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. -
图 1 基层医疗卫生机构全科医生岗位吸引力结构方程模型
Figure 1. Structural equation model of job attraction of general practitioners in primary health care institutions
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 
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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
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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)
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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
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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。
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