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Chow MS, Gordon AJ, Talwar A, Lydiatt WM, Yueh B, Givi B. The RVU Compensation Model and Head and Neck Surgical Education. Laryngoscope 2024; 134:113-119. [PMID: 37289069 DOI: 10.1002/lary.30807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/04/2023] [Accepted: 05/17/2023] [Indexed: 06/09/2023]
Abstract
BACKGROUND The present study aims to quantify the opportunity cost of training residents and fellows for head and neck surgery. METHODS A 2005-2015 review of ablative head and neck surgical procedures was performed using the National Surgical Quality Improvement Program (NSQIP). Work relative value units (wRVU) generated per hour were compared among procedures performed by attendings alone, attendings with residents, and attendings with fellows. RESULTS Among 34,078 ablative procedures, the rate of wRVU generation per hour was greatest for attendings alone (10.3), followed by attendings with residents (8.9) and attendings with fellows (7.0, p < 0.001). Resident and fellow involvement was associated with opportunity costs of $60.44 per hour (95% CI: $50.21-$70.66/h) and $78.98 per hour ($63.10-$94.87/h, 95% CI), respectively. CONCLUSION wRVU-based physician reimbursement does not consider or adjust for the extra effort involved in training future head and neck surgeons. LEVEL OF EVIDENCE NA Laryngoscope, 134:113-119, 2024.
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Affiliation(s)
- Michael S Chow
- Department of Otolaryngology, Head and Neck Surgery, New York University, New York, New York, USA
| | - Alex J Gordon
- Grossman School of Medicine, New York University, New York, New York, USA
| | - Abhinav Talwar
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - William M Lydiatt
- Methodist-Creighton Head and Neck, Creighton University, Omaha, Nebraska, USA
| | - Bevan Yueh
- Department of Otolaryngology, Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Babak Givi
- Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Wen Z, Xu J, Yu J, Huang X, Ni Y. Effects of work-family conflict on turnover intention among primary medical staff in Huaihai Economic Zone: a mediation model through burnout. Front Psychiatry 2023; 14:1238315. [PMID: 37817834 PMCID: PMC10561281 DOI: 10.3389/fpsyt.2023.1238315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/29/2023] [Indexed: 10/12/2023] Open
Abstract
Background Countries worldwide face the challenge of how medical personnel manage conflicts between work and family. Especially after the challenge of the COVID-19 epidemic, it is necessary to explore the possible mechanisms of work-family conflict, burnout, and turnover intention among primary medical staff. Objectives This study aims to observe the turnover intention of Chinese primary medical staff and explore the relationship between work-family conflict, burnout, and turnover intention. Methods A cross-sectional study included a turnover intention questionnaire, the Maslach Burnout Inventory-General Survey (MBI-GS), and the Work-Family Conflict Scale (WFCS) to understand turnover intention, burnout, and work-family conflict among primary medical staff in four cities (Xuzhou, Linyi, Huaibei, and Shangqiu cities) within the Huaihai Economic Zone. Spearman correlation analysis and hierarchical multiple regression analysis were used to examine the related factors of turnover intention. Structural equation modeling (SEM) was used to study the mediating role of burnout between work-family conflict and turnover intention. Results In this study, there is a positive correlation between work-family conflict and turnover intention (P < 0.01). Demographic characteristics, work-family conflict, and burnout explained 2.3%, 20.3%, and 8.8% of the incremental variances, respectively. Burnout mediated the association between work-family conflict and turnover intention. Conclusions Burnout can be regarded as a mediator between two different variables: work-family conflict and turnover intention. Improving work-family conflict and alleviating burnout may play a key role in reducing the willingness of primary medical staff to resign. Corresponding measures can be taken to balance the conflict between work and family, alleviate burnout, reduce turnover rates, and build a primary medical staff team with higher medical service quality and stability.
