Turnover intention and its influencing factors among general practitioners in the Eastern, Central and Western China
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摘要:
目的 了解中国东中西部地区全科医生的离职意愿现状及其影响因素,为稳定全科医生队伍、提升全科医生职业吸引力以及提高基层医疗卫生服务质量提供理论依据和政策建议。 方法 于2017年10月 — 2018年2月采用多阶段分层随机抽样方法在中国东中西部地区12个省/市/自治区360个社区卫生服务机构抽取3244名全科医生进行微信问卷调查。 结果 中国东中西部地区全科医生离职意愿总分为(15.07 ± 4.33)分,其中东部地区(15.11 ± 4.10)分,中部地区(15.26 ± 4.52)分,西部地区(14.83 ± 4.40)分。中国东中西部地区调查的3236名全科医生中,离职意愿很高者667人(20.61 %),较高者1633人(50.46 %),较低者728人(22.50 %),很低者208人(6.43 %)。多元线性逐步回归分析结果显示,本科及以上文化程度、任职方式为合同制、工作压力较高、情绪耗竭得分较高、去人格化得分较高和个人成就感得分较高的中国东中西部地区全科医生离职意愿较高,女性、年龄较大、无行政职务、物质满意度得分较高和成长满意度得分较高的中国东中西部地区全科医生离职意愿较低;情绪耗竭得分较高的中国东部地区全科医生离职意愿较高,年龄较大、无行政职务、个人年均收入 ≥ 5万元、物质满意度得分较高和成长满意度得分较高的中国东部地区全科医生离职意愿较低;本科文化程度、任职方式为合同制、情绪耗竭得分较高、去人格化得分较高和个人成就感得分较高的中国中部地区全科医生离职意愿较高,物质满意度得分较高和成长满意度得分较高的中国中部地区全科医生离职意愿较低;本科及以上文化程度、任职方式为合同制、工作压力较高和情绪耗竭得分较高的中国西部地区全科医生离职意愿较高,女性、年龄较大、物质满意度得分较高和成长满意度得分较高的中国西部地区全科医生离职意愿较低。 结论 中国东中西部地区全科医生的离职意愿较高,性别、年龄、文化程度、任职方式、行政职务、工作压力以及物质满意度、成长满意度、情绪耗竭、去人格化和个人成就感得分是中国东中西部地区全科医生离职意愿的主要影响因素,不同地区的影响因素不同。 Abstract:Objective To investigate the prevalence of turnover intention and its influencing factors among general practitioners (GPs) in the Eastern, Central and Western China and to provide evidences for policymaking on the improvement of GPs system. Methods With stratified multistage random sampling, we recruited 3 244 GPs from 360 community health service institutions in 12 provinces, cities or autonomous regions in the Eastern, Central and Western China; then we conducted an online questionnaire survey among the GPs via WeChat between October 2017 and February 2018. Results For the 3 236 GPs with valid responses, the total turnover intention score was 15.07 ± 4.33 assessed by a scale with marks from 6 to 24; for the GPs in Eastern, Central and Western China, the total turnover intention score was 15.11 ± 4.10, 15.26 ± 4.52, and 14.83 ± 4.40, respectively. The number (percentage) of GPs assessed with the highest, higher, lower, and the lowest turnover intention was 667 (20.61%), 1 633 (50.46%), 728 (22.50%), and 208 (6.43%), respectively. The results of multivariate linear stepwise regression analysis demonstrated that: (1) among all the GPs, those with a bachelor degree or higher education, employed under a temporal work contract, with heavy work stress, with a higher emotional exhaustion score, with a higher depersonalization score, and with higher personal accomplishment score were more likely to have a higher turnover intention, while those being female, at elder age, without an administrative responsibility, with a higher score for material satisfaction, and with a higher score for career development satisfaction were more likely to have a lower