Analysis On The Current Situation And Causes Of The Change Of The Number Of Clinicians At County And Township Levels

Objectives And to find out the deep-seated reasons since the health reform of medical institutions in China since the two levels of county and township in the number of clinician changes,turnover intention,change the direction of changes and influence and turnover factors are found in the process of the construction team doctors and the reasons for turnover intention;machine change situation and the reason analysis.Summarize the experience,in terms of personnel development good samples in typical practices and innovative initiatives,"congenitally deficient"grass-roots organizations of team of clinicians"blood","blood transfusion"and keep the doctor put forward policy suggestions,and puts forward the measures and policy recommendations for the problems existing in the present stage.Methods The combination of qualitative research methods and quantitative research methods,through literature analysis and preliminary information retrieval,relevant literature at home and abroad,clinicians flow changes,understand the research status at home and abroad,to determine the research direction,the research ideas and research methods.Subsequently,an expert seminar was held to discuss and demonstrate the scientific and feasibility of the research program,and to determine the final research program.Then is in a preliminary analysis based on existing data,information and data,selected two medical institutions in recent years and clinicians increased year by year,declining or abnormal changes in the provinces,the comprehensive economic development level and regional distribution,the final choice of Anhui Province as the object to carry out on-site survey,select five samples a sample of city,county,the basic circumstances of clinicians,inflow and outflow of medical institutions in the investigation sample area and survey of physicians,and related personnel of the sample area by qualitative interviews.Finally,we use EpiData 3.1 and SPSS16.0 to input,process and analyze data,analyze the basic situation by descriptive method,and analyze the influencing factors of turnover intention by Logistic regression.Results The county hospitals and township hospital clinicians number changes:(1)county hospitals showed a general increasing trend,2010-2015 years of practicing doctors and assistant doctors in addition to reduced in 2011,the overall upward trend,the growth rate was 11%and 6.1%respectively.The number of clinicians in township health centers increased in a wave type.(2)the number of clinicians in township hospitals varied in different provinces.In 2009-2015 years,nine provinces increased year by year,two provinces decreased year by year,thirteen provinces rose or fell,and five provinces did not fluctuate.(3)the changes in the number of clinicians in township hospitals are more obvious in the east than in the middle and western regions.In2010-2015 years,the eastern part of the township of practicing(Assistant)physicians,the number of practicing doctors and assistant doctors were decreased first and then increased and decreased thereafter,Anhui decreased first,after rising,the township hospitals in the western areas of practice(Assistant)physicians more gentle than growth.The number of doctors in township health centers was slower than that of the hospital,and there was a negative increase.(4)the number of county-level hospital physicians is greater than the growth rate of township hospitals in 2014,county hospitals and township hospitals practicing(Assistant)physicians are the number of negative growth in 2011,2011 data show that the township hospital practicing(Assistant)physicians decrease than in the county hospital,which has experienced negative growth in 2014 but in 2015,a substantial increase.The flow of clinicians in the sample organization:a total of data on the flow of clinicians in 10 county hospitals in Anhui and 31 township hospitals.The analysis found that(1)the total inflow of clinicians in the sample area was greater than the outflow,and the number of inflows was greater than the outflow number of county medical institutions and township hospitals.The total number of doctors inflow to the township health centers increased year by year,and the inflow in each area was different,and the county hospital in 2015 was less than in 2014.In three years,the outflow doctors from the county hospitals outflow in southern Anhui more than the other two areas,and the township hospitals are more than the South and the north.(3)2013-2015 years of county-level hospitals inflow to the outflow of clinicians are mainly male.In the past three years,the age distribution of migrant workers is quite different.The average age of the inflow persons is 26.5 years old,and the average age of outgoing personnel is30.64 years old.The inflow of physicians is mainly local,and the local gap is not large.From the point of view of the compilation,the inflow personnel are not much more,and the outflow personnel have little difference.The flow of physicians is dominated by undergraduate,non-professional,or junior professional titles.(3)more women were inflow in township hospitals than men,and more men were outflow clinicians than women.The average age of the inflow of doctors is 30.92 years old,mainly in the middle and young people,the average age of the outflow people is 39.38 years,and the middle-aged doctor is the main.The mobile doctors are mainly the junior college,the secondary school and the junior professional title.The sample area clinician turnover intention survey:a total of 899 clinicians,in which no turnover of 601 people,accounting for 66.9%of all respondents,with turnover of 298 people,accounting for 33.1%,using the chi square test,found in municipal hospitals,county hospitals and township hospital clinical doctors have no statistical significance on turnover intention on(?~2=30.944,p<0.001),which is the county hospital turnover accounted for more than doctors in township hospital.The main reason for turnover intention is the poor salary.Among the 298 doctors with turnover intention,268 chose the bad salary,accounting for 89.9%,accounting for20.5%of all the selected people.A single factor analysis of turnover intention of clinicians found that the lower the job satisfaction,the stronger the turnover intention.The interview found that:the main source of inflow of doctors is the recruitment of new graduates,and the outflow of doctors mainly goes to the better medical institutions at the same level or higher level.The main reason that affects the movement of doctors is income treatment.Conclusions On the whole,the number of clinicians in hospitals at the county level than township hospitals,but the medical institutions at the county level and township hospitals jointly play a grassroots play the role of underpinning"keeper"role,the problem of human resources is still the common problems affecting the sustainable development of county and township level two hospital.The county and township level two medical institutions are difficult to introduce and stabilize the personnel,and in the end they can not retain the talent and keep the patients.Especially in county hospitals,the turnover tendency of sample county hospitals is higher than that of township hospitals.The county clinicians have higher expectations in terms of income and occupation development space than Township doctors.Therefore,the government focus on strengthening the team construction of county and township level two hospitals,the establishment of special funds for primary care physicians talent introduction and training of talents,stability,support and reward organization and service payment mechanism should be based on reasonable salary to attract and stabilize the clinical doctors,improve the occupation development space.Finally,the primary medical institutions can not only introduce talents,but also retain talents,so as to ensure the service ability of the three level medical service network to meet people’s medical needs.