Article(id=1324050797994058169, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050669933572771, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202510089, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1759852800000, receivedDateStr=2025-10-08, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793607909915, onlineDateStr=2026-11-02, pubDate=1778342400000, pubDateStr=2026-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793607909915, onlineIssueDateStr=2026-11-02, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793607909915, creator=13701087609, updateTime=1793607909915, updator=13701087609, issue=Issue{id=1324050669933572771, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='9', pageStart='1537', pageEnd='1728', issueExtLink='null', onlineDate='null', pubDate='1778342400000', pubDateStr='2026-05-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793607879384, creator='13701087609', updateTime=1793670100562, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1324311644528050975, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050669933572771, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1324311644528050976, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1324050669933572771, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1651, endPage=1656, ext={EN=ArticleExt(id=1324050798220550586, articleId=1324050797994058169, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Influencing factors and countermeasures of doctors’ turnover intention in primary healthcare institutions from a multi-theoretical integration perspective, columnId=1228016567846367388, journalTitle=Modern Preventive Medicine, columnName=Health Policy and Management, runingTitle=null, highlight=null, articleAbstract=

In recent years, the country has vigorously promoted the construction of medical consortia to implement hierarchical medical diagnosis and treatment, and protect public health. However, the phenomenon of doctors leaving primary healthcare institutions has become increasingly prominent, seriously undermining the stability and continuity of primary healthcare services and becoming a core bottleneck restricting the efficient development of medical consortia. This study focuses on the intrinsic relationship between doctors’ turnover intention and influencing factors in primary healthcare institutions. Based on two-factor theory, expectancy theory, and social exchange theory, an analytical framework was constructed. A hybrid research method of“questionnaire survey+empirical analysis+semi-structured interviews” was adopted to identify core influencing factors and construct a theoretical model. After extracting practical problems, appropriate countermeasures were proposed. The research results can provide a scientific basis and practical support for stabilizing the doctor workforce in primary healthcare institutions and consolidating the talent foundation of medical consortia.

, authors=Yang LI1, 2, authorsList=Yang LI, authorCompany=null, correspAuthors=Yang LI, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1324050799378178495, articleId=1324050797994058169, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=多理论整合视角下基层医疗卫生机构医生离职意图的影响因素与对策研究, columnId=1228016568014139551, journalTitle=现代预防医学, columnName=卫生政策与管理, runingTitle=null, highlight=null, articleAbstract=

近年来,国家大力推进医疗共同体(简称医共体)建设以落实分级诊疗、保障群众健康,但基层医疗卫生机构医生离职现象日益凸显,严重破坏基层医疗服务稳定性与连续性,成为制约医共体高效发展的核心瓶颈。本研究聚焦基层医生离职意图与影响因素的内在关联,基于双因素理论、期望理论与社会交换理论构建分析框架,采用“问卷调研+实证分析+半结构化访谈”的混合研究方法,识别核心影响因素并构建理论模型,提炼实践问题后提出适配型对策。研究结果可为基层机构稳定医生队伍、筑牢医共体人才根基提供科学依据与实践支撑。

, authors=李阳1, 2, authorsList=李阳, authorCompany=null, correspAuthors=李阳, authorNote=