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Affiliation(s)
- Zongliang Wen
- School of Management, Xuzhou Medical University, Xuzhou, China
- School of Public Health, Xuzhou Medical University, Xuzhou, China
- Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jintao Xu
- School of Management, Xuzhou Medical University, Xuzhou, China
| | - Jinxun Yu
- School of Public Health, Xuzhou Medical University, Xuzhou, China
| | - Xiaojing Huang
- School of Management, Xuzhou Medical University, Xuzhou, China
| | - Yuting Ni
- School of Management, Xuzhou Medical University, Xuzhou, China
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Lin T, Li Y, Li Y, Guo W, Guo X, Tang C. Individual- and institution-level predictors of the turnover intention of medical staff among rural primary medical institutions in Xinjiang Production and Construction Corps, China: a cross-sectional multi-level analysis. Front Psychol 2023; 14:1112057. [PMID: 37637903 PMCID: PMC10447901 DOI: 10.3389/fpsyg.2023.1112057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 07/26/2023] [Indexed: 08/29/2023] Open
Abstract
Background Primary medical staff (PMS) are the guardians of population health. However, their loss further worsens the shortage and uneven distribution of human health resources, which should be addressed immediately. This study aimed to investigate the current status of turnover intention of rural PMS in Xinjiang Production and Construction Corps (XPCC) in China and its influencing factors atthe individual and institutional levels to provide reliable baseline data for intervention strategies to protect valuable rural PMS. Methods Participants were recruited from rural public health institutions of the XPCC using a cross-sectional multistage sampling process. Data on participants' turnover intention and individual- and institution-level indicators were obtained through standardized electronic questionnaires and statistical reports of regional health administrative departments. The key factors influencing PMS turnover intention were identified us ingunivariateandmulti-level logistic regression analysis. Findings Overall, 20.5% (447/2182) of participants reported turnover intention. Univariate analysis showed that the occurrence of turnover intention was significantly influenced by marriage, education, age, year of working, monthly income, human resource management practices (HRMP), job satisfaction, per capita served population (PCSP) and number of beds (p < 0.05). Multi-level logistic regression analysis showed that bachelor's degree or above and intermediate professional title were closely related to the occurrence of turnover intention (p < 0.05), age 41-50 years old and above, high human resource management practice, and high job satisfaction effectively reduced the odds (p < 0.05). The odds of turnover intention increased by 37% (p < 0.10) for PMS in institutions with PCSP more than 250 people. In contrast, the odds of turnover intention decreased to 68% (p < 0.05) for PMS in institutions with more than 50 beds. Conclusion Government-run primary medical institutions face the risk of PMS turnover intention. From a personal perspective, the high-risk population fortheturnover intention was mainly the PMS with bachelor's degrees or above and intermediate professional titles. The low-risk population was the PMS with aged over 40 years, a higher evaluation of human resource management practice, and job satisfaction. From the perspective of primary medical institutions, larger institutions can reduce the turnover intention of individuals, whereas the size of the service population has the opposite effect.
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Affiliation(s)
- Taoyu Lin
- The People’s Hospital of Suzhou New District, Suzhou, Jiangsu, China
| | - Ye Li
- School of Medicine, Shihezi University, Shihezi, Xinjiang, China
| | - Yuanyuan Li
- School of Medicine, Shihezi University, Shihezi, Xinjiang, China
| | - Wei Guo
- School of Medicine, Shihezi University, Shihezi, Xinjiang, China
| | - Xiaoying Guo
- School of Medicine, Shihezi University, Shihezi, Xinjiang, China
| | - Changmin Tang
- School of Management, Hubei University of Chinese Medicine, Wuhan, Hubei, China
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Ezura M, Sawada K, Takushima Y, Igarashi A, Teng L. A systematic review of the characteristics of data assessment tools to measure medical doctors' work-related quality of life. JOURNAL OF MARKET ACCESS & HEALTH POLICY 2023; 11:2234139. [PMID: 37496728 PMCID: PMC10367570 DOI: 10.1080/20016689.2023.2234139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE Remarkable progress in healthcare technology has recently been made alongside changes in concepts related to drugs and medical devices. It is speculated that this progress benefits not only patients but also healthcare professionals, such as medical doctors. We performed a systematic review of the characteristics of current data assessment tools to measure medical doctors' work-related quality of life (QOL). METHODS A literature search was conducted through PubMed and Ichushi-Web in 2020. The related search terms used were 'medical doctor,' 'quality of work life,' and 'questionnaire/interview.' Two reviewers independently screened the studies, and the characteristics of the QOL assessment tools used in the identified studies were qualitatively reviewed and summarized. RESULTS In total, 5,443 and 760 articles were retrieved from PubMed and Ichushi-Web, respectively, of which 82 studies were included in this review. Sixty-five (79%) studies used structured questionnaires, and 17 (21%) studies used semistructured questionnaires. In terms of the study purpose, the identified studies mainly included four: mental health, the work or labor situation, satisfaction, and QOL. Components used to measure work-related QOL included satisfaction, burnout, QOL, the work environment, stress, mental health, work-life balance, and others. None of the studies used an originally developed QOL questionnaire to assess the work-related benefits of medical doctors. CONCLUSION This systematic review found that there is a lack of studies directly assessing the work-related QOL of medical doctors and a lack of effective data collection tools to assess all work-related QOL components.
