Both the quantity and quality of general practitioners (GPs) are two important aspects in human resource management in healthcare, among which the increase, maintaining and loss of the number of GPs is an important indicator for assessing the dynamic planning, management and evaluation in human resource management for GPs, and also is an indicator for assessing the effectiveness of the standardized general practice residency program (SGPRP) . Studying the employment status and associated factors in trainees of the SGPRP will be references for the development of policies and incentives regarding the SGPRP. But there is a lack of such studies in non-targeted admission medical graduates completing the SGPRP.
To understand the employment status of non-targeted admission medical graduates finishing the SGPRP in Henan Province, and to identify the causes of choosing other careers instead of being a GP, providing a reference for the improvement of SGPRP management and incentive mechanisms for human resource management.
In August 2021, multistage random sampling was used to select non-targeted admission medical graduates (n=326) who had been admitted to the SGPRP during 2014 to 2017 and had completed it in Henan Province. They were invited to complete a self-administered survey questionnaire through the platform of wjx.cn for understanding their general information, and self-perceived status of training with SGPRP, current job, and causes of being a GP or choosing other careers.
The survey obtained a response rate of 83.1% (271/326) . Among the respondents, 77 (28.4%) chose GP as a career, and other 194 (71.6%) chose other careers after completing the SGPRP. Multivariate Logistic regression analysis showed that age, education level, type of source and the location of the general practice residency training base were associated with the career choice (P<0.05) . Compared with respondents with a non-GP career choice, those with a GP career choice had higher prevalence of having general practice as the registered major 〔70.1% (54/77) vs 32.0% (62/194) , P<0.05〕, and working at township health centers or community health centers〔49.4% (38/77) vs 6.2% (12/194) , P<0.05) 〕. Among those with a non-GP career choice, the top three careers were internal medicine practitioners〔40.2% (78/194) 〕, emergency and critical care practitioners〔17.0% (33/194) 〕, and surgical care practitioners〔8.8% (17/194) 〕. The three major causes of choosing a non-GP career were appointed by the employed hospital〔34.5% (67/194) 〕, lack of general practice department in the employed hospital〔29.9% (58/194) 〕 and low salary〔26.8% (52/194) 〕.
In these non-targeted admission medical graduates finishing the SGPRP, the prevalence of choosing a GP career was relatively low, which may be associated with age, education level, type of source, and the location of the general practice residency training base. To increase the attractiveness of GP as a career, it is recommended to expand the publicity of the concept of general medicine, accelerate the construction of the general practice department in general hospitals, and improve the salary of GPs.
The turnover intention level of general practitioners (GPs) in primary care in China is relatively high, and identification of its associated factors will offer insights into the curbing of outflow of health talents in primary care. The targeted admission medical graduates (TAMG) who completed the "5+3" standardized general residency program (5-year undergraduate medical education plus 3-year standardized residency training) have gradually entered primary care to fulfill their preadmission commitments, but research on their turnover intention after the tenure is few.
To explore the turnover intention and associated factors in Guizhou's TAMG trained with the "5+3" standardized general residency program after fulfilling their preadmission commitments in primary care, providing a basis for improving the policies about retaining the in-service health talents and developing the general practice workforce.
Participants were TAMG who were working in primary hospitals of Guizhou for fulfilling their preadmission commitments after finishing the "5+3" standardized general residency program at the end of 2020 (with a starting time for the 3-year standardized residency training of 2015—2017) . An online questionnaire survey was conducted with them from January 20 to February 10, 2021 for understanding their general information, self-assessed job satisfaction, turnover intention and planned career development after the expiration of services. Three hundred and eleven (89.6%) of the 347 cases who returned responsive questionnaires were selected as the final participants. Univariate and stepwise multiple linear regression analyses were used to explore the factors related to turnover intention.
The average turnover intention score for the respondents was (3.98±0.98) points. The prevalence of having turnover intention was 73.6% (229/311) . The level of turnover intention differed obviously by sex, hospital location, and daily workload (P<0.05) . Stepwise multiple linear regression analysis found that the way leaders treating their subordinates, sense of work-related, the level of satisfaction with current income, family's support for their job, the implementation of local incentive policies accomplishment were associated with turnover intention (P<0.05) . In terms of the post-expiration development, 12 (3.9%) planned to continue working at the current hospital, 21 (6.7%) planned to work at another primary care setting, 196 (63.0%) planned to work at a higher level hospital, and 60 (19.3%) planned to study full-time to get a master's degree.
The level of turnover intention was high in TAMG working as a GP in primary care in Guizhou, and it is estimated that many of them would outflow after the expiration of services. To improve this, it is suggested to value their needs, take actions to increase income and optimize trainings and employment forms for them, and to further develop primary care hospitals, as well as to strengthen the publicity of general practice.
