New Advances in Turnover Intention of General Practitioners at Home and Abroad

doi:10.12114/j.issn.1007-9572.2021.00.106

Abstract

Abstract: Reducing the turnover intention among general practitioners（GPs） and strengthening the construction of GPs workforce are the key links to improve the development of primary healthcare system and hierarchical medical system to maintain and improve people's health，and achieve the goals of Healthy China. Considering global shortage of primary healthcare and China's increasing emphasis on both general medicine and GPs，we discussed the role of GPs in primary healthcare，and systematically analyzed the significance of reducing GPs turnover intention，and comprehensive summarized the key factors associated with turnover intention among GPs，including demographic characteristics，job satisfaction，organizational identity，salary and work enthusiasm，then put forward some advice on dealing with turnover intention among domestic GPs，which may provide effective evidence for related departments to formulate policies and measures to stabilize GPs team，and to improve the attractiveness of GPs as an occupation.

Key words: General practitioners, Turnover intention, Review

摘要： 降低全科医生离职意愿，加强全科医生人才队伍建设，是加强基层医疗卫生服务体系建设、建立分级诊疗制度、维护和增进人民群众健康、实现“健康中国”目标意义的关键环节。本研究从全球范围内初级卫生保健供给不足、我国对全科医学与全科医生的重视日益提高的现状入手，探讨全科医生在初级卫生保健中的作用，系统分析降低全科医生离职意愿的重要意义，全面总结影响全科医生离职意愿的人口学特征、工作满意度、组织认同度、薪酬待遇和工作积极性关键因素，提出应对我国全科医生离职意愿的政策建议，为相关部门制定政策和措施、稳定全科医生队伍、提升全科医生的职业吸引力提供参考。

关键词: 全科医生, 离职意愿, 综述

SHEN Xin,JIANG Heng,FENG Jing, et al. New Advances in Turnover Intention of General Practitioners at Home and Abroad　[J]. Chinese General Practice, 2021, 24(22): 2770-2776. DOI: 10.12114/j.issn.1007-9572.2021.00.106.
申鑫,姜恒,冯晶等. 国内外全科医生离职意愿研究进展[J]. 中国全科医学, 2021, 24(22): 2770-2776. DOI: 10.12114/j.issn.1007-9572.2021.00.106.