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Affiliation(s)
- Miyuki Ezura
- Department of Corporate Planning, Otsuka Holdings Co. Ltd, Tokyo, Japan
- Department of Health Technology Assessment Program, Graduate School of Health Management, Keio University, Tokyo, Japan
| | - Katsuhiko Sawada
- Clinical Development Department, Otsuka Medical Devices Co. Ltd, Tokyo, Japan
| | - Yusuke Takushima
- Medical Affairs Department, Taiho Pharmaceutical Co. Ltd., Tokyo, Japan
| | - Ataru Igarashi
- Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
- Department of Public Health, Yokohama City University School of Medicine, Yokohama, Kanagawa, Japan
| | - Lida Teng
- Department of Health Economics and Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
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Lv B, Cui C, Feng X, Meng K. What factors affect Beijing residents' contracts with family doctors? A comparative study of Beijing's urban and suburban areas. Front Public Health 2023; 11:1159592. [PMID: 37483950 PMCID: PMC10356989 DOI: 10.3389/fpubh.2023.1159592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 06/15/2023] [Indexed: 07/25/2023] Open
Abstract
Objective To improve the health of residents and promote hierarchical diagnosis and treatment to achieve an orderly pattern of medical treatment, Beijing implemented family doctor contract services (FDCSs) in 2011. The aims of this study were to analyze the current status of Beijing residents' contracts with family doctors (FDs), compare the differences in contracting between urban and suburban residents, and explore the factors that affect residents' contract behavior. Methods From August 2020 to October 2020, a stratified sampling method was adopted to select residents from community health centers (CHCs) in districts D (urban area) and S (suburb) of Beijing to conduct a questionnaire survey. Chi-square tests, rank sum tests and logistic regression analyzes were used to analyze the current status and influencing factors of residents' contracting with FDs. Results A total of 4,113 valid questionnaires were included in the final analysis. District D was rich in medical resources, and the FD contract rate of residents there (93.09%) was significantly higher than that of residents in district S (78.06%; p < 0.05). Residents' district (OR = 1.55, 95% CI = 1.18-2.05), understanding of FDCS policies (OR = 4.13, 95% CI = 3.63-4.69), preferred medical institutions (OR = 0.58, 95% CI = 0.42-0.79 for tertiary hospitals in the district; OR = 0.36, 95% CI = 0.22-0.59 for urban medical institutions in Beijing), age, education level, average annual medical expenses and medical insurance type were factors that influenced residents' contracts with FDs (p < 0.05). Conclusion This study shows that residents who are located in districts with rich medical resources, prefer CHCs as their first choice, have a better understanding of FDCS policies, and are more inclined to contract with FDs than other residents. It is recommended that the number and quality of FDs in suburban areas be increased and that medical staff strengthen publicity about FDCSs and actively encourage residents to contract with FDs.
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Hasebrook J, Hecke J, Volkert T, Singer M, Hinkelmann J, Michalak L, Hahnenkamp K. Individual perspectives and mental maps of working conditions and intention to stay of physicians in academic medicine. Front Psychol 2023; 14:1106501. [PMID: 37251059 PMCID: PMC10213555 DOI: 10.3389/fpsyg.2023.1106501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/10/2023] [Indexed: 05/31/2023] Open
Abstract
Introduction Job satisfaction has a strong impact on the intention to stay which is an important aspect to counter skills shortage in academic medicine. The purpose of the three studies reported here is to find out what specific factors are relevant for the intention to stay and turnover intention of physicians in academic medicine -and what measures might have a positive impact on employee retention. Methods In an interview study combining qualitative and quantitative methods, we investigated how the individual mental representation of working conditions influences job satisfaction and its impact on the intention to stay. In total, 178 physicians from German university hospitals, residents, and physicians, in 15 departments of anesthesiology were interviewed and surveyed. In a first study, chief physicians participated in interviews about job satisfaction in academic hospitals. Answers were segmented into statements, ordered by topics, and rated according to their valence. In a second study, assistant physicians during and after their training period talked about strengths, weaknesses, and potential improvements of working conditions. Answers were segmented, ordered, rated, and used to develop a "satisfaction scale." In a third study, physicians participated in a computer-led repertory grid procedure composing 'mental maps' of job satisfaction factors, filled in the job satisfaction scale and rated if they would recommend work and training in their clinic as well as their intention to stay. Results Comparing the interview results with recommendation rates and intention to stay show that high workload and poor career perspectives are linked to a negative attitude. A positive attitude towards work environment and high intention to stay is based on sufficient personnel and technical capacities, reliable duty scheduling and fair salaries. The third study using repertory grids showed that the perception of current teamwork and future developments concerning work environment were the main aspects to improve job satisfaction and the intention to stay. Discussion The results of the interview studies were used to develop an array of adaptive improvement measure. The results support prior findings that job dissatisfaction is mostly based on generally known "hygiene factors" and whereas job satisfaction is due to individual aspects.
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Affiliation(s)
| | - Juliane Hecke
- Department of Anesthesiology, University Hospital Muenster, Münster, Germany
| | - Thomas Volkert
- Department of Anesthesiology, University Hospital Muenster, Münster, Germany
| | - Maren Singer
- ZEB Business School, Steinbeis University, Berlin, Germany
| | - Juergen Hinkelmann
- Department of Anesthesiology, Lukas Hospital Dortmund, Dortmund, Germany
| | | | - Klaus Hahnenkamp
- Department of Anesthesiology, University Medicine Greifswald, Greifswald, Germany
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Adriaans J, Sauer C, Moya C. Pay Justice and Pay Satisfaction: The Influence of Reciprocity, Social Comparisons, and Standard of Living. SOCIAL PSYCHOLOGY QUARTERLY 2023. [DOI: 10.1177/01902725231151671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This study compares two pay evaluations: pay justice and pay satisfaction. Conceptually, pay justice entails a moral assessment and is more specific to work, whereas pay satisfaction is a broader attitude that includes non-work-related factors. We analyzed German employee data and found overall similarity in determinants but differences in proximity to work contexts. Pay satisfaction was more strongly associated with private pay comparisons and standard of living, whereas pay justice was more strongly associated with reciprocity in the employer-employee relationship through working hours and comparisons at work. The results therefore suggest that employers can influence pay justice more easily than pay satisfaction by means of addressing imbalances in the employer-employee exchange and within organizational pay structures.
