Research On The Dynamic Mechanism Of Superior Doctors To Work In Primary Medical Institutions

ObjectiveBased on the framework of push-pull theory,we analyze the current situation and mechanism of superior doctors working in primary medical institutions,and then explore the influencing factors of doctors' behaviors and finds out the factors,then we establish dynamic mechanism of superior doctors to work in primary medical institutions,and provide countermeasures for the health administration sectors to formulate effective promotions of doctors' behaviors.Method(1)Using literature research method,we collected the relevant literature of doctors' flow,and provided sufficient theoretical basis for the research of the subject.(2)We used expert group discussion method to determine the factors affecting the behavior of superior doctors,and to construct the dynamic model,and to explore discrete selection experiment of design work preference.(3)Through on-the-spot interview,we understood the basic driving force,resistance and countermeasures of superior doctors to work in primary medical institutions.(4)A questionnaire survey was conducted among doctors in four tertiary public hospitals in Guangzhou to find out the behaviors of superior doctors and their preference for job choice.(5)Using SPSS and Amos software,we verified the relationship between the influencing factors and superior doctors' behaviors,and we explored the influence of different job attributes on the selection preference of superior doctorsResultsThe reliability and validity analysis shows that Cronbach's alpha coefficient,content validity and structure validity are all within a reasonable range,indicating that the data collected through the questionnaire is of good quality.Through factor analysis,5 common factors such as s supporting measures,professional skills,promotion and recognition,and practice opportunities and communication and interaction are extracted from 14 original variables.Promotion,commendation and practice opportunities have a positive impact on the behavior of superior doctors,and communication and interaction on the behavior of superior doctors has not been verified.But Supporting measures and business capabilities have a negative impact on the behavior;The results of discrete selection experiment show that the three attributes,such as monthly income,have different effects on work selection,and the preferences of individual doctors for work attributes are significantly different,the monetary value of noneconomic work attributes is different.Conclusions(1)The factors affecting the superior doctors' working in primary mainly include supporting measures,professional skills,promotion and recognition,and practice opportunities,among which the imperfect supporting measures has the greatest influence on the doctors' behavior.(2)The attributes affecting the superior doctors' choice are the increase of working hours per week,increase of monthly income and working location;The most acceptable work combination for doctors is 1 hour of work per week and monthly income increased 30%and work in urban hospitals.(3)We preliminarily constructed the dynamic mechanism of superior doctors to work in primary medical institutions,which includes four parts:push mechanism,pull mechanism,support mechanism and guarantee mechanism.We promote superior doctors to work in primary hospital by giving promotions and recognition,providing practice opportunities,optimizing job mix,and improving supporting measures and business capabilities.SuggestionsIn order to encourage doctors to work in primary hospitals,we propose the following optimization strategies:(1)Improving the mechanism of fiscal compensation and strengthening the role of fiscal support.(2)Constructing the sharing system of medical responsibility.(3)Establishing a performance evaluation system for the superior doctors.(4)With the virtual medical platform,developing team model to work in primary medical institutions.(5)Formulating the appropriate work plan in line with the doctor's preference.(6)Accelerating the improvement of incentive mechanisms to fully motivate doctors.