Objective To explore the mediating roles of job content plateau and centralization plateau in the relationship between hierarchical plateau and turnover intention among Chinese family doctor team members.

Methods A cross-sectional study was conducted based on a network questionnaire survey from September to November 2021 among 1 474 family doctor team members in eastern, central, and western China. The Turnover Intention Scale and Career Plateau Scale were adopted for measurement. The mediating effects of job content plateau and centralization plateau on the relationship between hierarchical plateau and turnover intention were analyzed.

Results Chinese family doctor team members exhibited low turnover intention (2.33 ± 0.763) and moderately low perceived career plateau (2.80 ± 0.83). The hierarchical plateau (3.58 ± 0.64) demonstrated greater severity than the job content plateau (2.46 ± 0.93) and centralization plateau (2.82 ± 1.04). Hierarchical plateau, job content plateau, and centralization plateau had significantly positive correlations with turnover intention. Job content plateau (indirect effect = 0.08, 95%CI: 0.05–0.09, P < 0.001) and centralization plateau (indirect effect = 0.05, 95%CI: 0.02–0.06, P < 0.001) both partially mediated the effect of hierarchical plateau on turnover intention.

Conclusion  Targeted interventions focusing on reducing job content and centralization plateaus may partially mitigate the transmission path from hierarchical plateau to turnover intention. However, the three dimensions may constitute a nonlinear compensatory system, highlighting the need for considering population-specific adaptability in intervention designs.