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Chen Y, You Y, Shen Y, Du Z, Dai T. Village doctors' dilemma in China: A systematic evaluation of job burnout and turnover intention. Front Public Health 2022; 10:970780. [PMID: 36438210 PMCID: PMC9684668 DOI: 10.3389/fpubh.2022.970780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/05/2022] [Indexed: 11/11/2022] Open
Abstract
Background Village doctors (VDs) in China undertook arduous primary healthcare missions. However, they received little attention in comparison to doctors in urban public secondary and tertiary hospitals. There is an urgent need to explore the overall situation of turnover intention and job burnout among VDs to evaluate and adjust current health manpower policy. Methods In this study, seven databases like PubMed, EMBASE, Web of Science (WOS), WanFang, China Science and Technology Journal Database (VIP), Chinese BioMedical Literature Database (CBM), and China National Knowledge Infrastructure (CNKI) were systematically searched, relevant experts were consulted, and empirical research on job burnout and turnover intention among VDs in international publications was evaluated. Therefore, we evaluated the prevalence of job burnout among VDs in general, across all dimensions and different severity levels, as well as the scores of each category. For turnover intention, we assessed the prevalence of different groups and their overall situation and also identified significant contributors. Results In this study, we integrated 20 research evidences on job burnout and turnover intention among 23,284 VDs from almost all provinces in China, and the prevalence of turnover intention among VDs in China was as high as 44.1% [95% confidence interval (CI): 34.1-54.2], which was two to four times that of primary health workers in high-income countries, but not much different from some developing countries. Simultaneously, VDs with the highest risk of turnover intention were men [odds ratio (OR): 1.22 (1.05-1.43)], those with a monthly income below USD 163.4 [OR: 0.88 (0.78-0.98)], those with a high educational level [OR: 0.88 (0.78-0.98)], and those <40 years old [OR: 1.27 (1.16-1.40)]. Similarly, the detection rate of job burnout toward them was 59.8% (95% CI: 38.7-79.1) with the MBI-GS score being 44.44 (95% CI: 37.02-51.86) in a total of 90, while the detection rate of job burnout in moderate and above almost reached 20%. The most significant contributor that affects job burnout was low personal accomplishment (LPA), and the detection rate for moderate and higher severity was 65.2% (95% CI: 58.7-71.7). Conclusion Attention should be paid to the high turnover intention and severe job burnout of primary health workers in rural areas of developing countries, and targeted measures should be taken to improve the situation. Health policymakers should increase financial subsidies for VDs, set a reasonable workload, improve various health policies such as pension insurance for VDs, and encourage "targeted training" for medical students to enrich and expand their team. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42021289139.
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Affiliation(s)
- Yuquan Chen
- Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences, Beijing, China,Peking Union Medical College, Beijing, China
| | - Yanwei You
- School of Social Sciences, Tsinghua University, Beijing, China,Division of Sports Science and Physical Education, Tsinghua University, Beijing, China
| | - Yaying Shen
- Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences, Beijing, China,Peking Union Medical College, Beijing, China
| | - Zifei Du
- The Affiliated TCM Hospital of Guangzhou Medical University, Guangzhou, China
| | - Tao Dai
- Institute of Medical Information/Medical Library, Chinese Academy of Medical Sciences, Beijing, China,*Correspondence: Tao Dai
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Singh N, Doshi MD, Schold JD, Preczewski L, Klein C, Akalin E, Leca N, Nicoll K, Pesavento T, Dadhania DM, Friedewald J, Samaniego-Picota M, Bloom RD, Wiseman AC. Survey of Salary and Job Satisfaction of Transplant Nephrologists in the United States. Clin J Am Soc Nephrol 2022; 17:1372-1381. [PMID: 35914792 PMCID: PMC9625100 DOI: 10.2215/cjn.03490322] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/09/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND OBJECTIVES There are no standardized benchmarks to measure productivity and compensation of transplant nephrologists in the United States, and consequently, criteria set for general nephrologists are often used. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A web-based survey was sent to 809 nephrologists who were members of the American Society of Transplantation to gather data on measures of productivity, compensation, and job satisfaction. Factors associated with higher total compensation and job satisfaction were examined. RESULTS Of 365 respondents, 260 were actively practicing in the United States and provided data on compensation. Clinical productivity was assessed variably, and although 194 (76%) had their work relative value units (wRVUs) reported to them, only 107 (44%) had an established RVU target. Two hundred thirty-four respondents (90%) had fixed base compensation, and 172 (66%) received a bonus on the basis of clinical workload (68%), academic productivity (31%), service (32%), and/or teaching responsibility (31%). Only 127 respondents (49%) filled out time studies, and 92 (35%) received some compensation for nonbillable transplant activity. Mean total compensation (base salary and bonus) was $274,460±$91,509. The unadjusted mean total compensation was higher with older age and was higher for men; Hispanic and White respondents; adult care transplant nephrologists; residents of the western United States; US medical school graduates; nonuniversity hospital employees; and those with an administrative title, higher academic rank, and a higher number of years in practice. Two hundred and nine respondents (80%) thought their compensation was unfair, and 180 (70%) lacked a clear understanding of how they were compensated. One hundred forty-five respondents (55%) reported being satisfied or highly satisfied with their job. Job satisfaction was greater among those with higher amounts of compensation and US medical school graduates. CONCLUSIONS We report significant heterogeneity in the assessment of productivity and compensation for transplant nephrologists and the association of compensation with job satisfaction.
