Abstract: Objective　To understand the change of doctors' working status from single hospital development to the medical treatment partnership system in order to provide a basis for promoting the construction of partnership system.Methods　Cluster sampling method was used to select physicians from Yicheng People's Hospital，Yicheng Hospital of Traditional Chinese Medicine，Dangyang People's Hospital and Dangyang Hospital of Traditional Chinese Medicine as investigation subjects from April to July 2017.Working status questionnaire of medical staff was used to evaluate work pressure，interpersonal relationship，professional quality，performance assessment and economic income，and turnover intention scale was used to investigate current turnover intention of physicians in counties.Results　Of the 210 clinicians，181 returned responsive questionnaires，with a response rate of 86.2%.After the construction of medical treatment partnership system，scores of work pressure，interpersonal relationship，professional quality，performance assessment and economic income of physicians in counties were （1.77±2.63），（2.37±2.63），（2.79±2.85），（1.15±2.39），（0.82±2.08），respectively.Those aged over 50 years had lower scores in interpersonal relations than those <50 years，and lower scores in professional quality than those <39 years （P<0.05）．The scores of interpersonal relationship in physicians with bachelor degree or above were higher than that of physicians with college diploma.Doctors with graduate degree or above had higher scores of professional quality than physicians with college diploma，and higher scores of performance assessment than physicians with bachelor degree or below（P<0.05）．The scores of working pressure，interpersonal relationship，professional quality，performance assessment and economic income of doctors without budgeted posts were higher than those of the doctors with budgeted posts，and the scores of above dimensions of doctors from non-compact medical treatment partnership system were lower than those of doctors from compact medical treatment partnership system（P<0.05）．There was a statistically significant difference in turnover intention among doctors with different results of work pressure，interpersonal relationship and economic income （P<0.05）．Conclusion　Doctors hold a positive attitude towards the medical treatment partnership system，while the negative influences from the system，such as working pressure，interpersonal relationship and economic income，may increase the turnover intention.Therefore，medical examination under the partnership system should takes into account the business changes after the system is carried out.In the reform of performance assessment，the social value of doctor cooperation should be reflected in order to promote this cooperation.

Key words: Medical treatment partnership system, County hospital, Physician, Turnover intention

摘要： 目的　了解县级医院从单体发展到医联体模式转变下县级医生工作状态的变化，为促进医联体建设提供依据。方法　2017年4—7月，采用整群抽样的方法，选取宜城市人民医院、宜城市中医院、当阳市人民医院、当阳市中医院临床医生为调查对象。采用医务人员工作状态调查表，评价医联体对县级医生工作压力、人际关系、专业素质、绩效考核以及经济收入的影响；采用离职倾向量表调查县级医生当前的离职倾向。结果　共发放问卷210份，回收有效问卷181份，有效回收率为86.2%。开展医联体后县级医生工作压力、人际关系、专业素质、绩效考核、经济收入评分分别为（1.77±2.63）、（2.37±2.63）、（2.79±2.85）、（1.15±2.39）、（0.82±2.08）分。≥50岁的医生人际关系评分低于<50岁者，专业素质评分低于<39岁者（P<0.05）。本科及本科以上学历的医生人际关系评分高于本科以下学历者，本科以上学历的医生专业素质评分高于本科以下学历者，绩效考核评分高于本科及本科以下学历者（P<0.05）。无编制的医生工作压力、人际关系、专业素质、绩效考核以及经济收入评分高于有编制者，非紧密型医联体内的医生工作压力、人际关系、专业素质、经济收入评分低于紧密型医联体内者（P<0.05）。认为对工作压力、人际关系、经济收入有不同影响的医生离职倾向评分比较，差异有统计学意义（P<0.05）。结论　县级医生对医联体总体持积极态度，医联体消极的工作压力、人际关系、经济收入影响增加了医生的离职倾向。医联体内的医生考核应考虑医联体开展后的业务变化，在绩效改革中应体现医生服务协作的社会价值，以促进医生服务协作。

关键词: 医联体, 县级医院, 医生, 离职倾向