Wang Xiaoxu, Sun Qiufen, Chen Lijin, Zhang Yaoguang, Cai Yue, Wu Ruixian, Wang Shuai, Cui Xiang, Lv Jun, Wu Shiyong, Li Liming
Department of Epidemiology & Biostatistics, School of Public Health, Peking University, Beijing, 100191, China.
Center for Health Statistics and Information, National Health Commission of the PRC, Beijing, 100044, China.
Hum Resour Health. 2025 Aug 12;23(1):40. doi: 10.1186/s12960-025-01009-z.
There have been a globally paucity of comprehensive quantitative studies on the physician turnover trends. This study aimed to investigate the trajectory and magnitude of Chinese physician turnover, as well as its influencing factors.
We established a retrospective cohort by combining annual physician surveillance data and annual medical institution report data between 2011 and 2021. Turnover was defined as physicians who changed their practice institution at least once between 2011 and 2021. We reported the national annual turnover rate, net turnover rate of different regions and types of healthcare institutions. The direction of turnover across provinces and institutions was exhibited using Sankey diagrams. A time-dependent Cox regression analysis was used to examine the factors that influence physician turnover.
This study included 3.7 million physicians, with 19.4% changing practice institutions between 2011 and 2021. The national annual turnover rate has risen from 1.6% to 4.4%. The majority of turnover occurred within provinces and the same type of healthcare institutions. Eastern regions and urban areas experienced net turnover inflow. Factors that increased the likelihood of physician turnover include: being younger, male, more educated, having senior professional titles, having non-permanent employment contracts, working in rural, non-hospital, or private institutions, and working in institutions with relatively low revenue or high workload.
This study suggests that the physician turnover rate is rising in China. Polices should pay more attention to physician retention in less-developed regions. The underlying causes of physician turnover should be thoroughly investigated. Continuous monitoring of physician turnover is critical to leverage its potential positive impact on revitalizing the healthcare system and to avoid its possible negative impact on equal geographic distribution of physicians.
全球范围内对医生流动趋势的全面定量研究较少。本研究旨在调查中国医生流动的轨迹、规模及其影响因素。
我们通过整合2011年至2021年的年度医生监测数据和年度医疗机构报告数据建立了一个回顾性队列。流动被定义为在2011年至2021年期间至少更换过一次执业机构的医生。我们报告了全国年度流动率、不同地区和类型医疗机构的净流动率。使用桑基图展示了跨省份和机构的流动方向。采用时间依赖性Cox回归分析来检验影响医生流动的因素。
本研究纳入了370万名医生，其中19.4%在2011年至2021年期间更换了执业机构。全国年度流动率从1.6%上升到了4.4%。大多数流动发生在省内和同一类型的医疗机构之间。东部地区和城市地区出现了净流动流入。增加医生流动可能性的因素包括：年龄较小、男性、受教育程度较高、拥有高级职称、签订非长期雇佣合同、在农村、非医院或私立机构工作，以及在收入相对较低或工作量较大的机构工作。
本研究表明中国医生流动率正在上升。政策应更加关注欠发达地区的医生留存问题。应深入调查医生流动的根本原因。持续监测医生流动对于发挥其对振兴医疗系统的潜在积极影响以及避免其对医生地理分布平等可能产生的负面影响至关重要。
