Association between Burnout, Workplace Violence, and Turnover Intention among Medical Graduates from a National Compulsory Service Programme

Abstract

Background China's National Compulsory Service Programme (CSP) is an important measure to alleviate its shortage of primary health care (PHC) workforce and improve quality of care in rural areas. Currently, the work status and turnover intention of the CSP medical graduates (the fully-fledged general practitioners in China) have received considerable attention. Objective This article will investigate the medical graduates' workplace violence, burnout, and turnover intention, in order to provide policy recommendations to stabilize the general practitioners. Methods From December 2021 to February 2022, an online structural questionnaire survey was conducted in nine out of 22 provinces adopting a stratified random sampling method. The electronic questionnaires were distributed to medical graduates with the assistance of the Science and Education Department of the Provincial Health Commission. The burnout of medical graduates was assessed using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) . Workplace violence involved the verbal and physical violence. Turnover intention was measured by "Are you willing to continue serving at the PHC institutions upon the completion of the contract (the compulsory service) ?" Multivariate Logistic regression analysis was used to explore the impact of burnout and workplace violence on turnover intention. Results A total of 3 615 questionnaires were effectively collected. 87.77% (3 173/3 615) of medical graduates were unwilling or unsure to continue their employment after finishing the contract. 17.46% (631/3 615) of medical graduates had experienced physical violence, and 60.33% (2 181/3 615) had experienced verbal violence. In addition, the detection rate of burnout was 55.82% (2 018/3615) , of which 60.80% (2 198/3 615) were in moderate or severe emotional exhaustion, while the proportions of depersonalization and personal accomplishment were 67.55% (2 442/3 615) and 83.76% (3 028/3 615) , respectively. Logistic regression analysis showed that after controlling for socio-economic factors such as gender, professional title, and personal monthly income, medical graduates who were experiencing burnout had a 4.92 times[95%CI (3.87-6.25) ] higher risk of leaving, a 1.92[95%CI (1.50-2.46) ]times higher risk of uncertain retention (P<0.05) . Medical graduates who experienced verbal and physical violence were 1.46 times[95%CI (1.12-1.91) ] and 0.38 times[95%CI (0.27-0.52) ] more likely to leave after the contract expires (P<0.05) . Conclusion Medical graduates have a high intention to leave, and it is expected that there will be a significant loss of general practitioners after the contract expires. Burnout is a significant and prevalent problem affecting turnover intention. Efforts should be made from multiple perspectives to alleviate medical graduates' negative emotions, and thus stabilize the general practitioners.

Keywords

• burnout|workplace violence|turnover intention|medical graduates from a national compulsory service programme|general practitioners|root cause analysis