Influencing factors of the job attraction of general practitioners in primary medical and health institutions
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摘要:
目的 探讨基层医疗卫生机构全科医生岗位吸引力的影响因素,制定有效策略吸引更多的医学毕业生选择全科岗位,以期稳定并壮大基层医疗卫生机构全科医师队伍。 方法 在文献研究和预调查的基础上设计问卷,2020年4月—7月对403名应届医学毕业生进行问卷调查,收回有效问卷394份,有效回收率为97.77%。采用结构方程模型分析工作环境、政策保障、个人发展和人际关系4个方面与基层医疗卫生机构全科医生岗位吸引力之间的关系。 结果 在基层医疗卫生机构全科医生岗位吸引力结构模型中,工作环境、政策保障、个人发展和人际关系对岗位吸引力的标准化路径系数分别为0.375、0.145、0.236、0.176,表明工作环境对岗位吸引力的影响作用最大,其他影响因素依次是个人发展、人际关系和政策保障。而政策保障、人际关系、工作环境对个人发展的标准化路径系数是0.255、0.168、-0.116,表明政策保障对个人发展的影响最大,而工作环境对个人发展具有一定的负面影响。 结论 轻松的工作环境、稳定的政策保障、和谐的人际关系和良好的个人发展空间有效提升基层医疗卫生机构全科医生岗位吸引力,且稳定的政策保障、和谐的人际关系通过促进个人发展对全科医生岗位吸引力具有显著的间接影响,但松散的工作环境不利于全科医生个人发展成长。 Abstract:Objective To explore the influencing factors of the job attraction of general practitioners in primary medical and health institutions and formulate effective strategies to attract more medical graduates to choose the position of general practitioners, so as to stabilise and expand the team of general practitioners in primary medical and health institutions. Methods A questionnaire was designed on the basis of literature research and pre survey. From April 2020 to July 2020, a total of 403 fresh medical graduates were selected for questionnaire survey. A total of 394 valid questionnaires were recovered, and the effective recovery rate was 97.77%. The structural equation model was used to analyse the relationship between work environment, policy guarantee, personal development, interpersonal relationship and the job attraction of general practitioners in primary medical and health institutions. Results In the model, the standardised path coefficients of work environment, policy guarantee, personal development and interpersonal relationship on job attraction were 0.375, 0.145, 0.236 and 0.176, respectively, indicating that the work environment had the greatest impact on job attraction. The other influencing factors included personal development, interpersonal relationship and policy guarantee. The standardised path coefficients of policy guarantee, interpersonal relationship and working environment on personal development were 0.255, 0.168 and -0.116, indicating that policy guarantee had the greatest impact on personal development and the working environment had a certain negative impact on personal development. Conclusion Relaxed working environment, stable policy guarantee, harmonious interpersonal relationship and good personal development space effectively enhance the job attraction of general practitioners in primary medical and health institutions, and stable policy guarantee and harmonious interpersonal relationship have a significant indirect impact on the job attraction of general practitioners by promoting personal development. However, the loose working environment is not conducive to the personal development of general practitioners. -