References

［1］SHANAFELT T，TROCKEL M，RIPP J，et al. Building a program on well-being：key design considerations to meet the unique needs of each organization［J］. Acad Med，2019，94（2）：156-161. DOI：10.1097/ACM.0000000000002415.
［2］梁万年. 全科医学、全科医疗和全科医生［J］. 中国学校卫生，2004，25（2）：252-256. DOI：10.3969/j.issn.1000-9817.2004.02.098.
［3］李丽清，卢祖洵. 全科医生职业吸引力的结构方程模型研究［J］. 中国卫生统计，2019，36（4）：601-603.
［4］马晓静，代涛，杨顺心，等. 全科医生执业及服务方式的国际经验与启示［J］. 中国卫生政策研究，2015，8（2）：13-18. DOI：10.3969/j.issn.1674-2982.2015.02.003.
MA X J，DAI T，YANG S X，et al. International experiences and implications of the practice and service mode of general practitioners［J］. Chinese Journal of Health Policy，2015，8（2）：13-18. DOI：10.3969/j.issn.1674-2982.2015.02.003.
［5］HOLT-LUNSTAD J，SMITH T B，LAYTON J B. Social relationships and mortality risk：a meta-analytic review［J］. PLoS Med，2010，7（7）：e1000316. DOI：10.1371/journal.pmed.1000316.
［6］ALLEN L N，BARRY E，GILBERT C，et al. How to move from managing sick individuals to creating healthy communities［J］. Br J Gen Pract，2019，69（678）：8-9. DOI：10.3399/bjgp19X700337.
［7］HUSK K，ELSTON J，GRADINGER F，et al. Social prescribing：where is the evidence?［J］. Br J Gen Pract，2019，69（678）：6-7. DOI：10.3399/bjgp19X700325.
［8］代涛，黄菊，马晓静. 国际全科医生制度发展历程：影响因素分析及政策启示［J］. 中国卫生政策研究，2015，8（2）：1-7. DOI：10.3969/j.issn.1674-2982.2015.02.001.
DAI T，HUANG J，MA X J. Recent advances in attractiveness of a career as a general practitioner［J］. Chinese Journal of Health Policy，2015，8（2）：1-7. DOI：10.3969/j.issn.1674-2982.2015.02.001.
［9］甘勇，杨婷婷，杨宇迪，等. 国内外全科医生职业吸引力研究进展［J］. 中国全科医学，2019，22（28）：3490-3494. DOI：10.12114/j.issn.1007-9572.2019.00.333.
GAN Y，YANG T T，YANG Y D，et al. Research progress of incidence and risk factors associated with workplace violence［J］. Chinese General Practice，2019，22（28）：3490-3494. DOI：10.12114/j.issn.1007-9572.2019.00.333.
［10］SHANAFELT T D，NOSEWORTHY J H. Executive leadership and physician well-being：nine organizational strategies to promote engagement and reduce burnout［J］. Mayo Clin Proc，2017，92（1）：129-146. DOI：10.1016/j.mayocp.2016.10.004.
［11］NORFUL A A，YE S，VAN DER-BIEZEN M，et al. Nurse practitioner-physician comanagement of patients in primary care［J］. Policy Polit Nurs Pract，2018，19（3/4）：82-90. DOI：10.1177/1527154418815024.
［12］FREY J R. Colluding with the decline of continuity［J］. Ann Fam Med，2018，16（6）：488-489. DOI：10.1370/afm. 2322.
［13］ENGAMBA S A，STEEL N，HOWE A，et al. Tackling multimorbidity in primary care：is relational continuity the missing ingredient?［J］. Br J Gen Pract，2019，69（679）：92-93. DOI：10.3399/bjgp19X701201.
［14］LEGGE D G. Striving towards integrated people-centred health services：reflections on the Australian experience［J］. Fam Med Community Health，2019，7（1）：e56. DOI：10.1136/fmch-2018-000056.
［15］徐静，周亚夫，葛运运，等. 国外全科医学教育和全科医生培训情况分析及启示［J］. 中国全科医学，2013，16（27）：3155-3158. DOI：10.3969/j.issn.1007-9572.2013.27.001.
XU J，ZHOU Y F，GE Y Y，et al. Education of general practice and training of general practitioners abroad and the enlightenment［J］. Chinese General Practice，2013，16（27）：3155-3158. DOI：10.3969/j.issn.1007-9572.2013.27.001.
［16］杨森，石建伟，金花，等. 基层医疗机构全科医学管理者领导力研究进展［J］. 中国全科医学，2020，23（22）：2763-2767. DOI：10.12114/j.issn.1007-9572.2020.00.127.
YANG S，SHI J W，JIN H，et al. Development of international general practice system：influencing factors and policy implications［J］. Chinese General Practice，2020，23（22）：2763-2767. DOI：10.12114/j.issn.1007-9572.2020.00.127.
［17］LOWN M，LEWITH G，SIMON C，et al. Resilience：what is it，why do we need it，and can it help us?［J］. Br J Gen Pract，2015，65（639）：e708-710. DOI：10.3399/bjgp15X687133.
［18］SWINBURN B A，KRAAK V I，ALLENDER S，et al. The global syndemic of obesity，undernutrition，and climate change：the lancet commission report［J］. Lancet，2019，393（10173）：791-846. DOI：10.1016/S0140-6736(18)32822-8.