turnover intention; (2) among the GPs in Eastern China, those with a higher emotional exhaustion score were more likely to have a higher turnover intention and those at elder age, without an administrative responsibility, having an average annual personal income of ≥ 50 000 RMB yuan, with a higher score for material satisfaction, and with a higher score for career development satisfaction were more likely to have a lower turnover intention; (3) among the GPs in Central China, those with a bachelor education, employed under a temporal work contract, with a higher emotional exhaustion score, with a higher depersonalization score, and with a higher personal accomplishment score were more likely to have a higher turnover intention; but those with a higher score for material satisfaction and with a higher score for career development satisfaction were more likely to have a lower turnover intention; and (4) among the GPs in Western China, those with a bachelor degree or higher education, employed under a temporal work contract, with heavy work stress, and with a higher emotional exhaustion score were more likely to have a higher turnover intention, but those being female, at elder age, with a higher score for material satisfaction, and with a higher score for career development satisfaction were more likely to have a lower turnover intention. Conclusion The turnover intention is relatively high and mainly influenced by gender, age, education, employment contract, administrative responsibility, work stress, material satisfaction, career development satisfaction, emotional exhaustion, depersonalization, and personal accomplishment among GPs in Eastern, Central and Western China. -
表 1 中国东中西部地区全科医生离职意愿总分及各维度得分情况比较
项目 东部地区(分,$\bar x \pm s$) 中部地区(分,$\bar x \pm s$) 西部地区(分,$\bar x \pm s$) F 值 P 值 离职意愿Ⅰ 4.76 ± 1.76 4.74 ± 1.86 4.61 ± 1.84 2.205 0.110 离职意愿Ⅱ 4.64 ± 1.58 4.68 ± 1.70 4.53 ± 1.65 2.244 0.106 离职意愿Ⅲ 5.71 ± 1.63 5.84 ± 1.76 5.69 ± 1.74 2.165 0.115 离职意愿总分 15.11 ± 4.10 15.26 ± 4.52 14.83 ± 4.40 2.531 0.080 表 2 中国东中西部地区不同特征全科医生离职意愿得分情况比较
特征 东中西部地区(分,$\bar x \pm s$) 东部地区(分,$\bar x \pm s$) 中部地区(分,$\bar x \pm s$) 西部地区(分,$\bar x \pm s$) 性别 男性 15.42 ± 4.50 15.26 ± 4.39 15.59 ± 4.65 15.46 ± 4.47 女性 14.86 ± 4.22 b 15.02 ± 3.92 15.04 ± 4.43 14.55 ± 4.34 b 年龄(岁) < 30 15.16 ± 4.40 15.57 ± 3.65 15.14 ± 4.66 14.91 ± 4.63 30~39 15.63 ± 3.98 15.76 ± 3.67 15.94 ± 4.28 15.20 ± 4.09 40~49 14.68 ± 4.46 14.46 ± 4.48 15.09 ± 4.40 14.53 ± 4.50 ≥ 50 12.83 ± 4.90 b 12.36 ± 4.52 b 13.10 ± 5.13 b 13.04 ± 5.05 b 文化程度 大专及以下 14.27 ± 4.66 14.09 ± 4.80 14.35 ± 4.83 14.29 ± 4.48 本科 15.33 ± 4.16 15.23 ± 3.92 15.63 ± 4.33 15.15 ± 4.33 硕士及以上 16.07 ± 4.03 b 15.89 ± 4.11 b 16.23 ± 4.09 b 16.41 ± 3.77 b 婚姻状况 非在婚 15.19 ± 4.42 15.50 ± 4.00 15.05 ± 4.83 15.05 ± 