表 1 基层医疗卫生机构全科医生岗位吸引力影响因素
Table 1. Influencing factors of job attractiveness of general practitioners in primary medical and health institutions
一级指标 二级指标 指标代码 医院实力因素 硬件设备 q1 医疗水平 q2 综合实力 q3 工作环境因素 工作稳定 q4 竞争压力 q5 发展空间 q6 工作氛围 q7 文化传统 q8 医疗事故风险 q9 政策保障因素 薪酬待遇 q10 事业编制 q11 人才政策补助 q12 就业政策倾斜 q13 职称晋升政策 q14 个人发展因素 职称聘任 q15 职务晋升 q16 个人综合能力提升 q17 人际关系因素 同事关系 q18 上下级关系 q19 医患关系 q20 表 2 本研究采用的模型拟合指标及评价标准
Table 2. Model fitting index and evaluation criteria used in this study
指标 拟合优劣标准 χ2值/自由度 < 3.0拟合良好 拟合优度指数(goodness-of-fit index,GFI) ≥0.90拟合良好 调整后拟合优度指数(adjusted goodness-of-fit index,AGFI) ≥0.90拟合良好 规范拟合指数(normative fit index,NFI) ≥0.90拟合良好 递增拟合指数(incremental fitting index,IFI) ≥0.90拟合良好 近似误差均方根(root mean square error of approximation,RMSEA) < 0.01(拟合理想); < 0.05(拟合良好); < 0.08(拟合较好) 比较适配指数(comparative fit index,CFI) ≥0.90拟合良好 表 3 394名调查对象基本情况
Table 3. The basic information of 394 respondents
项目 类别 人数(%) 性别 男性 129(32.74) 女性 265(67.26) 学历 大专 41(10.41) 本科 294(74.61) 硕士 59(14.98) 籍贯 江苏省内 153(38.84) 江苏省外 241(61.16) 表 4 模型修正后的拟合优度指标
Table 4. Goodness-of-fit index after model modification
项目 χ2值/自由度 GFI AGFI NFI IFI CFI RMSEA 工作环境→岗位吸引力 1.963 0.976 0.952 0.978 0.989 0.989 0.050 政策保障→岗位吸引力 1.592 0.980 0.962 0.991 0.997 0.997 0.039 个人发展→岗位吸引力 2.245 0.989 0.962 0.986 0.992 0.992 0.056 人际关系→岗位吸引力 2.489 0.986 0.957 0.984 0.990 0.990 0.062 医院实力→岗位吸引力 5.535 0.966 0.912 0.953 0.961 0.961 0.107 表 5 岗位吸引力结构方程模型主要参数表
Table 5. Table of main parameters of structural equation model of job attraction
路径 SE CR P值 标准化参数估计 个人发展 ← 政策保障 0.050 4.792 < 0.001 0.255 个人发展 ← 工作环境 0.057 -2.096 0.036 -0.116 个人发展 ← 人际关系 0.044 2.519 0.012 0.168 岗位吸引力 ← 工作环境 0.053 6.579 < 0.001 0.375 岗位吸引力 ← 政策保障 0.043 2.858 0.004 0.145 岗位吸引力 ← 人际关系 0.038 2.75 0.006 0.176 岗位吸引力 ← 个人发展 0.053 4.033 < 0.001 0.236 q9 ← 工作环境 - - - 0.789 q8 ← 工作环境 0.074 16.198 < 0.001 0.867 q7 ← 工作环境 0.061 15.68 < 0.001 0.758 q6 ← 工作环境 0.067 15.483 < 0.001 0.765 q5 ← 工作环境 0.063 16.177 < 0.001 0.777 q4 ← 工作环境 0.065 16.211 < 0.001 0.786 q14 ← 政策保障 - - - 0.926 q13 ← 政策保障 0.032 35.938 < 0.001 0.943 q12 ← 政策保障 0.031 34.572 < 0.001 0.933 q11 ← 政策保障 0.029 37.346 < 0.001 0.951 q10 ← 政策保障 0.028 36.871 < 0.001 0.947 q20 ← 人际关系 - - - 1.013 q19 ← 人际关系 0.128 5.078 < 0.001 0.692 q18 ← 人际关系 0.066 15.443 < 0.001 0.940 F1 ← 岗位吸引力 - - - 0.782 F2 ← 岗位吸引力 0.061 14.109 < 0.001 0.717 F3 ← 岗位吸引力 0.069 16.672 < 0.001 0.900 q17 ← 个人发展 - - - 0.876 q16 ← 个人发展 0.055 12.433 < 0.001 0.630 q15 ← 个人发展 0.064 14.442 < 0.001 0.805 注:“←”表示单向效应的路径,“-”表示该指标为测量尺度,SE、CR、P值无数据。 -
