Faculdade de Medicine (FMUSP), Departamento de Medicina Preventiva, Universidade de São Paulo, São Paulo, Brasil.
Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom.
PLoS One. 2023 Apr 27;18(4):e0271655. doi: 10.1371/journal.pone.0271655. eCollection 2023.
The short tenure of primary care physicians undermines the continuity of care, compromising health outcomes in low-, middle and in high-income countries. The purpose of this study was to investigate the contextual and individual factors associated with the tenure of physician in Primary Health Care (PHC) services. We consider individual-level sociodemographic variables such as education and work-related variables, as well as the characteristics of employers and services.
This study is a retrospective cohort study of 2,335 physicians in 284 Primary Health Care Units across the São Paulo, Brazil, public health care system from 2016 to 2020. A multivariate hierarchical model was selected, and an adjusted Cox regression with multilevel analysis was employed. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist was used to report the findings from the study.
The average physician tenure was 14.54 ± 12.89 months, and the median was 10.94 months. Differences between Primary Health Care Units accounted for 10.83% of the variance observed in the outcome, while the employing organizations were responsible for only 2.30%. The physician characteristics associated with higher tenure in PHC were age at hire, i.e., being between 30 and 60 years old, [HR: 0.84, 95% CI: (0.75-0.95)] and professional experience over five years [HR: 0.76, 95% CI: (0.59-0.96)]. Specialties not related to PHC practices were associated with a short tenure [HR: 1.25, 95% CI: (1.02-1.54)].
Differences between Primary Health Care Units and in the individual characteristics, such as specializations and experience, are related to the low tenure of professionals, but such characteristics can be changed through investments in PHC infrastructure and changes in work conditions, policies, training, and human resource policies. Finding a remedy for the short tenure of physicians is essential for guaranteeing a robust PHC system that can contribute to universal, resilient, and proactive health care.
初级保健医生任期短，破坏了医疗服务的连续性，降低了中低收入国家的医疗效果。本研究旨在探讨与初级保健（PHC）服务中医生任期相关的背景和个体因素。我们考虑了个体层面的社会人口统计学变量，如教育和与工作相关的变量，以及雇主和服务的特征。
这是一项回顾性队列研究，纳入了 2016 年至 2020 年期间巴西圣保罗市 284 个初级保健单位的 2335 名医生。选择了一个多变量层次模型，并采用具有多层次分析的调整后的 Cox 回归。采用强化观察性研究报告标准（STROBE）检查表报告研究结果。
医生的平均任期为 14.54±12.89 个月，中位数为 10.94 个月。初级保健单位之间的差异解释了观察结果中 10.83%的变异性，而用人单位仅占 2.30%。与 PHC 任期较长相关的医生特征是入职时的年龄，即 30-60 岁之间，[HR：0.84，95%CI：（0.75-0.95）]和五年以上的工作经验[HR：0.76，95%CI：（0.59-0.96）]。与 PHC 实践无关的专业与任期短有关[HR：1.25，95%CI：（1.02-1.54）]。
初级保健单位之间的差异以及个体特征，如专业和经验，与专业人员任期短有关，但可以通过投资 PHC 基础设施和改变工作条件、政策、培训和人力资源政策来改变这些特征。解决医生任期短的问题对于保证强大的初级保健系统至关重要，该系统可以为普及、有弹性和主动的医疗保健做出贡献。
