县级公立医院不同职业阶段医生离职倾向影响因素研究

Influencing factors of physicians＆#39; turnover intention at public county hospitals： a career stage perspective

目的 从职业阶段视角分析县级公立医院医生离职倾向影响因素.方法 按照职称等级将医生职业阶段划分为适应期、发展期和成熟期,利用多阶段分层抽样在山东省抽取750名县医院医生进行问卷调查.利用分组回归对各阶段医生离职倾向影响因素进行筛选.结果 调查医生中,23.0％具有中等程度离职倾向,有6.1％有较高离职倾向,3个职业阶段医生离职倾向经检验无差异.不同职业阶段医生离职倾向的关键预测变量不同,适应期医生为领导赏识（r=-0.22,P＜0.05）、薪酬公平（r=-0.21,P＜0.05）;发展期医生为工作自主（r=-0.39,P＜0.05）、学习要求（r=-0.22,P＜0.05）;成熟期医生为职业成长（r=-0.31,P＜0.05）、工作自主（r=-0.21,P＜0.05）.结论 工作自主权和工作负荷是影响县医院医生稳定性的共同因素,随着职业阶段的发展,医生的职业需求层次逐渐提升,关注重点逐渐转向自我价值实现.应根据医生职业需求有针对性地采取管理措施,稳定县级医院医生队伍.

Objective To analyze influencing factors of physicians＆#39; turnover intention at public county hospitals from career stage perspective.Methods Physicians career life was divided into three stages according to professional ranks and titles.The sample was drawn using stratified multistage random methods from public county hospitals in Shandong province and 677 questionnaires were completed,giving a 90.3% valid response rate.Data were analyzed using multi-group stepwise linear regression.Results The percentage of responders with middle and high-level turnover intention was 23.0%and 6.5% respectively,and there was no statistically significant difference in turnover intention across three stage subgroups.In physicians at stage 1,the most important factors to predict turnover intention were superiors ＇ appreciation （r =-0.22,P 〈 0.05） and payment rationality （r =-0.21,P〈0.05）,while in physicians at stage 2,the most important predicting factors were autonomy （r=-0.39,P〈0.05）and learning demand（r=-0.22,P〈0.05）,and in physicians at stage 3 were career development（r=-0.31,P〈0.05）and autonomy（r=-0.21,P〈0.05）.Conclusion Autonomy and workload are common factors of turnover intention with different predicting power across three career stages.Physicians adjust their career needs to self-actualization with development of career stage,so welltargeted incentives should be taken to stabilize the medical staff of public county hospitals.