乡镇卫生院医生离职现状及影响因素分析

Influence factors of physician turnover at township health centers

目的了解乡镇卫生院医生主动离职情况及医院层面的影响因素,并提出相应的建议。方法采用随机抽样方法在陕西、四川、安徽三省中抽取21个县,在每个县抽取10个乡镇卫生院,共计抽选208个乡镇卫生院。对乡镇卫生院的院长进行访谈,了解医院的基本情况以及近两年医生主动离职的情况;对当天在值并主要看病的6个医生访谈,了解医生的基本情况,如周工作时长、月工作天数、工作基础工资、年外部培训数、外部培训满意度。结果 2012-2014年,共有95所乡镇卫生院有医生主动离职,离职医生的主要去向是上级医院、私立医院、其他乡镇卫生院,分别占比47.3%、23%、18.9%。通过单因素分析,发现内部因素中的医院收入、固定资产值、病床数、医生人数、全年门诊人数、外部培训数、是否有处方点评、医生奖金是否一样、月基础工资对医院是否有医生主动离职有显著影响;外部因素中的服务人口数量、乡镇诊所数以及药店数量对医院是否有医生主动离职有显著影响。在对内部因素和外部因素中有显著影响的因素进行多因素分析时,发现外部培训是否超过10次、是否均分奖金、乡镇中的私人诊所数量对于是否有医生主动离职有显著影响(P<0.05)。结论建议医院管理部门注意调整激励机制、改善医院管理制度、营造人性化的工作环境、重视医生的培训学习等方面对于吸引与留住人才的影响。

Objective To know about the situation of physician initiative turnover and the influence factors at the hospital level in township health centers, and to make corresponding suggestions. Methods Random sampling method was used to select 21 counties from Shaanxi, Sichuan and Anhui Provinces. In each county 10 township health centers were selected and totally 208 township health centers were selected. In order to know about the basic information of the health centers and the situation of physician initiative turnover in the past 2 years, we interviewed the directors of the township health centers. And six physicians in each township health centers who were on duty that day were also interviewed to obtain such basic information as working hours in each week, working days in each month, basic salary, number of external trainings they attended, and their satisfaction with the external trainings. Results From 2012 to 2014, a total of 95 physicians left their posts. Upper-level hospitals, private hospitals, and other township health centers were their main destinations, accounting for 47.3%, 23% and 18.9%, respectively. Single factor analysis indicated that the internal factors including hospital income, fixed asset value, number of hospital beds, number of physicians, the year-round number of outpatients, number of external trainings, whether there was a prescription review, whether physicians’ bonuses were equally distributed, and physicians’ basic salary had significant impacts on physician turnover. The external factors including number of service populations, number of private clinics, and number of pharmacies had significant impacts on physician turnover. Multi-factor analysis of the internal and external factors which had significant impacts indicated that whether the external training exceeded ten times, whether the bonuses were equally distributed, and the number of private clinics in the township significantly influenced physician turnover(P<0.05). Conclusions It is recommended that the administrative department of township health centers adjust the incentive mechanism, improve the management system, create a humanizing working environment, and attach importance to the impact of physician training on attracting medical talents.