Masselink Leah E, Lee Shoou-Yih D, Konrad Thomas R
Department of Health Policy and Administration, University of North Carolina School of Public Health, Chapel Hill, USA.
Health Care Manage Rev. 2008 Apr-Jun;33(2):178-87. doi: 10.1097/01.HMR.0000304507.50674.28.
Physician turnover threatens continuity of care for patients and is a huge expense for health care organizations. Health care organizations have been advised to help physicians build positive relations with colleagues, staff, and patients as a strategy to socially integrate physicians in the workplace and to increase physician retention. Although these recommendations are touted as "evidence-based" practices, the importance of workplace relationships for physician retention has not been established empirically.
The purpose of this study is to examine two questions: Are physicians who report better relationships with colleagues, staff, and patients less likely to intend to withdraw from practice? Do the effects of these relational factors differ for large-group and solo/small-group practice physicians?
Using data from the Physician Worklife Survey, we analyzed the associations between physicians' reported relationships with colleagues, staff, and patients and intention to withdraw from practice within 2 years using logistic regression.
: Relationships with colleagues had a significant and negative association with intended withdrawal from practice for large-group practice physicians. The joint effect of relationships with colleagues, staff, and patients was significant for large-group practice physicians, but it only approached significance for solo/small-group practice physicians.
This study suggests that workplace relationships may influence physicians' intention to withdraw from practice, but the mechanisms by which they do so are unclear. Possible interventions to improve physician retention include promotion of informal mentoring and efforts to support community involvement of physicians and their families. Further research examining the role of these and other programs in promoting physician retention can help employers to foster positive workplace relationships and improve retention.
医生流失威胁患者的连续护理，对医疗保健机构而言是一笔巨大开支。有人建议医疗保健机构帮助医生与同事、员工和患者建立积极关系，以此作为让医生在工作场所实现社会融入并提高医生留任率的策略。尽管这些建议被吹捧为“循证”做法，但工作场所关系对医生留任的重要性尚未得到实证确立。
本研究旨在探讨两个问题：与同事、员工和患者关系较好的医生退出执业的可能性是否较低？这些关系因素对大型团体执业医生和个体/小型团体执业医生的影响是否不同？
利用医生工作生活调查的数据，我们使用逻辑回归分析了医生报告的与同事、员工和患者的关系与两年内退出执业意向之间的关联。
对于大型团体执业医生，与同事的关系与退出执业的意向呈显著负相关。对于大型团体执业医生，与同事、员工和患者的关系的联合效应显著，但对个体/小型团体执业医生而言仅接近显著水平。
本研究表明工作场所关系可能会影响医生退出执业的意向，但其作用机制尚不清楚。提高医生留任率的可能干预措施包括促进非正式指导以及支持医生及其家人参与社区活动。进一步研究这些及其他项目在促进医生留任方面的作用，有助于雇主营造积极的工作场所关系并提高留任率。