[1] 新华社. 习近平致信祝贺博鳌亚洲论坛全球健康论坛大会开幕[OL]. (2019-06-11)[2021-10-06]. https://www.12371.cn/2019/06/11/ARTI1560229324006495.shtml?from=singlemessage. [2] 孙涛, 曹秋茹, 张淑娥, 等. 城市社区全科医生职业满意度及其影响因素[J]. 中华全科医学, 2017, 15(2): 183-185. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.001SUN T, CAO Q R, ZHANG S E, et al. The influence factors of career satisfaction of general practitioner in city ' s community health service institution[J]. Chinese Journal of General Practice, 2017, 15(2): 183-185. doi: 10.16766/j.cnki.issn.1674-4152.2017.02.001 [3] 杨慧敏, 尹德卢, 辛倩倩, 等. 我国基层全科医生队伍现状和继续医学教育内容需求分析[J]. 中华全科医学, 2018, 16(10): 1591-1594. doi: 10.16766/j.cnki.issn.1674-4152.000433YANG H M, YIN D L, XIN Q Q, et al. Current situation of primary general practitioners and demand on continuing medical education content in China[J]. Chinese Journal of General Practice, 2018, 16(10): 1591-1594. doi: 10.16766/j.cnki.issn.1674-4152.000433 [4] 匡莉. 全科医疗核心特征功能概念与内涵界定的研究思路[J]. 中国卫生政策研究, 2017, 10(5): 1-6. doi: 10.3969/j.issn.1674-2982.2017.05.001KUANG L. Approach for defining and conceptualizing the core attributes of general practice[J]. Chinese Journal of Health Policy, 2017, 10(5): 1-6. doi: 10.3969/j.issn.1674-2982.2017.05.001 [5] 姜春燕, 郑加麟, 童曾翰, 等. 近观美国全科医生规范化培训有感[J]. 中华全科医学, 2017, 15(10): 1639-1641. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.001JIANG C Y, ZHENG J L, TONG Z H, et al. General practice residency training program in USA[J]. Chinese Journal of General Practice, 2017, 15(10): 1639-1641. doi: 10.16766/j.cnki.issn.1674-4152.2017.10.001 [6] 李艳超, 张淑娥, 张进, 等. 全科医生组织支持感与工作压力的关系: 职业认同感的中介作用[J]. 中华医学教育探索杂志, 2020, 19(5): 609-614. doi: 10.3760/cma.j.cn116021-20191206-00139LI Y C, ZHANG S E, ZHANG J, et al. Relationship between perceived organizational support and occupational pressure of general practitioners: the mediating role of professional identity[J]. Chinese Journal of Medical Education Research, 2020, 19(5): 609-614. doi: 10.3760/cma.j.cn116021-20191206-00139 [7] 郑艳玲, 余芳, 陈艳黎, 等. 我国全科医生离职意愿及其影响因素分析[J]. 中华全科医学, 2019, 17(9): 1543-1546. doi: 10.16766/j.cnki.issn.1674-4152.000993ZHENG Y L, YU F, CHEN Y L, et al. Turnover intention and related factors among general practitioners in China[J]. Chinese Journal of General Practice, 2019, 17(9): 1543-1546. doi: 10.16766/j.cnki.issn.1674-4152.000993 [8] 岳铭坤, 叶利军. 中医药专业学生基层就业意愿及影响因素分析[J]. 湖南中医药大学学报, 2020, 40(7): 909-912. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZX202007026.htmYUE M K, YE L J. Analysis of the grassroots employment intention and influencing factors of students majored in traditional Chinese medicine[J]. Journal of Hunan University of Chinese Medicine, 2020, 40(7): 909-912. https://www.cnki.com.cn/Article/CJFDTOTAL-HNZX202007026.htm [9] 田蓝岚, 朱靖, 孙振宇, 等. 医学生农村基层医疗机构就业意愿及影响因素[J]. 中国农村卫生事业管理, 2020, 40(7): 499-504. https://www.cnki.com.cn/Article/CJFDTOTAL-ZNWS202007012.htmTIAN L L, ZHU J, SUN Z Y, et al. Employment willingness and influencing factors of medical students to work in rural primary healthcare institutions[J]. Chinese Rural Health Service Administration, 2020, 40(7): 499-504. https://www.cnki.com.cn/Article/CJFDTOTAL-ZNWS202007012.htm [10] 杨宇迪. 中国全科医生职业吸引力研究[D]. 