李阳(1981—),男,博士在读,档案馆员,研究方向:城市医疗集团管理、医共体管理

, correspAuthorsNote=
李阳,E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点,除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=Vsr78V9YORBSaVvabErtsQ==, magXml=qM71A79PREQ2nsTkSnJr1w==, pdfUrl=null, pdf=oZYog0cUiGMf4DSQLYB67g==, pdfFileSize=957982, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=gFZ46mP+2/0MOyvnP07wMQ==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=E022kNLUFJI0YbTh1ufAiQ==, mapNumber=null, fund=null)}, authors=[Author(id=1324050800510640582, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050797994058169, orderNo=0, firstName=null, middleName=null, lastName=null, nameCn=null, orcid=null, stid=null, country=null, authorPic=null, dead=0, email=412567566@qq.com, emailSecond=null, emailThird=null, correspondingAuthor=1, authorType=1, ext={EN=AuthorExt(id=1324050800602915273, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050797994058169, authorId=1324050800510640582, language=EN, stringName=Yang LI, firstName=Yang, middleName=null, lastName=LI, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, 2, address=Neijiang First People’s Hospital, Neijiang, Sichuan 641000, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1324050800674218442, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050797994058169, authorId=1324050800510640582, language=CN, stringName=李阳, firstName=null, middleName=null, lastName=null, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=1, 2, address=1.四川省内江市第一人民医院,四川 内江 641000
2.中国社会科学院财经战略研究院,北京 100006, bio={"content":"

李阳(1981—),男,博士在读,档案馆员,研究方向:城市医疗集团管理、医共体管理

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李阳(1981—),男,博士在读,档案馆员,研究方向:城市医疗集团管理、医共体管理

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Demographic characteristics of the sample (n=668)

, figureFileSmall=null, figureFileBig=null, tableContent=
名称选项频数百分比(%)
性别男39859.58
女27040.42
年龄(岁)18~3013720.51
31~4014922.31
41~5023134.58
51及以上15122.60
学历高中及以下6910.33
大专30044.91
本科29944.76
工作年限(年)1~38212.28
4~68112.13
7~1038757.93
10以上11817.66
职称医士17526.20
医师21932.78
主治医师19128.59
副主任医师7611.38
主任医师71.05
居住区域乡镇51677.25
县区12118.11
市区314.64
合计668100.0
), ArticleFig(id=1324050804369400280, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050797994058169, language=CN, label=表1, caption=

样本人口统计学特征(n=668)

, figureFileSmall=null, figureFileBig=null, tableContent=
名称选项频数百分比(%)
性别男39859.58
女27040.42
年龄(岁)18~3013720.51
31~4014922.31
41~5023134.58
51及以上15122.60
学历高中及以下6910.33
大专30044.91
本科29944.76
工作年限(年)1~38212.28
4~68112.13
7~1038757.93
10以上11817.66
职称医士17526.20
医师21932.78
主治医师19128.59
副主任医师7611.38
主任医师71.05
居住区域乡镇51677.25
县区12118.11
市区314.64
合计668100.0
), ArticleFig(id=1324050804570726873, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050797994058169, language=EN, label=Table 2, caption=

Results of multiple linear regression analysis (dependent variable: turnover intent)

, figureFileSmall=null, figureFileBig=null, tableContent=
非标准化系数标准化系数t值P值共线性诊断
B标准误BetaVIF容忍度
常数5.4740.130—41.9680.000***——
薪酬待遇-0.1300.040-0.127-3.2790.001***1.5410.649
工作环境-0.1080.036-0.116-2.9880.003***1.5420.649
工作强度-0.1590.041-0.147-3.8790.000***1.4680.681
职业发展-0.1170.036-0.123-3.1960.001***1.5290.654
政策管理-0.0860.034-0.092-2.5040.013**1.3960.716
人际关系-0.1200.034-0.135-3.5500.000***1.4830.674
家庭选择-0.1160.041-0.110-2.8250.005***1.5650.639
R20.358
调整R20.351
F52.464***
), ArticleFig(id=1324050804704944602, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050797994058169, language=CN, label=表2, caption=

多元线性回归分析结果(因变量:离职意图)

, figureFileSmall=null, figureFileBig=null, tableContent=
非标准化系数标准化系数t值P值共线性诊断
B标准误BetaVIF容忍度
常数5.4740.130—41.9680.000***——
薪酬待遇-0.1300.040-0.127-3.2790.001***1.5410.649
工作环境-0.1080.036-0.116-2.9880.003***1.5420.649
工作强度-0.1590.041-0.147-3.8790.000***1.4680.681
职业发展-0.1170.036-0.123-3.1960.001***1.5290.654
政策管理-0.0860.034-0.092-2.5040.013**1.3960.716
人际关系-0.1200.034-0.135-3.5500.000***1.4830.674
家庭选择-0.1160.041-0.110-2.8250.005***1.5650.639
R20.358
调整R20.351
F52.464***
), ArticleFig(id=1324050804797219291, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050797994058169, language=EN, label=Table 3, caption=