［19］SOLER J K，YAMAN H，ESTEVA M，et al. Burnout in European family doctors：the EGPRN study［J］. Fam Pract，2008，25（4）：245-265. DOI：10.1093/fampra/cmn038.
［20］WILLARD-GRACE R，KNOX M，HUANG B，et al. Burnout and health care workforce turnover［J］. Ann Fam Med，2019，17（1）：36-41. DOI：10.1370/afm.2338.
［21］余芳，郑艳玲，乔岩，等. 国内外护理人员工作场所暴力发生率及其影响因素研究进展［J］. 中国社会医学杂志，2019，36（5）：498-501. DOI：10.3969/j.issn.1673-5625.2019.05.015.
YU F，ZHENG Y L，QIAO Y，et al. Study on the relation of job burnout and turnover intention in the resident physician of general standardized training program［J］. Chinese Journal of Social Medicine，2019，36（5）：498-501. DOI：10.3969/j.issn.1673-5625.2019.05.015.
［22］FLETCHER E，ABEL G A，ANDERSON R，et al. Quitting patient care and career break intentions among general practitioners in South West England：findings of a census survey of general practitioners［J］. BMJ Open，2017，7（4）：e15853. DOI：10.1136/bmjopen-2017-015853.
［23］GARDINER M，SEXTON R，DURBRIDGE M，et al. The role of psychological well-being in retaining rural general practitioners［J］. Aust J Rural Health，2005，13（3）：149-155. DOI：10.1111/j.1440-1854.2005.00677.x.
［24］MCCOMB E D. Which psycho-demographic factors predict a doctor's intention to leave New Zealand general practice?［J］. N Z Med J，2008，121（1273）：25-36.
［25］VANASSE A，SCOTT S，COURTEAU J，et al. Canadian family physicians' intentions to migrate：associated factors［J］. Can Fam Physician，2009，55（4）：396-397.
［26］KUUSIO H，HEPONIEMI T，V?NSK? J，et al. Psychosocial stress factors and intention to leave job：differences between foreign-born and Finnish-born general practitioners［J］. Scand J Public Health，2013，41（4）：405-411. DOI：10.1177/1403494813477248.
［27］GAN Y，JIANG H，LI L，et al. A national survey of turnover intention among general practitioners in China［J］. Int J Health Plann Manage，2020，35（2）：482-493. DOI：10.1002/hpm.2921.
［28］WEN T，ZHANG Y，WANG X，et al. Factors influencing turnover intention among primary care doctors：a cross-sectional study in Chongqing，China［J］. Hum Resour Health，2018，16（1）：10. DOI：10.1186/s12960-018-0274-z.
［29］MINAMIZONO S，NOMURA K，INOUE Y，et al. Gender division of labor，burnout，and intention to leave work among young female nurses in Japan：a cross-sectional study［J］. Int J Environ Res Public Health，2019，16（12）：2201. DOI：10.3390/ijerph16122201.
［30］LU Y，HU X M，HUANG X L，et al. The relationship between job satisfaction，work stress，work-family conflict，and turnover intention among physicians in Guangdong，China：a cross-sectional study［J］. BMJ Open，2017，7（5）：e14894. DOI：10.1136/bmjopen-2016-014894.
［31］MOU H，OLFERT M R. Inter-provincial migration intentions of family physicians in Canada：the roles of income and community characteristics［J］. Healthc Policy，2015，11（2）：58-71.
［32］KELLEY M L，KULUSKI K，BROWNLEE K，et al. Physician satisfaction and practice intentions in Northwestern Ontario［J］. Can J Rural Med，2008，13（3）：129-135.
［33］ROY A，VAN DER WEIJDEN T，DE VRIES N. Relationships of work characteristics to job satisfaction，turnover intention，and burnout among doctors in the district public-private mixed health system of Bangladesh［J］. BMC Health Serv Res，2017，17（1）：421. DOI：10.1186/s12913-017-2369-y.
［34］BEASLEY J W，KARSH B T，SAINFORT F，et al. Quality of work life of family physicians in Wisconsin's health care organizations：a WReN study［J］. WMJ，2004，103（7）：51-55.
［35］黄蕾，胡世钰，汪浩，等. 全科住培医师职业倦怠与离职意愿的相关性研究［J］. 上海医药，2017，38（24）：7-11. DOI：10.3969/j.issn.1006-1533.2017.24.003.
HUANG L，HU S Y，WANG H，et al. status quo of occupational pressure and job satisfaction of general practitioners and its influencing factor［J］. Shanghai Medical & Pharmaceutical Journal，2017，38（24）：7-11. DOI：10.3969/j.issn.1006-1533.2017.24.003.
［36］李姝洁，张海瑞，朱丽娜，等. 全科医生工作压力和工作满意度现状及其影响因素研究［J］. 中国全科医学，2015，18（4）：387-390. DOI：10.3969/j.issn.1007-9572.2015.04.008.