武汉: 华中科技大学, 2019.YANG Y D. Occupational attractiveness of general practitioners in China[D]. Wuhan: Huazhong University of Science and Technology, 2019. [11] 朱斌. 基于新制度经济理论的基层社区全科医生岗位吸引力研究[D]. 南京: 南京中医药大学, 2018.ZHU B. Research on the post attraction of general practitioners in primary community based on new institutional economic theory[D]. Nanjing: Nanjing University of Traditional Chinese Medicine, 2018. [12] 陈雪兰. 开封市基层公共卫生人员工作满意度及激励对策研究[D]. 开封: 河南大学, 2019.CHEN X L. Study on job satisfaction and incentive strategies of grass-roots public health workers in Kaifeng[D]. Kaifeng: Henan University, 2019. [13] STOBBE E J, GRONEWEGEN P P, SCHAFER W. Job satisfaction of general practitioners: A cross-sectional survey in 34 countries[J]. Hum Resour Health, 2021, 19(1): 57. [14] 申鑫, 冯晶, 甘勇, 等. 提升全科医生职业吸引力的SWOT分析[J]. 中国全科医学, 2021, 24(22): 2765-2769. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202122002.htmSHEN X, FGENG J, GAN Y, et al. Enhancing the attractiveness of general practice as a Career: A SWOT analysis[J]. Chinese General Practice, 2021, 24(22): 2765-2769. https://www.cnki.com.cn/Article/CJFDTOTAL-QKYX202122002.htm [15] 刘玲, 方金鸣, 彭义香. 全科医生岗位胜任力模型及理论的研究进展[J]. 中国临床研究, 2021, 34(11): 1565-1568. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK202111030.htmLIU L, FANG J M, PENG Y X. Research progress on post competency model and theory of general practitioners[J]. Chinese Journal of Clinical Research, 2021, 34(11): 1565-1568. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGCK202111030.htm [16] 苏曼. 社区卫生技术人员薪酬水平研究[D]. 太原: 山西医科大学, 2017.SU M. Study on the salary level of community health technicians[D]. Taiyuan: Shanxi Medical University, 2017. [17] 陈静静, 黎彦岚, 田学斌, 等. 我国全科医生资源配置公平性及预测研究[J]. 卫生软科学, 2021, 35(2): 62-65. https://www.cnki.com.cn/Article/CJFDTOTAL-WRKX202102015.htmCHEN J J, LI Y L, TIAN X B, et al. Research on equity and prediction of general practitioner resource allocation in China[J]. Soft Science of Health, 2021, 35(2): 62-65. https://www.cnki.com.cn/Article/CJFDTOTAL-WRKX202102015.htm [18] WANG H P, JIN Y Z, WANG D, et al. Job satisfaction, burnout, and turnover intention among primary care providers in rural China: Results from structral equation modeling[J]. BMC Fam Pract, 2020, 21(1): 12. [19] 甄诚, 毛羽. 医联体框架下各省市关于强基层举措的现状分析[J]. 北京医学, 2017, 39(1): 93-96. https://www.cnki.com.cn/Article/CJFDTOTAL-BJYX201701030.htmZHEN C, MAO Y. Status Analysis of Primary health care strengthening in different provinces and cities under the framework of medical association[J]. Beijing Medical Journal, 2017, 39(1): 93-96. https://www.cnki.com.cn/Article/CJFDTOTAL-BJYX201701030.htm [20] 郑艳玲, 余芳, 陈艳黎, 等. 我国全科医生离职意愿及其影响因素分析[J]. 中华全科医学, 2019, 17(9): 1543-1546. doi: 10.16766/j.cnki.issn.1674-4152.000993ZHENG Y L, YU F, CHEN Y L, et al. Turnover intention and related factors among general practitioners in China[J]. Chinese Journal of General Practice, 2019, 17(9): 1543-1546. doi: 10.16766/j.cnki.issn.1674-4152.000993 -