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Affiliation(s)
- Neeraj Singh
- John C. McDonald Regional Transplant Center, Willis Knighton Health System, Shreveport, Louisiana
| | - Mona D. Doshi
- Division of Nephrology, University of Michigan, Ann Arbor, Michigan
| | - Jesse D. Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Luke Preczewski
- Jackson Health System, Miami Transplant Institute, Miami, Florida
| | - Christina Klein
- Piedmont Healthcare, Piedmont Transplant Institute, Atlanta, Georgia
| | - Enver Akalin
- Renal Transplantation, Albert Einstein College of Medicine, Montefiore Medical Center, New York
| | - Nicolae Leca
- Division of Nephrology, University of Washington, Seattle, Washington
| | - Kimberly Nicoll
- US Transplant Reimbursement, TransMedics, Inc., Andover, Massachusetts
| | - Todd Pesavento
- Division of Nephrology, Ohio State University Medical Center, Columbus, Ohio
| | - Darshana M. Dadhania
- Division of Nephrology, Weill Cornell Medical College, Cornell University, New York, New York
| | - John Friedewald
- Division of Nephrology and Hypertension, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Roy D. Bloom
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Wang X, Zhu Y, Wang F, Liang Y. Association of organizational and patient behaviors with physician well-being: A national survey in China. PLoS One 2022; 17:e0268274. [PMID: 35639674 PMCID: PMC9154115 DOI: 10.1371/journal.pone.0268274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/26/2022] [Indexed: 11/19/2022] Open
Abstract
This study aims to investigate the association of organizational and patient behaviors (reflecting the internal and external environment of hospital, respectively) with physician well-being. A national cross-sectional survey was conducted in 77 hospitals across seven provinces in China between July 2014 and April 2015. Physician well-being was assessed with job satisfaction, career regret and happiness. Organizational behaviors were assessed with organizational fairness, leadership attention and team interaction; patient behaviors were assessed with patient trust and unreasonable requests from patients. Of a study sample of 3,159 physicians, 1,788 were men (56.6%) and 1,371 were women (43.4%). Overall, positive organizational and patient behaviors reported by physicians were relatively low. Negative organizational behaviors and patient behaviors including lower organizational fairness, lower leadership attention, lower team interaction and lower patient trust were associated with lower job satisfaction and lower life satisfaction, and higher career regret. The association between organizational behaviors and physician well-being exhibited some gender differences, while no clear gender difference was found for the relationship between patient behaviors and physician well-being. Given the importance of physician well-being for the healthcare system, interventions for improving internal and external hospital environments (e.g., organizational fairness, leadership attention, team interaction and patient trust) may benefit physician well-being.
