Investigation on the working status of rural oriented general practitioners and their willingness to stay after service expiration
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摘要:
目的 对定向全科医师工作现状及服务期满后留任意愿和影响因素进行调查分析，为浙江省订单定向培养保障政策的制定提供科学的借鉴依据。 方法 采用方便抽样法通过问卷星于2024年8月对浙江省已工作4年的定向全科医生进行《乡村定向全科医师工作现状及服务期满后留任意愿调查》的问卷调查，共回收有效问卷105份。 结果 本研究共调查105名全科医师，毕业后89.5%(94人)履约回到原单位工作，毕业后绝大部分在乡镇卫生院(47.6%，50人)及社区卫生服务中心(32.4%，34人)工作，其中从事全科的占62.9%(66人)。45.7%(48人)服务期满后愿意继续留在原单位工作，16.2%(17人)不愿意继续留在原单位工作。愿意留在原单位的前3位原因依次为距离家近(68.8%，33人)、压力较小(45.8%，22人)、专业认同(35.4%，17人)；不愿意留在原单位工作原因排名前3位的分别为发展空间小(82.4%，14人)、收入低(76.5%，13人)和工作内容烦琐(58.8%，10人)。Logistic回归分析显示，医院对全科医学的认可以及全科医师对职业前景的态度均为订单定向全科医师服务期满后是否愿意留任的影响因素(P＜0.05)。 结论 定向全科医师服务期满后的留任意愿较低，职业发展难是影响服务期满留任意愿的首要原因。 Abstract:Objective To investigate the willingness of rural oriented general practitioners to stay after service expiration and the influencing factors, and provide scientific advices for the formulation of the policy of Zhejiang Province. Methods In August 2024, the convenient sampling method was used to conduct a questionnaire survey (investigation on the working status of rural oriented general practitioners and their willingness to stay after service expiration) on the oriented general undergraduate students enrolled in Zhejiang Province in 2012. A total of 105 valid questionnaires were collected. Results In this study, a total of 105 general practitioners were surveyed. Among them, 89.5% (94 people) returned to the contracted community hospital after graduation. After graduation, the vast majority of them worked in township health centers (47.6%, 50 people) and community health service centers (32.4%, 34 people), among which 62.9% (66 people) were engaged in general practice. 45.7% (48 people) were willing to continue working in the contracted community hospital after completing their service, and 16.2% (17 people) oriented general practitioners were unwilling to continue working in the contracted community hospital. The top three reasons for being willing to stay in the contracted community were proximity to home (68.8%, 33 people), less pressure (45.8%, 22 people), and professional identification (35.4%, 17 people). The top three reasons for not wanting to stay in the contracted community hospital were the available development space is limited (82.4%, 14 people), low income (76.5%, 13 people) and cumbersome work content (58.8%, 10 people). Logistic regression analysis found that the community hospital ' s emphasis on general practice and the attitude of general practitioners towards career prospects had a significant impact on whether general practitioners were willing to stay after the service expiration (P < 0.05). Conclusion The willingness of oriented general practitioners to remain on the job after the completion of their service period is relatively low. The difficulty in career development is the primary reason affecting the willingness to remain on the job after the service period. -
Key words:
- Oriented general practitioners /
- Willingness to stay /
- Influencing factors
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表 1 105名订单定向医学生毕业后工作岗位分布情况
Table 1. The distribution of job positions for 105 order-oriented medical students after graduation
工作岗位 人数(%) 全科 66(62.9) 内科 17(16.2) 外科 5(4.8) 儿科 5(4.8) 妇产科 1(1.0) 急诊科 2(1.9) 精神卫生科 1(1.0) 公共卫生 1(1.0) 耳鼻咽喉科 2(1.9) 医技科室 2(1.9) 行政 1(1.0) 皮肤科 1(1.0) 国企医务室 1(1.0) 合计 105(100.0) 
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表 2 订单定向全科医师服务期满后留任意愿影响因素的单因素分析[人(%)]
Table 2. Univariate analysis of factors influencing the intention to retain order-oriented general practitioners upon completion of their service commitment [person (%)]
项目 愿意留任(n=48) 不愿意留任(n=17) χ2值 P值 是否了解定向培养政策及就业前景 9.632 0.002 是 44(91.7) 10(58.8) 否 4(8.3) 7(41.2) 培训基地 0.393 0.531 省级基地 8(16.7) 4(23.5) 市级基地 40(83.3) 13(76.5) 医院对全科认可 32.705 0.001 是 47(97.9) 6(35.3) 否 1(2.1) 11(64.7) 领导对您的认可 11.270 0.001 是 46(95.8) 11(64.7) 否 2(4.2) 6(35.3) 居民对您的认可 9.791 ＜0.001 是 37(77.1) 6(35.3) 否 11(22.9) 11(64.7) 职业前景态度 26.208 ＜0.001 乐观 37(77.1) 1(5.9) 不乐观 11(22.9) 16(94.1) 工作现状满意度 22.212 ＜0.001 满意 39(81.2) 3(17.6) 不满意 9(18.8) 14(82.4) 收入满意度 6.932 0.008 满意 23(47.9) 2(11.8) 不满意 25(52.1) 15(88.2)
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表 3 自变量赋值情况
Table 3. The assignment situation of independent variables
变量 赋值方法 是否了解定向培养政策及就业前景 是=1，否=2 培训基地 省级基地=1，市级基地=2 医院对全科的认可 是=1，否=2 领导对您的认可 是=1，否=2 居民对您的认可 是=1，否=2 职业前景态度 乐观=1，不乐观=2 工作现状满意度 满意=1，不满意=2 收入满意度 满意=1，不满意=2
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表 4 订单定向全科医师服务期满后留任意愿影响因素的logistic回归分析
Table 4. Logistic regression analysis of factors influencing the retention intention of order-oriented general practitioners after the expiration of their service period
变量 B SE Waldχ2 P值 OR(95% CI) 政策了解程度 1.206 1.890 0.407 0.523 3.339(0.082~135.519) 培训基地级别 -2.826 1.765 2.563 0.109 0.059(0.002~1.885) 医院对全科医学认可 4.491 1.914 5.509 0.019 89.233(2.097~3 796.484) 领导对全科医师是否认可 2.756 2.441 1.275 0.259 15.736(0.132~1 882.500) 居民对全科医师是否认可 -1.071 1.570 0.465 0.495 0.343(0.016~7.431) 职业前景态度 4.626 2.297 4.054 0.044 102.094(1.131~9 217.748) 工作现状满意度 0.293 1.452 0.041 0.840 0.746(0.043~12.850) 收入满意度 0.027 1.321 ＜0.001 0.984 1.027(0.077~13.674)
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