| BackgroundIn recent years, the nature and values of medicine are threatened greatly by the health care delivery system changes in the worldwide. The medical profession is influenced more and more by the government, market and self-profession. Due to medical guide missteps, medical materialization, doctor-patient interest conflicts, the righteousness and profits viewpoints of clinicians have changed, the money worship, utilitarianism, pragmatism, individualism are increased, so promoting and developing the medical professionalism has been faced new challenges. Over the years, the apprehensions on medical professionalism of Chinese scholars are almost limited to the level of professional ethics, and the formation of medical professionalism mainly emphasize on self-regulation of physician and profession. As the shared core value of physician groups, medical professionalisms not only stay at the level of ethics and attitudes, but also subject to the material factors and systems at the same time. Pay not only is a necessary condition for the reproduction of labor, but also is the material basis to achieve the personal value goals, the attitudes and reactions of individuals on pay would seriously affect their feelings and behavior on organization. Research shows that pay satisfaction is the ligament between salary and individual behavior research, and its direct effects on the individual and organization attract widespread attention. Currently, scientific and reasonable formulating the pay institution of medical agency, improving the pay satisfaction of clinicians, playing the incentive effects of pay mostly, promoting the construction of medical professionalism, improving the overall performance and core competitiveness of hospital, have been become the focus of the new health care reforms.ObjectiveThe total objectives of this study were investigating the relationship between pay satisfaction and medical professionalism to prefer the theoretical basis for medical professionalism construction. (1) Discussing the theoretical relationship between pay satisfaction and medical professionalism.(2) Measuring the levels of pay satisfaction and medical professionalism by certain scales or questionnaire(3) Investigating the correlations between pay satisfaction and medical professionalism from the empirical study(4) Providing some suggestions to improve the pay satisfaction and medical professionalism of cliniciansMethodsFirstly, the related theories of medical professionalism construction were discussed from Confucian ethics, institutional ethics and virtue ethics, while the theoretical relationship between pay satisfaction and medical professionalism was studied. Secondly, the pay satisfaction questionnaire (PSQ) compiled by American scholar Heneman and Schwab at1985was properly corrected to measure the Chinese physician pay satisfaction. Based on related questionnaire in some researchs, the questionnaire for medical professionalism under Chinese cultural background was complied to measure the medical professionalism of clinicians in some representative hospitals. Based on the data analysis and theoretical assumptions, the structural-equation model was established, the relationships between variables were tested by statistical analysis software. Finally, on the basis of theoretical and empirical researches, some recommendations and strategies were proposed to increase the pay satisfaction and medical professionalism of clinicians.ResultsTheoretical part of this study showed that, the medical professionalism construction had some practical value and theoretical significance in sight of Confucian ethics, the righteousness and profits viewpoints of Confucian provided some ideas for dealing with relation between salary and medical professionalism under the market economy, the medical professionalism construction should be re-placed in the moral visual fields, which not only focus on physician moral training but on the legitimate interests pursued by the physician being, so as to build a harmonious medical professionalism under market economic conditions. Currently, the domestic institutionalization of salary and medical professionalism had some problems, the medical professionalism construction in sight of institutional ethics had some practical significances, the pay system was an important part of the medical system, establishing a reasonable pay system could raise the pay satisfaction of medical staff, and the high pay satisfaction reflected the rationality of system, which could promote the construction of medical professionalism. Virtue ethics and institutional ethics were interacted and complemented each other, in the construction process of medical professionalism the conjunction of institutional ethics and virtue ethics should be achieved, the reasonable pay system could increase the pay satisfaction and inherent virtue at the same time, which could promote the construction of medical professionalism.In this study, the empirical results showed that, on the difference in pay, satisfaction between clinicians with different demographic characteristics, the differences in pay levels, pay raise, welfare, compensation management satisfaction and overall satisfaction levels between male and female were significant, the latter were higher than the former. The differences in pay levels, welfare, compensation management satisfaction and overall satisfaction levels between different ages were not significant, but the difference in pay raise was significant, the clinicians aged less than30years and more than40years were higher than those aged from30-40years (P=0.010,0.015). The differences in the four dimensions of pay satisfaction and overall satisfaction levels between clinicians with different working life and departments were not significant. Except for pay raise satisfaction, the differences in pay levels, welfare, compensation management and overall satisfaction levels between clinicians with different educational background were significant. In