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Affiliation(s)
- Xiaoyu Wang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yimei Zhu
- School of Media, Communication and Sociology, University of Leicester, Leicester, United Kingdom
| | - Fang Wang
- Department of Epidemiology and Health Statistics, School of Health, Wuhan University, Wuhan, China
| | - Yuan Liang
- Department of Social Medicine and Health Management, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail: ,
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Jia H, Yu X, Jiang H, Yu J, Cao P, Gao S, Shang P, Qiang B. Analysis of factors affecting medical personnel seeking employment at primary health care institutions: developing human resources for primary health care. Int J Equity Health 2022; 21:37. [PMID: 35300695 PMCID: PMC8929258 DOI: 10.1186/s12939-022-01638-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 02/28/2022] [Indexed: 11/10/2022] Open
Abstract
Background The serious shortage of human resources for primary health care (PHC) is a common issue in health reforms worldwide. China has proposed that it is an effective way to encourage and guide qualified medical personnel to work in primary health care institutions (PHCIs). However, few studies have been conducted on the willingness and influencing factors of medical personnel to seek employment at PHCIs. Methods Based on implicit theory and lexical approach, pre-investigation was conducted to collect the items that influence the medical personnel to seek employment at PHCIs from the perspective of guided objects. Through a three-phase investigation of 1160 doctors in 29 public hospitals in 9 cities, the items were categorized, and a structural equation model was established and verified to explore the interrelationship of influencing factors. Results A total of 6 factors were rotated, including Sense of Gain (SG), Internal Organization Development (IOD), Remuneration and Development (RD), Condition of the City Where the PHCI Is Located (CCPL), Job Responsibilities (JR) and Family Support (FS). The results of the model showed that IOD, RD, JR and FS had a significantly positive effect on the SG. In addition, the FS, RD and JR significantly mediated the relationship between the internal and external environment of PHCIs and SG. The values of the fit index indicated an acceptable-fitting model. Conclusion Family, remuneration, individual development, and job responsibility are closely related to the willingness of medical personnel to seek employment at PHCIs, and the internal and external environment of PHCIs is also an important factor. Therefore, the development of PHC providers can be promoted by paying attention to the family members of medical personnel, establishing a reasonable remuneration system, providing suitable development opportunities, arranging work rationally and improving the internal construction of PHCIs.
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Affiliation(s)
- Huanhuan Jia
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Xihe Yu
- School of Public Health, Jilin University, Changchun City, Jilin Province, China.
| | - Hairui Jiang
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Jianxing Yu
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Peng Cao
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Shang Gao
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Panpan Shang
- School of Public Health, Jilin University, Changchun City, Jilin Province, China
| | - Bayuzhen Qiang
- School of Public Health, Jilin University, Changchun City, Jilin Province, China.,Lhasa People's Hospital, Lhasa City, Tibet Autonomous Region, China
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Pearson ACS, Leffert LR, Kain ZN. The "Unexplained" Portion of the Gender Pay Gap in Anesthesiology. Anesth Analg 2022; 134:44-48. [PMID: 34908545 DOI: 10.1213/ane.0000000000005798] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Amy C S Pearson
- From the Department of Anesthesia, University of Iowa, Iowa City, Iowa
| | - Lisa R Leffert
- Department of Anesthesiology at Yale School of Medicine, Anesthesiology at Yale, New Haven Hospital and Bridgeport Hospital, New Haven, Connecticut
| | - Zeev N Kain
- UCI Center on Stress & Health and Department of Anesthesiology & Perioperative Care, University of California, Irvine, California.,Child Study Center, Yale University School of Medicine, New Haven, Connecticut.,Department of Pediatrics, Children's Hospital of Orange County, Orange, California
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Leider JP, Sellers K, Bogaert K, Liss-Levinson R, Castrucci BC. Voluntary Separations and Workforce Planning: How Intent to Leave Public Health Agencies Manifests in Actual Departure in the United States. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:38-45. [PMID: 32769420 PMCID: PMC7690638 DOI: 10.1097/phh.0000000000001172] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To ascertain levels of turnover in public health staff between 2014 and 2017 due to retirement or quitting and to project levels of turnover for the whole of the state and local governmental public health in the United States nationally. DESIGN Turnover outcomes were analyzed for 15 128 staff from public health agencies between 2014 and 2017. Determinants of turnover were assessed using a logit model, associated with actually leaving one's organization. A microsimulation model was used to project expected turnover onto the broader workforce. RESULTS Between 2014 and 2017, 33% of staff left their agency. Half of the staff who indicated they were considering leaving in 2014 had done so by 2017, as did a quarter of the staff who had said they were not considering leaving. Staff younger than 30 years constituted 6% of the workforce but 13% of those who left (P < .001). CONCLUSIONS Public health agencies are expected to experience turnover in 60 000 of 200 000 staff positions between 2017 and 2020. IMPLICATIONS As much as one-third of the US public health workforce is expected to leave in the coming years. Retention efforts, especially around younger staff, must be a priority. Succession planning for those retiring is also a significant concern.
