Page 85 - 2022-28-中国全科医学

·3538· http://www.chinagp.net E-mail:zgqkyx@chinagp.net.cn

general practitioners team. There are few available studies on primary care physicians' satisfaction with work unit，job and career
development in township hospitals. Objective To examine the relationships among work unit satisfaction，career development
satisfaction and job satisfaction in primary care physicians working at township hospitals，providing scientific evidence for the
construction of healthcare talent team in township hospitals. Methods This study was implemented from December 2019 to
August 2020. By use of stratified multistage sampling，1 736 physicians were selected from 193 township hospitals in 9 counties
（districts） of Yulin，Baoji and Shangluo，three cities of Shaanxi to attend a questionnaire survey for understanding their basic
demographics，work unit satisfaction，career development satisfaction and job satisfaction. SPSS AU and R were used for data
analysis. Pearson correlation was used to analyze correlations among work unit satisfaction，job satisfaction and career development
satisfaction. Hierarchical regression was used for mediation analysis. The mediating effect of job satisfaction was further tested
by bootstrap test for product of coefficients. Results Among the 1 736 cases，1 727（99.48%） who returned responsive
questionnaires were included for final analysis. The average score of work unit satisfaction in the respondents was（2.03±0.52）
points，and the average scores for its five dimensions（satisfaction with the overall management，the management system，
welfare benefits，and development prospect，as well as the sense of identity obtained from the unit） were（1.94±0.93），
（2.55±1.21），（2.17±0.73），（1.91±0.80），and（1.57±0.72） points，respectively. The average score of job
satisfaction was（1.98±0.45），and that of career development satisfaction was（2.42±0.49）. Pearson correlation analysis
showed that career development satisfaction was positively correlated with work unit satisfaction and job satisfaction（P<0.05）.
Hierarchical regression analysis revealed that job satisfaction played a mediating role in the relationship of satisfaction with welfare
benefits，unit development prospect，and sense of identity obtained from the unit with career development satisfaction（P<0.05）.
Further examination of mediation effect of job satisfaction showed that job satisfaction partially mediated in the relationship
between satisfaction with welfare benefits and career development satisfaction（with an effect size of 0.020），satisfaction with
unit development prospect and career development satisfaction（with an effect size of 0.022），or satisfaction with the sense of
identity obtained from the unit and career development satisfaction（with an effect size of 0.012）（P<0.05）. Conclusion As
job satisfaction plays a mediating role between work unit satisfaction and career development satisfaction in primary care physicians
in township hospitals，it is suggested to improve their satisfaction with welfare benefits，unit development prospect and sense of
identity obtained from the unit，to enhance their job satisfaction，thereby improving their career development satisfaction.
【Key words】 Health workforce；Primary healthcare institutions；Career development satisfaction；Job satisfaction；
Unit satisfaction；Mediation

乡镇卫生院人才队伍工作满意度是指乡镇卫生院基 镇卫生院承担着基层卫生健康服务功能，人才队伍是影
层医生对自身的工作环境、条件、岗位、关系及工作强度、 响乡镇卫生院服务水平和发展状况的核心因素 ［7-8］ 。
压力的满意度评价 ［1］ 。单位满意度指基层医生对其工 本课题组前期通过数据调研发现，我国西部地区乡镇卫
作单位的管理水平、管理制度、福利待遇、发展前景的 生院人才队伍单位满意度和工作满意度为职业发展满意
满意度评价及认同感。目前的研究对于职业发展满意度 度的独立影响因素 ［1］ 。但单位满意度和工作满意度影
还没有一个统一、确定的界定。本研究在广泛参阅相关 响职业发展满意度的方式及三者之间的逻辑关系并不清
资料的基础上，将乡镇卫生院基层医生职业发展满意度 晰。本研究拟采用横断面调查的方法 ［9］ ，从中介分析
理解为基层医生对其职业及相关环境所持的一种态度或 的角度 ［10］ ，了解陕西乡镇卫生院基层医生单位满意度、
看法 ［2-3］ ，其主要影响因素包括职业认同感、职业期望 职业发展满意度、工作满意度之间的逻辑关系，对于探
值和社会实现度。目前，工作满意度、单位满意度和职 析陕西乃至西部地区乡镇卫生院人才队伍建设具有重要
业发展满意度相关的研究主要是实证研究，调研对象多 意义。
以高校毕业生为主 ［4-5］ ，缺乏以乡镇卫生院基层医生为 1 对象与方法
分析人群的研究。以职业发展满意度为内容的研究多为 1.1 研究对象 2019 年 12 月至 2020 年 8 月，采用分
小样本研究，如广东省高职院校辅导员职业发展满意度 阶段分层抽样方法，抽取陕西省榆林、宝鸡和商洛 3 个
调查的样本量仅为 130 ［2］ ，基于科研培养的八年制医 市 9 个县（区）193 所乡镇卫生院的基层医生为调查对
学毕业生职业发展满意度调查的样本量仅为 101 ［5］ 。 象。首先，陕西省按地理位置分为 3 个区域，分别是陕
研究方法均以回归分析为主，缺少中介效应分析。党的 北、关中、陕南，从这 3 个区域分别抽取榆林、宝鸡和
十九大提出要加强基层医疗服务体系和全科医生队伍建 商洛 3 个市。其次，按照经济发展水平（好、中、差），
设，为人民群众提供全方位、全周期健康服务 ［6］ 。乡 从每个市抽取 3 个县（区），共计纳入 9 个县（区）。