我国全科医生离职意愿及其影响因素分析

目的 了解我国全科医生离职意愿现状，分析影响全科医生离职意愿的主要因素。 方法 于2017年10月—2018年2月,运用分层随机抽样方法在我国东、中、西部每个调查地区的社区卫生服务中心(东部:北京市、上海市、广东省和浙江省；中部:湖北省、黑龙江省、河南省和安徽省；西部:四川省、贵州省、云南省和内蒙古自治区)随机抽取3 244名全科医生进行微信问卷调查。采用自行设计的《全科医生职业吸引力调查表》进行调查，问卷内容包括全科医生的基本情况、工作满意度、职业倦怠和离职意愿情况4个部分，离职意愿调查量表参照Michael和Spector编制的医护人员离职意愿量表翻译修订。运用χ2检验比较全科医生离职意愿在不同组间的分布差异，采用多因素logistic逐步回归分析全科医生离职意愿的影响因素。 结果 调查结果显示，35.20%的全科医生离职意愿较高，其中东部33.69%、中部39.24%、西部33.20%。多因素logistic逐步回归分析结果显示，男性、中部地区、年龄小、学历高、合同制、物质满意度低、成长满意度低、情绪耗竭严重、去人格化程度高是离职意愿高的主要影响因素。 结论 我国全科医生的离职意愿较高，影响全科医生离职意愿的因素复杂，建议拓展全科医生职业发展前景，提高全科医生薪酬待遇，增加全科医生岗位吸引力，重视全科医生职业心理健康，以降低全科医生的离职意愿。 

Turnover intention and related factors among general practitioners in China

Objective To investigate the prevalence of turnover intention among general practitioners (GPs) in China and explore its influencing factors. Methods A stratified random sampling method was used to conduct a WeChat questionnaire survey on 3 244 GPs working in community health centers in China (East, Beijing, Shanghai, Guangdong, and Zhejiang; Central, Hubei, Heilongjiang, Henan, and Anhui; Western, Sichuan, Guizhou, Yunnan, and Inner Mongolia) between October 2017 and January 2018. The questionnaire of occupational attractiveness of GPs was self-designed. It included basic information of GPs job satisfaction, burnout, and turnover intention. The Chinese version of the turnover intention scale was modified according to the studies by Mickael and Spector. The chi-square test was conducted to compare the differences of the turnover intention in different groups, and multivariable logistic stepwise regression analysis was used to analyze the influencing factors for turnover intention among GPs. Results The results showed that 35.20% of the general practitioners had higher intention to leave their present positions, including 33.69% in the Eastern China, 39.24% in the Central China, and 33.20% in the Western China. Multivariable logistic stepwise regression analysis showed that male GPs, the Central China region, the younger, a higher educational level, with administrative responsibility, at a higher professional title, at a lower level of material satisfaction, at a lower level of relationship satisfaction, at a lower level of growth satisfaction, at a higher scores on serious emotional exhaustion, and at a higher scores on depersonalization were the significant factors associated with turnover intention. Conclusion The overall willingness of GPs to leave general practices is high in China, and the associated factors for turnover intention among GPs are complex. Actions such as expanding the career prospects of GPs, increasing the wages of GPs, enhancing the occupational attractiveness, and improving the occupational mental health of GPs, are needed to reduce the turnover intention of GPs.