06, 95% CI = 1.05-1.08; OR = 1.10, 95% CI = 1.09-1.12). Conversely, physicians who perceived shortage of manpower (OR = 0.74, 95% CI = 0.66-0.81), or reported higher score on positive affect (OR = 0.96, 95% CI = 0.94-0.97) were inclined to stay in emergency department. Conclusion This study shows that turnover intention among physicians in emergency department is high in China and was significantly associated with gender, average monthly income, perceived shortage of physicians, the times for provide out-of-hospital resuscitation services, exposure to workplace violence, depressive tendency, positive affect and negative affect. Targeted interventions are required to improve the retention rate among physicians in emergency department from the comprehensive aspects.

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“…According to a recent Lancet study, the Middle East and North Africa are lacking 636,000 doctors, with South Asia having the biggest gaps (GBD 2019 Human Resources for Health Collaborators, 2022). Also, turnover intentions have been reported in close to 50% of physicians in emergency department, resident physicians and village doctors in China (Chen et al, 2022;Feng et al, 2022;Sun et al, 2022a); more than 50% health professionals in Ethiopia (Mekonnen et al, 2022); more than 55% doctors in Iraq and 30% doctors in South Korea (Hou et al, 2021). Burnout among healthcare workers and deteriorating care quality are the immediate effects (De Hert, 2020;Džakula & Relić, 2022).…”

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“…The study found a positive correlation between positive affect in individuals, such as pride and determination and citizenship behaviour, however, leadership affect was not addressed (Wang et al 2021). Similarly, a study by Feng et al (2022), included positive affect of emergency physicians as one factor that was directly associated with lower turnover intentions. In a conceptual paper by Reyes et al (2020), the importance of leaders maintaining a positive affect during crisis situations was highlighted in order to convey optimism, openness and confidence.…”

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“…Organizational commitment was measured according to the Organizational Commitment Scale developed by Mowday et al ( 22 – 24 ). This scale has been used in several studies to describe physicians' perceived association and loyalty to the organization and has proven good reliability ( 23 ).…”