Related factors of turnover intention among general practitioners: a cross-sectional study in 6 provinces of China.

Abstract

Turnover among general practitioners (GPs) is an issue of growing concern. Therefore, identification of the variables which associated with GPs' decision in staying in or leaving their employer institutions is necessary. The aim of this study was to investigate the relationship between work stress, job satisfaction, and turnover intention, and explore factors associated with turnover intention of GPs in China. We conducted a cross-sectional survey among GPs in 6 provinces in China, utilizing a combination of stratified and purposive sampling methods, from April to October 2019. Data were collected using self-administered questionnaires and scales measuring their demographic characteristics, work stress, job satisfaction, and turnover intention. Statistical methods such as t test, one-way analysis of variance (ANOVA), multiple linear regression, exploratory factor analysis (EFA), and structural equation modeling (SEM) were used. Out of 386 GPs, 10.4% had higher turnover intention and 31.9% had medium turnover intention. The mean score of the overall perception of turnover intention of GPs was 2.24 on a scale ranging from 1 to 6. Over 80.0% of GPs had moderate to high level work stress. The facets that GPs were most dissatisfied were payment, welfare, training opportunity and career development. professional title, practicing setting, and work intensity associated with turnover intention (P < 0.05) significantly. Work stress, not only directly associated with turnover intention (β = 0.608, P < 0.001), but also presented an indirect association on turnover intention through job satisfaction (β = 0.042, P < 0.05). Meanwhile, job satisfaction also had a direct negative effect on turnover intention (β=-0.345, P < 0.001). Work stress, job satisfaction, professional title, practicing setting, and work intensity were influencing factors on turnover intention in Chinese GPs. Work stress had not only positive direct effects on turnover intention, but also had an indirect effect on turnover intention through job satisfaction as a mediator. Reducing workload, raising income, providing more opportunities for training and career development could potentially contribute to retaining and attracting GPs.