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Affiliation(s)
- Jonathon P. Leider
- School of Public Health, University of Minnesota, Minneapolis, Minnesota (Dr Leider); Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Leider); de Beaumont Foundation, Bethesda, Maryland (Drs Sellers and Castrucci); Association of State and Territorial Health Officials, Arlington, Virginia (Ms Bogaert); and Center for State and Local Government Excellence, Washington, District of Columbia (Dr Liss-Levinson)
| | - Katie Sellers
- School of Public Health, University of Minnesota, Minneapolis, Minnesota (Dr Leider); Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Leider); de Beaumont Foundation, Bethesda, Maryland (Drs Sellers and Castrucci); Association of State and Territorial Health Officials, Arlington, Virginia (Ms Bogaert); and Center for State and Local Government Excellence, Washington, District of Columbia (Dr Liss-Levinson)
| | - Kyle Bogaert
- School of Public Health, University of Minnesota, Minneapolis, Minnesota (Dr Leider); Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Leider); de Beaumont Foundation, Bethesda, Maryland (Drs Sellers and Castrucci); Association of State and Territorial Health Officials, Arlington, Virginia (Ms Bogaert); and Center for State and Local Government Excellence, Washington, District of Columbia (Dr Liss-Levinson)
| | - Rivka Liss-Levinson
- School of Public Health, University of Minnesota, Minneapolis, Minnesota (Dr Leider); Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Leider); de Beaumont Foundation, Bethesda, Maryland (Drs Sellers and Castrucci); Association of State and Territorial Health Officials, Arlington, Virginia (Ms Bogaert); and Center for State and Local Government Excellence, Washington, District of Columbia (Dr Liss-Levinson)
| | - Brian C. Castrucci
- School of Public Health, University of Minnesota, Minneapolis, Minnesota (Dr Leider); Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Dr Leider); de Beaumont Foundation, Bethesda, Maryland (Drs Sellers and Castrucci); Association of State and Territorial Health Officials, Arlington, Virginia (Ms Bogaert); and Center for State and Local Government Excellence, Washington, District of Columbia (Dr Liss-Levinson)
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Tobler S, Stummer H. Determinants of inpatient satisfaction: evidence from Switzerland. Int J Health Care Qual Assur 2021; ahead-of-print. [PMID: 33350289 DOI: 10.1108/ijhcqa-03-2020-0044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE A common way to handle quality problems and increasing costs of modern health care systems is more transparency through public reporting. Thereby, patient satisfaction is seen as one main reported outcome. Previous studies proposed several associated factors. Only a few of them included organizational determinants with potential to inform the health care provider's management. Therefore, the aim of this study was to investigate the influence of organizational contingency factors on patient satisfaction. DESIGN/METHODOLOGY/APPROACH As a case, Switzerland's inpatient rehabilitation sector was used. Therein, a cross-sectional study of public released secondary data with an exploratory multiple linear regression (MLR) modeling approach was conducted. FINDINGS Five significant influencing factors on patient satisfaction were found. They declared 42.2% of the variance in satisfaction on provider level. The organizations' supplementary insured patients, staff payment, outpatients, extracantonal patients and permanent resident population revealed significant correlations with patient satisfaction. RESEARCH LIMITATIONS/IMPLICATIONS Drawing on publicly available cross-sectional data, statistically no causality can be proved. However, integration of routine data and organization theory can be useful for further studies. PRACTICAL IMPLICATIONS Regarding inpatient satisfaction, improvement levers for providers' managers are as follow: first, service provision should be customized to patients' needs, expectations and context; second, employees' salary should be adequate to prevent dissatisfaction; third, the main business should be prioritized to avoid frittering. ORIGINALITY/VALUE Former studies regarding public reporting are often atheoretical and rarely used organizational variables as determinants for relevant outcomes. Therefore, uniformed data are useful.
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Affiliation(s)
- Stephan Tobler
- Institute for Management and Economics in Health Care, Private University of Health Sciences Medical Informatics and Technology, Hall, Austria
| | - Harald Stummer
- Institute for Management and Economics in Health Care, Private University of Health Sciences Medical Informatics and Technology, Hall, Austria
- Institute for Health Management and Innovation, University Seeburgcastle, Seekirchen am Wallersee, Austria
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Residents' Willingness to Maintain Contracts with Family Doctors: a Cross-sectional Study in China. J Gen Intern Med 2021; 36:622-631. [PMID: 33140279 PMCID: PMC7947157 DOI: 10.1007/s11606-020-06306-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 10/07/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Most previous studies of the family doctor contract services (FDCS) evaluated its quality by using residents' signing rates, awareness, and satisfaction. We hypothesize that renewal willingness could be another important indicator to examine the quality of FDCS. OBJECTIVE To measure residents' willingness to maintain contracts with family doctors and examine the influencing factors. DESIGN Cross-sectional study. PARTICIPANTS 11,250 residents in 31 provincial administrative regions across China. MAIN METHODS A multistage stratified random sampling method was used to recruit participants. Univariate analysis, mixed-effect regression model analysis, and stepwise multivariate logistic regression analysis were performed to determine the influencing factors of residents' willingness to maintain contracts with family doctors. KEY RESULTS About 71.3% participants who contracted with and received healthcare services from family doctors were willing to maintain contracts with family doctors in China. Residents registering as local households (OR = 1.192, 95% CI = 1.039-1.368), enrolled in medical insurance (OR = 1.299, 95% CI = 1.011-1.668), reporting better health (OR = 1.246, 95% CI = 1.100-1.413), with shorter walking time to the nearest healthcare center (compared with > 30 min walking time, < 15 min: OR = 1.209, 95% CI = 1.003-1.458; 15-30 min: OR = 1.288, 95% CI = 1.124-1.475), and trusting in (OR = 4.403, 95% CI = 3.849-5.036) and satisfied with (OR = 18.514, 95% CI = 16.195-21.165) their family doctors had significantly higher willingness to maintain contracts with family doctors. CONCLUSIONS Residents' willingness to maintain contracts with family doctors could be another evaluation indicator of the quality of FDCS in China. Improving the accessibility and quality of healthcare services from family doctors may increase residents' willingness to keep contracts with family doctors and promote the implementation of FDCS.
