Program of Collective Health, Faculty of Medicine of the São Paulo University (FMUSP), São Paulo, SP, Brazil.
Department of Gastroenterology, Faculty of Medicine of the São Paulo University (FMUSP), São Paulo, SP, Brazil.
BMC Health Serv Res. 2022 Feb 4;22(1):147. doi: 10.1186/s12913-022-07517-1.
The shortage and high turnover of physicians is a recurrent problem in health care systems; this is especially harmful to the expansion and full operation of primary health care (PHC). The aim of this paper is to analyze incidence and associated factors with physician turnover in primary health care services in the East Zone of São Paulo City.
This is a retrospective cohort study of 1378 physicians over a 15 years' time period based on physicians' administrative records from two distinct secondary databases. Physicians' individual characteristics were analyzed including graduation and specialization. Survival analysis techniques such Kaplan-Meier and Cox Regression were used to analyze the termination of contract.
One thousand three hundred seventy-eight physicians were included in the study of which 130 [9.4%(CI95 8.0-11.1%)] remained in the PHC services. The mean and median time until the occurrence of the physician leaving the service was 2.14 years (CI95% 1.98-2.29 years) and 1.17 years [(CI95% 1.05-1.28 years)]. The probability of contract interruption was 45% in the first year and 68% in the second year. Independent factors associated with TEC were identified: workload of 40 h/week HR = 1.71 [(CI95% 1.4-2.09), p < 0.001]; initial salary ≤1052 BGI HR = 1.87 [(CI95 1.64-2.15), p < 0.001]; time since graduation ≤2 years HR =1.36 [(CI95 1.18-1.56), p < 0.001]; and the conclusion of residency in up to 3 years after leaving the service HR = 1.69 [(CI95 1.40-2.04), p < 0.001].
The time of employment of the physician in PHC was relatively short, with a high probability of TEC in the first year. Modifiable factors such as working hours, starting salary, time since graduation from medical school and need to enter in a residency program were associated with TEC. In pointing out that modifiable factors are responsible for long term employment or the end of contract of physicians in PHC services of the Unified Health System in the periphery of a metropolitan area, the study provides support for the planning, implementation and management of policies and strategies aimed at attracting and retaining physicians in suburban, priority or underserved regions.
医生短缺和高离职率是医疗保健系统中反复出现的问题；这对扩大和全面运作初级卫生保健（PHC）尤其有害。本文旨在分析圣保罗市东区初级卫生保健服务中医生离职的发生率和相关因素。
这是一项基于两个不同二级数据库中医生管理记录的 1378 名医生的回顾性队列研究。分析了医生的个体特征，包括毕业和专业。使用 Kaplan-Meier 和 Cox 回归等生存分析技术分析合同终止。
共纳入 1378 名医生进行研究，其中 130 名[9.4%（95%CI8.0-11.1%）]仍在 PHC 服务中。从服务中离开的医生的平均和中位时间分别为 2.14 年（95%CI95%1.98-2.29 年）和 1.17 年（95%CI1.05-1.28 年）。第一年合同中断的概率为 45%，第二年为 68%。确定了与 TEC 相关的独立因素：每周工作 40 小时 HR=1.71（95%CI1.4-2.09），p<0.001）；初始工资≤1052 BGI HR=1.87（95%CI1.64-2.15），p<0.001）；毕业后时间≤2 年 HR=1.36（95%CI1.18-1.56），p<0.001）；毕业后服务结束后 3 年内完成住院医师培训 HR=1.69（95%CI1.40-2.04），p<0.001）。
医生在 PHC 的就业时间相对较短，第一年 TEC 的可能性较高。工作时间、起薪、毕业后时间以及是否需要进入住院医师培训等可改变因素与 TEC 相关。该研究指出，可改变的因素是导致大都市周边统一卫生系统的 PHC 服务中医生长期就业或合同终止的原因，为吸引和留住郊区、优先或服务不足地区的医生提供了规划、实施和管理政策和战略的支持。
