The incentivation for primary health workers is vital for the realization of two goals of the new healthcare reform in China, namely strengthening primary healthcare and achieving hierarchical diagnosis and treatment. Most previous studies put more emphasis on extrinsic incentive measures and their effect on job outcomes, ignoring the intrinsic motivation effect of job itself.
To perform an analysis of the job characteristics of primary health workers using the framework of Job Characteristics Model, assess their intrinsic motivation effect on job outcomes of these workers, and compare the strength of impact of the five dimensions of job characteristics and income and other extrinsic motivators on job outcomes, and put forward policy recommendations for improving work motivation and performance of primary health workers.
A survey using a self-developed questionnaire was conducted with primary health workers who were on duty on the day of the survey selected from a multistage sample of healthcare settings (including 18 community health centers and 20 township health centers) in three cities of Shandong Province from February to June 2021. Then, from those who effectively completed the survey, 167 cases were selected using convenience sampling to attend semi-structured interviews to understand their views of the characteristics of job as a primary health worker. Pearson correlation was used to analyze the correlations of the five dimensions of job characteristics and extrinsic motivators with autonomous motivation, performance, burnout, and turnover intention. Hierarchical multiple linear regression was used to analyze the strength of impact of the five dimensions of job characteristics and extrinsic motivators on job outcomes. Thematic analysis was used to analyze the interview data.
A total of 870 cases who handed in effective questionnaires were included for analysis. Among the five dimensions of job characteristics, respondents scored highest and lowest on skill variety (4.09±0.71) and task identity (3.18±1.04) , respectively, and their scores on task significance, feedback from job and autonomy were (3.91±0.76) (3.46±0.83) and (3.43±0.79) , respectively. Pearson correlation analysis showed that the level of each of the five dimensions of job characteristics had a positive correlation with autonomous motivation and performance (P<0.05) , and had a significant negative correlation with burnout and turnover intention (P<0.05) . Hierarchical multiple linear regression revealed that the five dimensions of job characteristics had significant impacts on job outcomes, specifically, autonomous motivation (R2=18.8%) , performance (R2=11.3%) , job burnout (R2=16.5%) and turnover intention (R2=21.9%) , whose explanatory power was stronger than that of five extrinsic motivators (The R2 values of the five extrinsic motivators' contributions to the four job outcomes were 1.7%, 3.4%, 5.8%, and 11.8%, respectively) . The interview results reflected the problems of task fragmentation, limited autonomy and insufficient feedback from job.
In primary health workers, the intrinsic motivation effect of job characteristics outweighs the extrinsic motivation effect in terms of explanatory power for job outcomes. And there is a gap between actual and theoretical job characteristics. Attention should be paid to the intrinsic motivation effect of job itself. Some measures should be taken, such as increasing training opportunities and quality, reducing work-related burden of these workers and empowering them, increasing resource investment and reducing policy constraints, improving the performance management system, to reshape job perceptions to improve work motivation and performance of primary health workers.
General practitioners (GPs) mainly provide basic medical and health services. The construction of GPs human resources is closely related to the development of primary care system.
To investigate the current status of psychological capital (PsyCap) , professional identity, and intention to stay of GPs in China and explore the relationship among the above three.
A total of 4 632 GPs were selected for electronic questionnaire investigation in the eastern, central, and western China from March to May in 2021 by using a multi-stage stratified random sampling. The questionnaire mainly included basic information, PsyCap, professional identity, and intention to stay. Pearson correlation analysis, hierarchical multiple regression analysis and structural equation model were used to explore the relationship among professional identity, PsyCap, and intention to stay.
A total of 4 376 GPs were included with the effective response rate of 94.47%. The total scores of PsyCap, professional identity, and intention to stay were (102.89±16.94) , (33.93±8.95) , and (21.69±4.04) , respectively. Pearson correlation analysis showed that there were significant positive correlations between PsyCap and professional identity, professional identity and intention to stay, PsyCap and intention to stay (r=0.402, 0.459, 0.236, respectively, P<0.001) . The results of hierarchical multiple regression analysis showed positive predictive effects of PsyCap and professional identity on intention to stay (b=0.079 and 0.361, respectively, P<0.001) , and professional identity had a mediating effect between PsyCap and intention to stay. The structural equation model showed that PsyCap and professional identity had a positive predictive effect on intention to stay (b=0.032, P<0.05; b=0.446, P<0.001) , and professional identity had a part mediating effect between PsyCap and intention to stay.
The intention to stay among GPs in China is at a moderate level. There are positive correlations among PsyCap, professional identity, and intention to stay among GPs in China. PsyCap can affect intention to stay through professional identity. Improving the PsyCap and professional identity of GPs is conducive to improving their intention to stay.
The free training for rural order-oriented medical students has trained a large number of primary health personnel for the central and western regions of China. By the summer of 2021, the first order-oriented medical graduates had completed their compulsory service and face the choice of staying or leaving. The income is an important influencing factor of their choices, however, there are still few studies on the income of order-oriented medical graduates.
The panel data of order-oriented medical graduate cohort study was used to compare and analyze the change trend of the income of order-oriented medical graduates and general clinical graduates in the early career, and to explore the influencing factors of the change of income.
Qinghai University, Guangxi Medical University, Jiujiang Medical University and Gannan Medical University were selected to establish the order-oriented medical graduate cohort every year from 2015 to 2019, matching the general clinical graduates of the same grade as controls. The baseline survey was conducted, including basic information and family information. A total of four follow-up surveys were conducted in 2016, 2017, 2018 and 2020, including the status of standardized resident training (hereinafter referred to as "standardized training") , passing of medical licensing examination, working conditions and other information. Fixed effects model was used to explore the factors influencing the income of order-oriented medical graduates and general clinical graduates, and propensity score matching (PSM) was used to test the stability of the results.
In the first two years after graduation, the income of order-oriented medical graduates was higher than general clinical graduates, and the difference was statistically significant (P<0.05) . Two years after graduation, the income of order-oriented graduates was lower than general clinical graduates, and the difference was statistically significant (P<0.05) . The results of the fixed effects model showed that completion of standardized training, passing of the medical licensing examination, working position, and year of graduation were factors influencing the income of order-oriented graduates (P<0.05) . The income of order-oriented graduates who completed the standardized training decreased by 47%, and the income of the graduates who passed the medical licensing examination and promoted increased by 16% and 10%, respectively; the income of the graduates in the third, fourth and fifth years after graduation increased by 7%, 16% and 34%, respectively, compared with the first year of graduation. Job change and graduation years were the factors influencing the income of general clinical graduates (P<0.05) ; Job change increased the income of general clinical graduates by 15%, and the income of graduates in the third, fourth and fifth year after graduation increased by 27%, 83% and 101%, respectively, compared with the first year. The regression results of two-way fixed effects model showed that the completion of standardized training, passing of the medical licensing examination, job change, staffing and graduation years had different effects on the income of order-oriented graduates and general clinical graduates (P<0.05) . The regression results of two-way fixed effects model using the data after PSM showed similar to the results of the original sample with good consistency.
The starting point of income of order-oriented graduates is higher, but the growth rate is significantly lower than general clinical graduates, the income gap between them has been increasing year by year. The main reasons include the loss of training allowance after the standardized training of order-oriented graduates and the income difference caused by different working institutions. At the same time, the income of order-oriented graduates decreases with the increase of graduation time, which will seriously affect their performance and willingness of primary care.