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He R, Liu J, Zhang WH, Zhu B, Zhang N, Mao Y. Turnover intention among primary health workers in China: a systematic review and meta-analysis. BMJ Open 2020; 10:e037117. [PMID: 33067275 PMCID: PMC7569945 DOI: 10.1136/bmjopen-2020-037117] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES To analyse the prevalence and determinants of turnover intention (TI) among primary health workers (PHWs) in China to provide evidence for improving retention measures. DESIGN Systemic review and meta-analysis. DATA SOURCES Four English-language databases (PubMed, EMBASE, Cochrane Library, PsycINFO) and three Chinese databases (CNKI, CSPD, CBM) were searched up to October 2019. ELIGIBILITY CRITERIA Eligible studies were observational or descriptive studies conducted in mainland China. The prevalence of TI among health workers and related factors had to be explicitly reported in each included study. DATA EXTRACTION AND SYNTHESIS Data were extracted by one author and reviewed independently by two other authors. For each factor analysed by a meta-analysis, the factor was required to be the same across different studies, and at least three studies had to include it. The quality of studies was assessed using the Newcastle-Ottawa Scale and heterogeneity was evaluated using the I2 statistic. RESULTS We identified 16 cross-sectional studies investigating a total of 37 672 PHWs. The prevalence of TI was 30.4%. Subgroup analysis revealed that the highest prevalence was observed in the community primary healthcare institutions and the eastern provinces of China. Meta-analyses indicated that 21 factors were significantly associated with TI, including demographic factors (gender, age, education, marital status), job characteristic factors (title, work seniority, remuneration, social status, organisational affiliation, work stress) and job satisfaction factors (learning and training opportunity, interpersonal relationship, work condition and environment, and so on). CONCLUSION This study highlights the problem of TI among PHWs in China. Efforts should be made to improve conditions in both work-related areas and areas outside of work. Policymakers should continue to improve reward systems, the construction of infrastructure and promotion systems, and pay more attention to PHWs' lives outside of work and meet their living needs.
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Affiliation(s)
- Rongxin He
- Department of Social Security, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi'an Jiaotong University, Xi'an, China
| | - Jinlin Liu
- Department of Social Security, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi'an Jiaotong University, Xi'an, China
| | - Wei-Hong Zhang
- International Centre for Reproductive Health, Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - Bin Zhu
- Department of Social Security, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi'an Jiaotong University, Xi'an, China
| | - Ning Zhang
- Department of Social Security, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi'an Jiaotong University, Xi'an, China
| | - Ying Mao
- Department of Social Security, School of Public Policy and Administration, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- Research Center for the Belt and Road Health Policy and Health Technology Assessment, Xi'an Jiaotong University, Xi'an, China
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Considering Leaving, But Deciding to Stay: A Longitudinal Analysis of Intent to Leave in Public Health. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2020; 25 Suppl 2, Public Health Workforce Interests and Needs Survey 2017:S78-S86. [PMID: 30720620 PMCID: PMC6586295 DOI: 10.1097/phh.0000000000000928] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Context: Public health has been hit by the first wave of the “silver tsunami”—baby boomers retiring en masse. However, thousands of staff members say they are considering voluntarily leaving for other reasons as well. Objective: To identify characteristics of staff who said they were planning on leaving in 2014 but stayed at their organizations through 2017. Design: Data from the 2014 and 2017 Public Health Workforce Interests and Needs Survey (PH WINS) were linked by respondent, and characteristics associated with intent to leave were analyzed. Longitudinal logistic models were fit to examine correlates of intent to leave, with job and pay satisfaction, demographic variables, and workplace engagement perceptions as independent variables. Setting and Participants: Respondents from state health agency–central offices and local health departments that participated in the PH WINS in 2014 and 2017. Main Outcome Measures: Intent to leave (excluding retirement), demographic measures, and changes in the perceptions of workplace engagement. Results: Among all staff members responding in 2014 and 2017, 15% said they were considering leaving in 2014, excluding retirement, compared with 26% in 2017 (P < .001). Overall, 21% of those who were not considering leaving in 2014 indicated they were doing so in 2017. Comparatively, 57% of those considering leaving in 2014 said they were still considering it in 2017. The regressions showed those who were somewhat or very satisfied were significantly more likely to indicate they were not (or were no longer) considering leaving. Conclusions: Among staff members who have been considering leaving but have not yet left their organization, improvements to workplace engagement perceptions and job satisfaction were highly associated with not considering leaving their job.
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It's Not Just About How Much You're Paid. J Gen Intern Med 2018. [PMID: 29532300 PMCID: PMC5975166 DOI: 10.1007/s11606-018-4394-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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