China-Japan Friendship Hospital, Beijing, China.
School of Public Health, Chinese Academy of Medical Sciences and Pecking Union Medical College, Beijing, China.
BMJ Open. 2019 Mar 13;9(3):e023756. doi: 10.1136/bmjopen-2018-023756.
The reasons that physicians leave the institutions have not been extensively studied. We aimed to evaluate these reasons, which include the desire to work at another hospital or the intention to make a career change, among physicians in tertiary hospitals in China and explore the associations between the individual-level and organizational-level factors related to these two reasons for leaving.
We conducted a national survey of 136 tertiary hospitals across all 31 provinces in China between December 2017 and January 2018. A total of 20 785 physicians were selected to self-report on the two evaluated reasons related to physicians' intent to leave. A univariate analysis and multilevel regression model were applied to evaluate the factors associated with intention to leave.
In all, 10.4% of the participating physicians had thought about working at another hospital, and 20.5% intended to leave to make a career change. At the hospital level, the government subsidy per bed (OR=0.88, 95% CI: 0.86 to 0.98 and OR=0.91, 95% CI: 0.90 to 0.99), personnel funding per capita (OR=0.86, 95% CI: 0.76 to 0.96 and OR=0.80, 95% CI: 0.73 to 0.88) and the number of physicians per bed (OR=0.83, 95% CI: 0.81 to 0.86 and OR=0.89, 95% CI: 0.81 to 0.92) were negatively associated, while the number of hospital-level medical disputes (OR=1.04, 95% CI: 1.03 to 1.05 and OR=1.06, 95% CI: 1.01 to 1.11) was positively associated with both reasons for leaving. At the individual level, income (OR=0.74, 95% CI: 0.71 to 0.79 and OR=0.88, 95% CI:0.83 to 0.92) and job satisfaction (OR=0.18, 95% CI: 0.17 to 0.20 and OR=0.16, 95% CI: 0.15 to 0.18) acted as preventive factors against both reasons for leaving, while work hours per week (OR=1.11, 95% CI: 1.06 to 1.17 and OR=1.23, 95% CI: 1.19 to 1.28) and medical dispute (OR=1.49, 95% CI:1.35 to 1.65 and OR=1.77, 95% CI: 1.64 to 1.91) acted as promotive factors.
Although the intention to leave is not prevalent among physicians in tertiary hospitals in China, providing more organisational support and a better occupational environment may promote retention among physicians.
医生离职的原因尚未得到广泛研究。我们旨在评估中国三级医院医生离职的原因，包括到其他医院工作的愿望和职业转变的意图，并探讨与这两个离职原因相关的个体和组织层面因素之间的关联。
我们于 2017 年 12 月至 2018 年 1 月在全国范围内对中国 31 个省的 136 家三级医院进行了一项全国性调查。共有 20785 名医生被选中报告与医生离职意愿相关的两个评估原因。采用单因素分析和多水平回归模型评估与离职意愿相关的因素。
共有 10.4%的参与医生考虑过到其他医院工作，20.5%的医生打算离职以寻求职业转变。在医院层面，人均床位政府补贴（OR=0.88，95%CI：0.86 至 0.98 和 OR=0.91，95%CI：0.90 至 0.99）、人均人员经费（OR=0.86，95%CI：0.76 至 0.96 和 OR=0.80，95%CI：0.73 至 0.88）和每床医生人数（OR=0.83，95%CI：0.81 至 0.86 和 OR=0.89，95%CI：0.81 至 0.92）与这两个离职原因呈负相关，而医院级别的医疗纠纷数量（OR=1.04，95%CI：1.03 至 1.05 和 OR=1.06，95%CI：1.01 至 1.11）与这两个离职原因呈正相关。在个体层面，收入（OR=0.74，95%CI：0.71 至 0.79 和 OR=0.88，95%CI：0.83 至 0.92）和工作满意度（OR=0.18，95%CI：0.17 至 0.20 和 OR=0.16，95%CI：0.15 至 0.18）是这两个离职原因的预防因素，而每周工作时间（OR=1.11，95%CI：1.06 至 1.17 和 OR=1.23，95%CI：1.19 至 1.28）和医疗纠纷（OR=1.49，95%CI：1.35 至 1.65 和 OR=1.77，95%CI：1.64 至 1.91）是这两个离职原因的促进因素。
尽管中国三级医院医生的离职意愿并不普遍，但提供更多的组织支持和更好的职业环境可能会促进医生的留用。