Path coefficient test results for structural equation model

, figureFileSmall=null, figureFileBig=null, tableContent=
X→Y非标准化路径系数 z(CR值)P值标准化路径系数
家庭选择→离职意图-0.1160.041-2.8440.004-0.110
人际关系→离职意图-0.1200.034-3.5790.000-0.135
政策管理→离职意图-0.0870.034-2.5530.011-0.093
职业发展→离职意图-0.1160.036-3.2140.001-0.123
工作强度→离职意图-0.1590.041-3.9000.000-0.146
工作环境→离职意图-0.1070.036-2.9910.003-0.115
薪酬待遇→离职意图-0.1300.039-3.3000.001-0.127
), ArticleFig(id=1324050804897882588, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1324050797994058169, language=CN, label=表3, caption=

结构方程模型路径系数检验结果

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X→Y非标准化路径系数 z(CR值)P值标准化路径系数
家庭选择→离职意图-0.1160.041-2.8440.004-0.110
人际关系→离职意图-0.1200.034-3.5790.000-0.135
政策管理→离职意图-0.0870.034-2.5530.011-0.093
职业发展→离职意图-0.1160.036-3.2140.001-0.123
工作强度→离职意图-0.1590.041-3.9000.000-0.146
工作环境→离职意图-0.1070.036-2.9910.003-0.115
薪酬待遇→离职意图-0.1300.039-3.3000.001-0.127
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多理论整合视角下基层医疗卫生机构医生离职意图的影响因素与对策研究
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李阳 1, 2
现代预防医学 | 卫生政策与管理 2026,53(9): 1651-1656
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现代预防医学 |卫生政策与管理 2026 , 53 (9) : 1651 -1656
多理论整合视角下基层医疗卫生机构医生离职意图的影响因素与对策研究
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2.中国社会科学院财经战略研究院,北京 100006, bio={"content":"

李阳(1981—),男,博士在读,档案馆员,研究方向:城市医疗集团管理、医共体管理

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李阳(1981—),男,博士在读,档案馆员,研究方向:城市医疗集团管理、医共体管理

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李阳1, 2
作者信息
  • 1.四川省内江市第一人民医院,四川 内江 641000
  • 2.中国社会科学院财经战略研究院,北京 100006
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李阳,E-mail:
作者简介:

李阳(1981—),男,博士在读,档案馆员,研究方向:城市医疗集团管理、医共体管理

Influencing factors and countermeasures of doctors’ turnover intention in primary healthcare institutions from a multi-theoretical integration perspective
Yang LI1, 2
Affiliations
  • Neijiang First People’s Hospital, Neijiang, Sichuan 641000, China
出版时间: 2026-05-10 doi: 10.20043/j.cnki.MPM.202510089
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近年来,国家大力推进医疗共同体(简称医共体)建设以落实分级诊疗、保障群众健康,但基层医疗卫生机构医生离职现象日益凸显,严重破坏基层医疗服务稳定性与连续性,成为制约医共体高效发展的核心瓶颈。本研究聚焦基层医生离职意图与影响因素的内在关联,基于双因素理论、期望理论与社会交换理论构建分析框架,采用“问卷调研+实证分析+半结构化访谈”的混合研究方法,识别核心影响因素并构建理论模型,提炼实践问题后提出适配型对策。研究结果可为基层机构稳定医生队伍、筑牢医共体人才根基提供科学依据与实践支撑。