4.38 在婚 15.05 ± 4.32 15.06 ± 4.11 15.30 ± 4.47 14.79 ± 4.41 任职方式 正式在编 14.86 ± 4.22 15.06 ± 4.05 14.76 ± 4.38 14.64 ± 4.34 合同制 15.49 ± 4.53 b 15.38 ± 4.37 15.86 ± 4.63 b 15.14 ± 4.48 职称 初级及以下 15.09 ± 4.41 15.36 ± 4.07 15.29 ± 4.45 14.75 ± 4.58 中级 15.17 ± 4.23 15.19 ± 4.04 15.33 ± 4.59 14.97 ± 4.15 副高及以上 14.62 ± 4.36 14.36 ± 4.32 a 14.86 ± 4.58 14.84 ± 4.23 行政职务 有 15.09 ± 4.29 15.04 ± 4.00 15.26 ± 4.49 15.01 ± 4.50 无 15.06 ± 4.34 15.14 ± 4.14 15.26 ± 4.54 14.78 ± 4.38 个人年均收入(万元) < 5 15.54 ± 4.22 15.62 ± 3.98 15.87 ± 4.38 15.15 ± 4.33 5~ 14.00 ± 4.31 13.88 ± 4.04 14.04 ± 4.47 14.09 ± 4.45 ≥ 10 13.34 ± 5.06 b 12.48 ± 5.04 b 13.27 ± 5.15 b 14.17 ± 4.99 b 加班频率 从不加班 13.88 ± 4.91 14.53 ± 4.55 13.49 ± 5.29 13.40 ± 4.91 偶尔加班 14.69 ± 4.22 14.84 ± 4.00 14.84 ± 4.35 14.39 ± 4.34 经常加班 15.74 ± 4.30 b 15.55 ± 4.14 b 16.16 ± 4.47 b 15.60 ± 4.31 b 工作压力 较低 13.43 ± 4.67 13.95 ± 4.69 13.12 ± 4.76 13.33 ± 4.54 中等 14.35 ± 4.29 14.48 ± 4.06 14.74 ± 4.45 13.85 ± 4.35 较高 15.72 ± 4.16 b 15.58 ± 3.97 b 16.03 ± 4.32 b 15.63 ± 4.24 b 职业发展机会 少 15.92 ± 4.20 15.90 ± 4.07 16.09 ± 4.37 15.78 ± 4.18 一般 14.34 ± 4.25 14.57 ± 3.96 14.48 ± 4.50 13.90 ± 4.35 多 13.28 ± 4.37 b 13.81 ± 4.19 b 12.81 ± 4.33 b 12.76 ± 4.67 b 注:各组内比较,a P < 0.05;b P < 0.01。 表 3 中国东中西部地区全科医生离职意愿影响因素多元线性逐步回归分析
地区 因素 参照组 β $S_{\bar x}$ β′ t 值 P 值 东中西部地区 性别 女性 男性 – 0.34 0.14 – 0.04 – 2.41 0.02 年龄较大 – 0.06 0.01 – 0.01 – 6.89 < 0.01 文化程度 本科 大专及以下 0.67 0.15 0.07 4.46 < 0.01 硕士及以上 1.47 0.31 0.08 4.79 < 0.01 任职方式 合同制 正式在编 0.90 0.15 0.10 6.19 < 0.01 行政职务 无 有 – 0.34 0.16 – 0.03 – 2.08 0.04 工作压力 较高 较低 0.31 0.15 0.04 2.13 0.03 物质满意度得分较高 – 0.35 0.03 – 0.22 – 10.95 < 0.01 成长满意度得分较高 – 0.32 0.04 – 0.17 – 8.66 < 0.01 情绪耗竭得分较高 0.06 0.01 0.19 9.58 < 0.01 去人格化得分较高 0.05 0.01 0.07 3.88 < 0.01 个人成就感得分较高 0.02 0.01 0.05 3.06 < 0.01 东部地区 年龄较大 – 0.11 0.01 – 0.19 – 7.55 < 0.01 行政职务 无 有 – 0.86 0.24 – 0.09 – 3.59 < 0.01 个人年均收入(万元) 5~ < 5 – 0.66 0.24 – 0.07 – 2.71 < 0.01 ≥ 10 – 1.50 0.72 – 0.05 – 2.10 0.04 物质满意度得分较高 – 0.34 0.05 – 0.22 – 6.60 < 0.01 成长满意度得分较高 – 0.36 0.06 – 0.19 – 6.90 < 0.01 情绪耗竭得分较高 0.07 0.01 0.22 8.43 < 0.01 中部地区 文化程度 本科 大专及以下 0.71 0.25 0.08 2.78 < 0.01 任职方式 合同制 正式在编 1.27 0.25 0.14 5.13 < 0.01 物质满意度得分较高 – 0.35 0.06 – 0.22 – 6.24 < 0.01 成长满意度得分较高 – 0.30 0.07 – 0.15 – 4.33 < 0.01 情绪耗竭得分较高 0.08 0.01 0.23 6.89 < 0.01 去人格化得分较高 0.09 0.02 0.12 3.73 < 0.01 个人成就感得分较高 0.04 0.01 0.11 3.77 < 0.01 西部地区 性别 女性 男性 – 0.77 0.26 – 0.08 – 2.94 < 0.01 年龄较大 – 0.05 0.02 – 0.09 – 3.13 < 0.01 文化程度 本科 大专及以下 0.50 0.24 0.06 2.03 0.04 硕士及以上 2.29 0.69 0.09 3.30 < 0.01 任职方式 合同制 正式在编 0.96 0.25 0.11 3.79 < 0.01 工作压力 较高 较低 0.64 0.27 0.07 2.39 0.02 物质满意度得分较高 – 0.31 0.06 – 0.19 – 5.26 < 0.01 成长满意度得分较高 – 0.35 0.07 – 0.19 – 5.21 < 0.01 情绪耗竭得分较高 0.06 0.01 0.20 6.24 < 0.01 -
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