Jiang Mao-Min, Gu Man-Li
School of Public Affairs, Xiamen University, Xiamen, China.
Kangda College of Nanjing Medical University, Lianyungang, China.
Work. 2025 Jan;80(1):352-366. doi: 10.3233/WOR-230375. Epub 2025 Mar 18.
Primary care physicians and their teams are the leading force in constructing primary medical services, undertaking the critical responsibility of residents' essential health, and also related to realizing the national health goal. However, primary care physicians generally have a high turnover rate due to problems such as high work pressure, low salary levels, and limited career development. Therefore, exploring primary care physicians' resignation intentions plays a vital role in promoting the construction of primary care physicians' health service system.
This study explores the factors influencing the resignation intentions of primary care physicians, specifically examining the roles of work-family conflict, job satisfaction, professional identity, and emotional exhaustion. By understanding these dynamics, the research aims to inform strategies that can enhance the stability and effectiveness of primary care services, ultimately contributing to the improvement of public health infrastructure and achieving national health goals. This investigation will utilize structural equation modeling to analyze the interrelationships among the identified variables, thereby providing a comprehensive framework for addressing the high turnover rates among primary care physicians.
This study uses the work-family conflict, job satisfaction, professional identity, and emotional exhaustion scales. The data comes from a cross-sectional survey in Zhejiang Province, China, in 2022. Using SPSS 27 and Mplus8.3 software to analyze 1205 primary care physicians and their team members, the selected cases all answered the relevant questions of resignation intention. The potential relationship among work-family conflict, job satisfaction, professional identity, emotional exhaustion, and family doctor resignation intention was explored by constructing structural equations.
Work-family conflict can directly and positively affect primary care physicians' resignation intention ( = -0.546, < 0.001). The results of the mediation model found that job satisfaction, professional identity, and emotional exhaustion were significantly related to work-family conflict, and primary care physicians' resignation intention has a significant mediating effect. It mainly includes six intermediary approaches: one is through the independent intermediary effect of job satisfaction; the second is through the independent intermediary effect of professional identity; the third is through the chain intermediary effect between Job satisfaction and professional identity; the fourth is through the intermediary effect of Job satisfaction and emotional exhaustion chain intermediary; fifth is through the chain intermediary of professional identity and emotional exhaustion; sixth is through the complex chain intermediary of job satisfaction, professional identity, and emotional exhaustion.
Primary care physicians have a high score in resignation intention, which deserves continuous attention. Relevant department can help primary care physicians balance work and family roles, provide them with appropriate resources and rewards, as well as a good working environment and career development opportunities, to improve their job satisfaction and professional identity and reduce emotional exhaustion, thereby reducing the risk of resignation intention.
基层医疗医生及其团队是构建基层医疗服务的主导力量，承担着居民基本健康的关键责任，也关系到国家健康目标的实现。然而，由于工作压力大、薪资水平低、职业发展受限等问题，基层医疗医生普遍离职率较高。因此，探索基层医疗医生的离职意愿对于推动基层医疗医生健康服务体系建设具有至关重要的作用。
本研究探讨影响基层医疗医生离职意愿的因素，具体考察工作家庭冲突、工作满意度、职业认同感和情绪耗竭的作用。通过了解这些动态关系，该研究旨在为提高基层医疗服务的稳定性和有效性提供策略依据，最终有助于改善公共卫生基础设施并实现国家健康目标。本调查将利用结构方程模型分析所识别变量之间的相互关系，从而为解决基层医疗医生高离职率问题提供一个全面的框架。
本研究采用工作家庭冲突、工作满意度、职业认同感和情绪耗竭量表。数据来自2022年在中国浙江省进行的一项横断面调查。使用SPSS 27和Mplus8.3软件对1205名基层医疗医生及其团队成员进行分析，所选案例均回答了离职意愿的相关问题。通过构建结构方程，探讨工作家庭冲突、工作满意度、职业认同感、情绪耗竭与家庭医生离职意愿之间的潜在关系。
工作家庭冲突能够直接且正向影响基层医疗医生的离职意愿（β = -0.546，p < 0.001）。中介模型结果发现，工作满意度、职业认同感和情绪耗竭与工作家庭冲突显著相关，且对基层医疗医生的离职意愿具有显著的中介效应。主要包括六种中介路径：一是通过工作满意度的独立中介效应；二是通过职业认同感的独立中介效应；三是通过工作满意度与职业认同感之间的链式中介效应；四是通过工作满意度与情绪耗竭链式中介的中介效应；五是通过职业认同感与情绪耗竭的链式中介；六是通过工作满意度、职业认同感和情绪耗竭的复杂链式中介。
基层医疗医生离职意愿得分较高，值得持续关注。相关部门可帮助基层医疗医生平衡工作和家庭角色，为其提供适当的资源和奖励，以及良好的工作环境和职业发展机会，以提高他们的工作满意度和职业认同感，减少情绪耗竭，从而降低离职意愿风险。