基层医疗卫生机构  /  医生  /  医共体  /  离职意图  /  对策

In recent years, the country has vigorously promoted the construction of medical consortia to implement hierarchical medical diagnosis and treatment, and protect public health. However, the phenomenon of doctors leaving primary healthcare institutions has become increasingly prominent, seriously undermining the stability and continuity of primary healthcare services and becoming a core bottleneck restricting the efficient development of medical consortia. This study focuses on the intrinsic relationship between doctors’ turnover intention and influencing factors in primary healthcare institutions. Based on two-factor theory, expectancy theory, and social exchange theory, an analytical framework was constructed. A hybrid research method of“questionnaire survey+empirical analysis+semi-structured interviews” was adopted to identify core influencing factors and construct a theoretical model. After extracting practical problems, appropriate countermeasures were proposed. The research results can provide a scientific basis and practical support for stabilizing the doctor workforce in primary healthcare institutions and consolidating the talent foundation of medical consortia.

Primary healthcare institutions  /  Doctors  /  Medical consortia  /  Turnover intention  /  Countermeasures
李阳. 多理论整合视角下基层医疗卫生机构医生离职意图的影响因素与对策研究. 现代预防医学, 2026 , 53 (9) : 1651 -1656 . DOI: 10.20043/j.cnki.MPM.202510089
Yang LI. Influencing factors and countermeasures of doctors’ turnover intention in primary healthcare institutions from a multi-theoretical integration perspective[J]. Modern Preventive Medicine, 2026 , 53 (9) : 1651 -1656 . DOI: 10.20043/j.cnki.MPM.202510089
近年来,为推进分级诊疗制度落地、保障群众就近享有优质健康服务,国家先后出台多项政策推动医共体建设。2017年《关于推进医疗联合体建设和发展的指导意见》明确提出,在县域组建以县级医院为龙头、乡镇卫生院为枢纽、村卫生室为基础的医共体,促进医疗资源下沉与服务能力提升[1];2023年《关于全面推进紧密型县域医疗卫生共同体建设的指导意见》进一步强调“强县域、强基层”导向,构建责任、管理、服务、利益“四个共同体”,为健康中国和乡村振兴提供支撑[2]。
然而,基层医疗卫生机构医生离职呈加剧趋势,不仅造成基层医疗人才梯队断层,更引发医疗服务连续性断裂、患者信任度下降等连锁反应,严重阻碍医共体“上下联动、资源共享”功能实现,亟需系统探究其离职意图的影响因素与应对策略。
