Department of Health and Social Behaviour, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, 610041, China.
School of Integrated Traditional Chinese and Western Medicine, Jining Medical University, Jining, 272067, China.
BMC Health Serv Res. 2020 Apr 6;20(1):283. doi: 10.1186/s12913-020-05154-0.
As the gatekeepers of rural residents' health, teams of village doctors play a vital role in improving rural residents' health. However, the high turnover of village doctors, both individually and collectively, threaten the stability of village medical teams. This research evaluated the influence of job satisfaction, resilience, and work engagement on the village doctors' turnover intention, and explored the mediating role of work engagement and resilience between job satisfaction and the turnover intention of village doctors in China.
A quantitative study using a self-administered questionnaire containing mostly structured items was conducted among village doctors with a sample size of 2693 from 1345 rural clinics in Shandong province, China, during May and June 2019. All variables including demographic characteristics, job satisfaction, resilience, work engagement and turnover intention were based on available literature, and measured on a 5- or 6-point Likert scale. Such statistical methods as one-way ANOVA, bivariate correlation, exploratory factor analysis (EFA), and Structural Equation Modelling (SEM) were used.
Up to 46.9% of the subjects had a higher turnover intention and more than 26.3% of them had a medium turnover intention. The job satisfaction of village doctors could not only have a direct negative effect on turnover intention (β = - 0.37, p < 0.001), but also have an indirect effect through work engagement (β = - 0.04,=< 0.001). Meanwhile, work engagement also had a direct negative impact on turnover intention (β = - 0.13, p < 0.001), and resilience had an indirect negative impact on turnover intention through work engagement (β = - 0.09, p < 0.001). The above results of this study strongly confirmed that job satisfaction, resilience, and work engagement were early, powerful predicators of village doctors' turnover intention.
According to the results, the following should be taken seriously to improve job satisfaction: reasonable and fair income, effective promotion mechanism, fair social old-age security, reasonable workload, and strong psychological coping mechanisms for work stress. The turnover intention of village doctors could be reduced through improving job satisfaction, resilience and work engagement.
作为农村居民健康的守门人，乡村医生团队在改善农村居民健康方面发挥着至关重要的作用。然而，乡村医生个体和集体的高离职率，威胁着乡村医疗队伍的稳定性。本研究评估了工作满意度、韧性和工作投入对乡村医生离职意愿的影响，并探讨了工作投入和韧性在乡村医生工作满意度与离职意愿之间的中介作用。
采用定量研究方法，使用自填式问卷对来自中国山东省 1345 个农村诊所的 2693 名乡村医生进行了调查，调查时间为 2019 年 5 月至 6 月。所有变量，包括人口统计学特征、工作满意度、韧性、工作投入和离职意愿，均基于现有文献，并采用 5 点或 6 点 Likert 量表进行测量。采用单因素方差分析、双变量相关性分析、探索性因子分析（EFA）和结构方程模型（SEM）等统计方法。
高达 46.9%的研究对象离职意愿较高，超过 26.3%的研究对象离职意愿处于中等水平。乡村医生的工作满意度不仅可以直接对离职意愿产生负向影响（β=-0.37，p<0.001），还可以通过工作投入产生间接影响（β=-0.04，p<0.001）。同时，工作投入也对离职意愿有直接的负向影响（β=-0.13，p<0.001），韧性通过工作投入对离职意愿产生间接负向影响（β=-0.09，p<0.001）。本研究的上述结果强烈证实，工作满意度、韧性和工作投入是乡村医生离职意愿的早期、有力预测指标。
根据研究结果，应认真对待以下方面以提高工作满意度：合理公平的收入、有效的晋升机制、公平的社会养老保障、合理的工作量以及应对工作压力的强大心理应对机制。通过提高工作满意度、韧性和工作投入，可以降低乡村医生的离职意愿。
