Study On The Occupational Attractiveness Of General Practitioners In China

Objective:General practitioners(GPs)are the‘gatekeepers'of residents'health.Their quantity and the quality are the key point to achieve the strategic goal of‘Healthy China'.This study investigated the occupational attractiveness of GPs from two aspects and identified the associated factors for occupational attractiveness,in order to improve the occupational appeal of GPs,stabilize the groups of GPs,and provide scientific evidence and political advices for improving the quality of primary healthcare services.Methods:Based on literature review and expert consultation,we designed“General Practitioner Occupational Attractiveness Survey”questionnaire.A multi-stage cluster random sampling method was used to conduct this study.During October2017 to February 2018,four provinces were randomly selected from the East,Central and West China,respectively(East:Beijing,Shanghai,Guangdong and Zhejiang provinces,Central:Hubei,Heilongjiang,Henan and Anhui provinces,Western:Sichuan Guizhou,Yunnan,and Inner Mongolia Autonomous Regions).Each province randomly selected 30 community health institutions(CHIs)as survey sites.A total of 3244 GPs of the CHIs were investigated,and 3236questionnaires(99.75%)were included in this study.SPSS 20.0 were used for all the statistical analysis.Descriptive analysis,?~2 test and logistic regression model were used to analyze the job satisfaction,burnout and turnover intention and influencing factors of GPs.The structural relationship between GP's material demands,interpersonal relationships,growth development,burnout and turnover intention and occupational attractiveness with Amos software 20.0.Results:1.Job satisfaction and influencing factors among GPsA total of 65.88%of GPs had a lower satisfaction with material needs,60.14%had a lower growth and development satisfaction,and 42.21%had a lower interpersonal satisfaction.Multivariable logistic regression analysis showed that education,income,and occupational development opportunities were the main associated factors for job satisfaction among GPs.The higher education,the lower job satisfaction;the higher income and the more occupational development opportunities,the higher job satisfaction.2.Burnout and influencing factors among GPsThe high levels of emotional exhaustion(EE),depersonalization(DP),and personal accomplishment(PA)were 46.11%,22.93%,and 41.19%respectively.Multivariable logistic regression analysis showed that regional,age,and promotion opportunities were the main influencing factors for burnout among GPs.The degree of burnout in the east is higher than that of in the central and western regions;the older GPs had a lower level of EE and DP burnout;those with more chances of occupational development have a lower level of burnout.3.Turnover intention and related factors among GPsA total of 35.20%of GPs had a higher willingness to leave their post.Multivariate logistic regression analysis showed that region,age,gender,marriage status,education,contract status,has an administrative responsibility,income,and promotion opportunities were significant factors for the willingness to leave among GPs.The middle area was higher than the east(OR=1.2,95%CI:1.01~1.5);the 45years old or older(OR=0.45,95%CI:0.35~0.58)was lower than 35 years old;female(OR=0.72,95%CI:0.61~0.85)was lower than male;married GPs(OR=0.76,95%CI:0.60~0.97)was lower than unmarried GPs;undergraduate(OR=1.33,95%CI:1.10~1.60),master(OR=2.07,95)%CI:1.44~2.99)was higher than junior college;GPs with a temporary work contract(OR=1.54,95%CI:1.29~1.84)was higher those with a permanent work contract;without having management responsibility(OR=0.77,95%CI:0.63~0.94)was lower than those with having management responsibility;middle income(OR=0.60,95%CI:1.62~4.97)was lower than the middle and lower;the general(OR=0.54,95%CI:0.46~0.64)and more occupational development opportunities(OR=0.24,95%CI:0.17~0.35)had a lower level of turnover intention.4.Occupational attractiveness model among GPsIn the structural equation model of occupational attractiveness among GPs,the path coefficients of material demands,interpersonal relationship,growth development,burnout and turnover intention were 0.91,0.96(t=-28.98,P<0.001)and 0.84(t=27.06,P<0.001),-0.51(t=-18.81,P<0.001)and-0.55(t=-23.15,P<0.001),material needs,interpersonal relationships,growth development are positively related to occupational attractiveness.Interpersonal relationship had a greatest impact on occupational attractiveness,and followed by material demand.There was a inverse association between burnout,turnover intention and occupational attractiveness.Conclusions:The level of job satisfaction of GPs is low,the degree of burnout is general,and the willingness to leave is relatively high.Poor salary,imperfect promotion system and large workload not only limit the value of GPs,but also affect their job satisfaction and burnout,and promote the willingness to leave,thus reducing the occupational attractiveness among GPs.It is recommended to improve the promotion mechanism of GPs,increase promotion opportunities,reform the salary system,improve their welfare,and pay more attention to their mental health and reduce burnout.