Kamien M
University of Western Australia, Perth.
Med J Aust. 1998 Sep 21;169(6):318-21. doi: 10.5694/j.1326-5377.1998.tb140285.x.
To examine the 1996 outcomes of a sample of Western Australian rural doctors who in 1986 had indicated their intentions to stay in or leave rural practice.
Postal questionnaire survey in December 1996, semi-structured interview and feedback by doctors on a draft of this article.
91 respondents from the 101 doctors who in 1986 had filled in a questionnaire on their intentions to stay in or leave rural practice.
Proportion of doctors whose actions by 1996 were at variance with their intentions in 1986, and the reasons for their change of direction.
49% (22/45) of doctors who intended to leave had stayed ("stayers") and 24% (11/46) who intended to stay had left ("leavers"). Doctors' main concerns in 1986 were overwork, lack of locum relief, professional contact with colleagues, specialist backup in emergencies, downsizing of hospital facilities, continuing medical education, and income. By 1996 stayers had solved most of these professional problems and felt they were doing a special job which made a difference to their community. Conversely, more than half the leavers were unable to solve these problems and felt disempowered and dispirited. Their most potentially solvable problems were overwork, forced deskilling and conflict with other healthcare professionals.
Professional satisfaction was the main reason for doctors staying in or leaving rural practice. Professionally dissatisfied rural doctors reach a critical phase which they have to surmount if they are going to stay. An examination of the positive experiences of the stayers points the way to retaining at least half the potential future leavers.
调查1986年表明打算留在或离开乡村医疗工作的西澳大利亚乡村医生样本在1996年的结局。
1996年12月进行邮寄问卷调查、半结构化访谈以及医生对本文草稿的反馈。
1986年填写了关于留在或离开乡村医疗工作意向问卷的101名医生中的91名受访者。
到1996年其行为与1986年意向不符的医生比例，以及他们改变方向的原因。
打算离开的医生中有49%（22/45）留了下来（“留任者”），打算留下来的医生中有24%（11/46）离开了（“离职者”）。医生在1986年主要关注的问题是工作过度、缺乏替班、与同事的专业联系、紧急情况下的专科支持、医院设施缩减、继续医学教育和收入。到1996年，留任者解决了这些专业问题中的大部分，并觉得自己在做一份对社区有意义的特殊工作。相反，超过一半的离职者无法解决这些问题，感到无力和沮丧。他们最有可能解决的问题是工作过度、被迫降低技能以及与其他医疗专业人员的冲突。
职业满意度是医生留在或离开乡村医疗工作的主要原因。对乡村医疗工作不满意的医生进入了一个关键阶段，如果他们想留下来就必须克服这个阶段。对留任者积极经历的研究为留住至少一半未来可能离职的人指明了方向。