LI S J，ZHANG H R，ZHU L N，et al. Status quo of occupational pressure and job satisfaction of general practitioners and its influencing factor［J］. Chinese General Practice，2015，18（4）：387-390. DOI：10.3969/j.issn.1007-9572.2015.04.008.
［37］甘勇，杨婷婷，杨宇迪，等. 我国东中西部全科医生职业倦怠现状及影响因素［J］. 医学与社会，2020，33（3）：99-103. DOI：10.13723/j.yxysh.2020.03.023.
GAN Y，YANG T T，YANG Y D，et al. Job burnout and its influencing factors among general practitioners in the eastern，central and western China［J］. Medicine and Society，2020，33（3）：99-103. DOI：10.13723/j.yxysh.2020.03.023.
［38］JOHNSON J，HALL L H，BERZINS K，et al. Mental healthcare staff well-being and burnout：a narrative review of trends，causes，implications，and recommendations for future interventions［J］. Int J Ment Health Nurs，2018，27（1）：20-32. DOI：10.1111/inm.12416.
［39］曹阳，宋雨佳. 基于结构方程的基层医生工作满意度及离职意愿影响因素研究［J］. 中国卫生事业管理，2018，35（1）：24-26.
CAO Y，SONG Y J. Studying on the doctors' job satisfaction and demission intention in grass-roots medical institutions and its influencing factors based on structural equation model［J］. Chinese Health Service Management，2018，35（1）：24-26.
［40］郑艳玲，余芳，陈艳黎，等. 我国全科医生离职意愿及其影响因素分析［J］. 中华全科医学，2019，17（9）：1543-1546. DOI：10.16766/j.cnki.issn.1674-4152.000993.
ZHENG Y L，YU F，CHEN Y L，et al. Turnover intention and related factors among general practitioners in China［J］. Chinese Journal of General Practice，2019，17（9）：1543-1546. DOI：10.16766/j.cnki.issn.1674-4152.000993.
［41］STEVANIN S，PALESE A，BRESSAN V，et al. Workplace-related generational characteristics of nurses：a mixed-method systematic review［J］. J Adv Nurs，2018，74（6）：1245-1263. DOI：10.1111/jan.13538.
［42］GAN Y，GONG Y，CHEN Y，et al. Turnover intention and related factors among general practitioners in Hubei，China：a cross-sectional study［J］. BMC Fam Pract，2018，19（1）：74. DOI：10.1186/s12875-018-0752-3.
［43］VAN DER HEIJDEN B，BROWN M C，XU Y. Impact of job demands and resources on nurses' burnout and occupational turnover intention towards an age-moderated mediation model for the nursing profession［J］. Int J Environ Res Public Health，2019，16（11）：2011. DOI：10.3390/ijerph16112011.
［44］余芳，郑艳玲，杨婷婷，等. 东中西部全科医生工作满意度现状及其影响因素分析［J］. 现代预防医学，2019，46（16）：2986-2990.
［45］刘坤，荆丽梅，周徐红，等. 卫生人才激励机制改革背景下医务人员离职意愿研究［J］. 中国全科医学，2017，20（19）：2338-2341. DOI：10.3969/j.issn.1007-9572.2017.19.009.
LIU K，JING L M，ZHOU X H，et al. Practical exploration of improving the professional identity of general resident doctorsin standardized training［J］. Chinese General Practice，2017，20（19）：2338-2341. DOI：10.3969/j.issn.1007-9572.2017.19.009.
［46］张水娟，郭发刚，杨璐，等. 提升全科住培医师职业认同感的实践探索［J］. 中国医学伦理学，2019，32（2）：255-259. DOI：10.12026/j.issn.1001-8565.2019.02.25.
ZHANG S J，GUO F G，YANG L，et al. Practical exploration of improving the professional identity of general resident doctorsin standardized training［J］. Chinese Medical Ethics，2019，32（2）：255-259. DOI：10.12026/j.issn.1001-8565.2019.02.25.
［47］HAMIDI M S，BOHMAN B，SANDBORG C，et al. Estimating institutional physician turnover attributable to self-reported burnout and associated financial burden：a case study［J］. BMC Health Serv Res，2018，18（1）：851. DOI：10.1186/s12913-018-3663-z.
［48］袁莎莎，王芳，李陈晨，等. 社区卫生服务机构签约服务模式分析［J］. 中国卫生政策研究，2015，8（8）：56-62. DOI：10.3969/j.issn.1674-2982.2015.08.011.
YUAN S S，WANG F，LI C C，et al. Analysis on the contracting service model in community health centers［J］. Chinese Journal of Health Policy，2015，8（8）：56-62. DOI：10.3969/j.issn.1674-2982.2015.08.011.
［49］袁莎莎，王芳，李陈晨，等. 社区卫生服务中心全科团队构成模式分析［J］. 中国卫生政策研究，2014，7（12）：37-42. DOI：10.3969/j.issn.1674-2982.2014.12.007.
YUAN S S，WANG F，LI C C，et al. Analysis on general practice teams in community health service centers［J］. Chinese Journal of Health Policy，2014，7（12）：37-42. DOI：10.3969/j.issn.1674-2982.2014.12.007.

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