我国中部地区乡村医生的离职意向及影响因素研究

Turnover Intention and Its Influencing Factors among Village Doctors in Central China

目的了解我国中部地区乡村医生的离职意向情况,探讨其影响因素,为稳定乡村医生队伍提供科学依据。方法基于"心血管病高危人群早期筛查与综合干预项目"的工作网络,将我国中部地区8个省中参与该工作网络的27个项目县(区)中的991家村卫生室中所有在岗的乡村医生作为调查对象。于2016年11月—2017年4月,采用自行设计的调查问卷进行调查。问卷主要内容包括乡村医生的人口学信息、工作年限、工作类型、阶段性培训情况、收入达到预期的程度、保险情况、职业倦怠及离职意向。共回收有效问卷1 669份。采用两水平Logistic回归模型对乡村医生离职意向的影响因素进行分析。结果 1 669例乡村医生中有568例(34.03%)具有离职意向。单因素分析结果显示,不同性别、年龄、工作年限、阶段性培训情况、收入达到预期的程度、保险情况、情绪衰竭程度、情感冷漠程度、成就感缺乏程度的乡村医生的离职意向比较,差异有统计学意义(P<0.05);不同民族、受教育程度、所学专业、职称、工作类型的乡村医生的离职意向比较,差异无统计学意义(P>0.05)。两水平Logistic回归结果显示,收入达到预期的程度低(0%～,OR=20.738;20%～,OR=6.101;40%～,OR=5.657;60%～,OR=4.457)、缺乏保险(OR=1.769)、职业倦怠程度严重(重度情绪衰竭,OR=2.436;重度情感冷漠,OR=1.626;中度情感冷漠,OR=1.486;重度成就感缺乏,OR=1.948)是乡村医生具有离职意向的影响因素(P<0.05)。结论我国中部地区乡村医生有离职意向情况较为严重,收入达到预期的程度、保险情况、职业倦怠程度是离职意向的影响因素。应加强相关补偿和保障政策的落实,提高乡村医生的薪酬水平,保证乡村医生队伍的稳定和发展。

ObjectiveTo explore the turnover intention and its influencing factors among the village doctors in central China,providing a scientific basis for stabilizing village doctors workforce.MethodsThis cross-sectional survey was conducted from November 2016 to April 2017 in 991 village clinics of 27 counties（districts） of 8 provinces in central China participating the project named ＂The China PEACE（Patient-centered Evaluative Assessment of Cardiac Events）MPP（Million Persons Project）＂.All on-the-job village doctors from the clinics took part in the survey to answer a self-developed questionnaire consisting of demographic characteristics,length of service,service content,phased training,actual-to-expected wage ratio,insurance,job burnout and turnover intention.A total of 1 669 participants returned responsive questionnaires.Two-level Logistic regression models were used to analyze the influencing factors of turnover intention.ResultsThe overall prevalence of turnover intention was 34.03%（568/1 669）.Univariate analysis revealed that the prevalence of turnover intention differed significantly by sex,age,service length,phased training,actual-to-expected wage ratio,insurance,emotional exhaustion,depersonalization,and low personal accomplishment（P〈0.05） but not by minzu,educational level,major,professional and title and service content （P〉0.05）. Two-level Logistic regression analysis showed that the low actual-to-expected wage ratio （0-,OR=20.738;20%-,OR=6.101;40%-,OR=5.657;60%-,OR=4.457）,lack of insurance（OR=1.769）,high level of job burnout（severe emotional exhaustion,OR=2.436;severe depersonalization,OR=1.626;moderate depersonalization,OR=1.486;lowest personal accomplishment, OR=1.948） were associated with a higher prevalence of turnover intention （P〈0.05）.ConclusionHigh prevalence of turnover intention among village doctors in central China was found,which was associated with actual-to-expected wage ratio,insurance and job burnout.In order to stabilize and develop the village doctors workforce,the salary of them should be improved by well implementing the policies about incentive and guaranteed compensations.