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      Association of professional identity, job satisfaction and burnout with turnover intention among general practitioners in China: evidence from a national survey

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          Abstract

          Background

          The complex interrelationships between professional identity, job satisfaction, burnout, and turnover intention among general practitioners (GPs) are insufficiently understood in China. This study aimed to investigate the interrelationships between professional identity, job satisfaction, burnout, and turnover intention in China, and to examine whether job satisfaction and burnout played mediating roles between professional identity and turnover intention.

          Methods

          A cross-sectional survey was conducted between October, 2017 and February, 2018 in China. The participants were selected using a multistage stratified random sampling method. Data were collected with a self-administered questionnaire from 3236 GPs (response rate, 99.8%) working in community health institutions in China. Professional identity was measured by the 13 items scale, and job satisfaction scale with an 11-item designed by Shi et al. was employed. Burnout was measured using a 22-item Maslach Burnout Inventory-Human Services Survey, and turnover intention was measured with a 6 items scale. Descriptive statistics were calculated and groups’ differences were estimated Student’s t-test and analyses of variance. Pearson’s correlation analysis was used to assess the degree of correlation among different dimensions of professional identity, job satisfaction, burnout, and turnover intention. Structural equation modeling analysis was applied to examine the interrelationships among these study variables based on the hypothesized model.

          Results

          The proposed model achieved a good model fit. Job satisfaction had a direct negative effect on turnover intention ( β = − 0.38, P < 0.001), burnout had a direct positive effect on turnover intention ( β = 0.37, P < 0.001), and professional identity had an indirect negative effect on turnover intention through the mediating effect of job satisfaction and burnout.

          Conclusions

          Our study elucidated the pathways linking professional identity, job satisfaction, and burnout to turnover intention of GPs. This revealed that turnover intention was significantly affected by job satisfaction and burnout, and the effects of professional identity on turnover intention can be mediated by job satisfaction and burnout.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12913-021-06322-6.

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          Most cited references55

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          The measurement of experienced burnout

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            Power analysis and determination of sample size for covariance structure modeling.

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              Harnessing the privatisation of China's fragmented health-care delivery

              Summary Although China's 2009 health-care reform has made impressive progress in expansion of insurance coverage, much work remains to improve its wasteful health-care delivery. Particularly, the Chinese health-care system faces substantial challenges in its transformation from a profit-driven public hospital-centred system to an integrated primary care-based delivery system that is cost effective and of better quality to respond to the changing population needs. An additional challenge is the government's latest strategy to promote private investment for hospitals. In this Review, we discuss how China's health-care system would perform if hospital privatisation combined with hospital-centred fragmented delivery were to prevail—population health outcomes would suffer; health-care expenditures would escalate, with patients bearing increasing costs; and a two-tiered system would emerge in which access and quality of care are decided by ability to pay. We then propose an alternative pathway that includes the reform of public hospitals to pursue the public interest and be more accountable, with public hospitals as the benchmarks against which private hospitals would have to compete, with performance-based purchasing, and with population-based capitation payment to catalyse coordinated care. Any decision to further expand the for-profit private hospital market should not be made without objective assessment of its effect on China's health-policy goals.
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                Author and article information

                Contributors
                scswj2008@163.com
                Journal
                BMC Health Serv Res
                BMC Health Serv Res
                BMC Health Services Research
                BioMed Central (London )
                1472-6963
                26 April 2021
                26 April 2021
                2021
                : 21
                Affiliations
                [1 ]GRID grid.33199.31, ISNI 0000 0004 0368 7223, Department of Health Management, , School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, ; Wuhan, Hubei China
                [2 ]GRID grid.410595.c, ISNI 0000 0001 2230 9154, Department of Social Medicine and Health Service Management, , School of Public Health, Hangzhou Normal University, Hangzhou, ; Zhejiang, China
                [3 ]GRID grid.33199.31, ISNI 0000 0004 0368 7223, Department of Social Medicine and Health Management, , School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, ; No. 13 Hangkong Road, Wuhan, 430030 Hubei China
                [4 ]GRID grid.1018.8, ISNI 0000 0001 2342 0938, Centre for Alcohol Policy Research, , School of Psychology and Public Health, La Trobe University, ; Melbourne, Victoria Australia
                [5 ]GRID grid.1008.9, ISNI 0000 0001 2179 088X, Centre for Health Equity, , Melbourne School of Population and Global Health, University of Melbourne, ; Melbourne, Victoria Australia
                [6 ]GRID grid.80510.3c, ISNI 0000 0001 0185 3134, School of Business and Tourism, Sichuan Agricultural University, ; Chengdu, Sichuan China
                Article
                6322
                10.1186/s12913-021-06322-6
                8074426
                33902579
                eb1154d4-9f2e-4095-a57c-3522abff6a61
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                Categories
                Research Article
                Custom metadata
                © The Author(s) 2021

                Health & Social care
                primary care,general practitioner,turnover intention,job satisfaction,professional identity,burnout

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