pay level satisfaction, the moderate vocational training education or less group were lower than the undergraduate group and graduate group (P=0.012,0.008), the high vocational training education group was significantly lower than the undergraduate group and graduate group (P=0.035,0.020); In welfare satisfaction, the moderate vocational training education or less group were lower than the high vocational training education group, undergraduate group and graduate group (P=0.029,0.000,0.000), while, the difference was not statistically significant among other three groups (all P>0.05); In compensation management satisfaction, the moderate vocational training education or less group were lower than the high vocational training education group, undergraduate group and graduate group (P=0.021,0.000,0.000), while the difference was not statistically significant among other three groups (both P>0.05); In the overall satisfaction levels, the moderate vocational training education or less group were significantly lower than the undergraduate group and graduate group (P=0.001,0.000), the high vocational training education group was significantly lower than graduate group (P=0.028). The differences in welfare, pay raise and compensation management satisfaction levels between different professional titles were not significant, and the differences in pay levels and overall level satisfaction were significant, in the pay level satisfaction, the resident physician group and attending physician group were significantly lower than the chief physician group (P=0.003,0.001); In the overall pay satisfaction, the resident physician group and attending physician group were also significantly lower than the chief physician group (P=0.005,0.026). Except for welfare satisfaction, the differences in pay levels, pay raise, compensation management and overall level satisfaction between physicians at different levels of hospital, in the pay levels, pay raise and overall level satisfaction, the grade-I hospital group were significantly lower than the grade-â…¢ hospital group (P=0.005,0.011,0.005); In satisfaction on compensation management, grade-1hospital group were significantly lower than the grade-â…¡ hospital group and grade-â…¢ hospital group (P=0.005,0.030).On the difference in medical professionalism between clinicians with different demographic characteristics, the differences in professional attitudes, professional behaviors, professional skills, professional discipline and overall professionalism levels between different sexes, ages, educational backgrounds, departments, levels of hospital were not significant. The differences in professional attitudes, professional skills, professional discipline and overall professionalism levels between clinicians with different working life were not significant, but the difference in professional behaviors was significant, the five years or less group were significantly lower than11-15year group and more than16year group (P=0.040,0.020), but no difference was found when compared with6-10year group(P=0.080); The differences between6-10year group and11-15year group, more than16year group were not significant (P=0.930,0.780), and the difference between11-15year group and more than16year group was also not significant (P=0.950). The differences in professional attitudes, professional skills, professional discipline and overall professionalism level between clinicians with different professional titles were not significant, but the difference in professional behaviors was significant, the resident physician group was significantly lower than associate chief physician group (P=0.040), and the differences between other groups were not significant.In the relations between pay satisfaction and medical professionalism, pay level satisfaction were positive correlated with professional attitudes, professional skills, professional discipline, and the overall level of professionalism (r=0.107,0.113,0.137,0.129, P=0.013,0.045,0.046,0.045), the welfare satisfaction were positive correlated with professional attitudes, professional behaviors, professional skills, professional discipline and the overall level of professionalism (r=0.272,0.201,0.106,0.100,0.210, P=0.016,0.039,-0.040,0.044,0.035), the pay raise satisfaction.was positive correlated with professional skills (r=0.108, P=0.031), the compensation management satisfaction were positive correlated with professional attitudes, professional behaviors, professional skills, professional disciplines and overall professionalism level (r=0.108,0.112,0.139,0.150,0.188, P=0.035,0.029,0.045,0.032,0.048).In the predictive ability of pay satisfaction dimensions for medical professionalism, the pay levels, welfare and compensation management satisfaction had the predictive ability for professional attitudes, while the compensation management satisfaction was the best; The welfare and compensation management satisfaction had the predictive ability for professional behaviors, while the compensation management satisfaction was the best; The four dimensions of pay satisfaction all had the predictive ability for professional skills, while the welfare satisfaction was the best; The pay levels, welfare and compensation management satisfaction had the predictive ability for professional discipline, while the pay level satisfaction was the best.ConclusionsThe dimensions of pay satisfaction of clinicians include pay levels, pay raise, welfare, compensation management satisfaction, and the dimensions of medical professionalism include professional attitudes, professional behaviors, professional skills, professional discipline. The differences in pay satisfaction and medical professionalism among different demographic characteristics of clinicians are statistically significant partly. Some dimensionas of pay satisfaction of clinicians are positive related with the medical professionalism, and the pay satisfaction have some the predictive ability for some dimensions of medical professionalism. |