国内人才离职研究已覆盖多领域,理论与实证探索均取得一定成果。在理论应用层面,有的学者通过生存比较法分析科学人才离职的影响机制,指出原始结构化数据在学术职业人口特征研究中的局限性[3];有的利用结构过程结果(structure-process-outcome,SPO)模型探讨了医共体的人才双向流动与医疗服务能力提升之间的关系[4]。在研究对象和场景层面,成果已延伸至国内外人才[5]、高学历青年[6]、临床护士[7]、公立医院[8],但针对基层医疗卫生机构医生的研究很少,已有研究存在两大核心缺口:其一,理论运用深度不足,多数研究侧重经验总结,未将核心理论与离职意图的作用机制结合,难以解释“影响因素如何作用于离职决策”的内在逻辑;其二,实证支撑薄弱,对基层医生离职意图的形成路径、关键影响因素的作用强度缺乏精准分析,导致结论针对性与说服力有限。
本研究的理论意义在于,首次将双因素理论、期望理论与社会交换理论整合纳入基层医生离职研究框架,通过构建多理论整合的概念模型,填补该领域的理论空白;意义在于,通过实证分析明确核心影响因素与离职意图的关联强度,结合半结构化访谈提炼实践痛点,提出“理论-问题-对策”高度匹配的解决方案,为基层机构制定人才稳定策略、卫生行政部门优化基层人才政策提供实证依据。
采用“问卷调研+实证分析+半结构化访谈”的混合研究方法,结合定量与定性分析,确保研究结论的科学性、针对性与可靠性。
遵循三大原则:(1)区域均衡性原则:覆盖东、中、西部三大经济区域,确保样本地域代表性;(2)机构类型全面性原则:涵盖乡镇卫生院、社区卫生服务中心等不同类型基层医疗卫生机构;(3)人群多样性原则:兼顾不同职称(初级、中级、高级)、年龄、工作年限的医生,避免抽样偏差。
采用多阶段分层随机抽样法:第一阶段,按东、中、西部行政区划分层,每层随机抽取3个城市(共9个城市);第二阶段,每个城市按基层机构类型(乡镇卫生院、社区卫生服务中心)分层,每层随机抽取1个机构(每个城市共2个机构,共18个机构);第三阶段,在每个抽中机构内,随机抽取调查对象。
参考结构方程模型(structural equation modeling,SEM)样本量估算标准,Hair等人于2017年提出SEM分析中观测变量与样本量比例宜为 1:5~1:10。本研究问卷包含32个李克特题项(视作32个观测变量),取保守比例 1:10,所需最小样本量为 320;为提升结果稳定性与代表性,样本量再放大一倍,取640,考虑有5%~10%无效问卷,再发放24~71份左右,实际发放705份问卷,最终回收有效问卷668份,有效回收率94.75%,满足分析需求。
问卷由两部分组成,(1)基本信息模块(6 题):包括性别、年龄、职称、工作年限、机构类型、编制状态等;(2)离职意图及影响因素量表(32题):基于双因素理论、期望理论与社会交换理论,围绕薪酬待遇、工作环境、工作强度、职业发展、政策管理、人际关系、家庭选择 7 个维度设计,采用李克特 5点量表计分(1 = 非常不同意,5 = 非常同意),其中离职意图和7个影响因素维度各含4个题项。
围绕7个影响因素设计访谈提纲,围绕每个因素存在的问题展开访谈。选取40名在基层医疗卫生机构工作年限≥10 年的医生开展访谈,每人时长20 min,确保获取深度实践信息。
采用电子问卷形式发放。调研前向调查对象说明研究目的、填写要求及隐私保护政策,问卷填写完毕后即时统计;访谈采用电话访谈。
采用SPSS 26.0 与 AMOS 26.0软件进行数据分析。(1)回归分析:构建多元线性回归模型,检验各影响因素对离职意图的显著性影响及作用强度;(2)SEM:验证“影响因素-离职意图”的路径关系,检验模型拟合度。
以社会交换理论为“顶层逻辑”,以双因素理论与期望理论为“维度支撑”,构建7个影响因素自变量(薪酬待遇X1、工作环境X2、工作强度X3、职业发展X4、政策管理X5、人际关系X6、家庭选择X7)与因变量离职意图Y的模型,数学表达式如下:Y=β1X1+β2X2+β3X3+β4X4+β5X5+β6X6+β7X7+ε。ε表示随机误差项。提出假设H1~H7,各影响因素X1~X7均分别与离职意图Y呈负相关。
由赫茨伯格(Herzberg)提出,将影响工作态度的因素分为保健因素与激励因素。保健因素(如薪酬待遇、工作环境、政策管理)缺失会导致不满,满足后仅消除不满;激励因素(如职业发展、人际关系)满足能显著提升满意度与留存意愿[9]。本研究中工作强度、家庭选择则兼具两类属性。
由弗鲁姆(Vroom)提出,核心公式为 “动机强度=效价×工具性×期望值”,效价指对目标结果的重视程度,工具性指对“努力-绩效-回报”关联度的感知,期望值指对实现目标的信心[10]。医生离职意图形成与三者感知不足密切相关。
由布劳(Blau)提出,核心观点是个体行为决策基于“成本-收益”权衡,感知“收益>成本”则维持现有关系,反之倾向终止[11]。基层医生与医疗机构、家庭形成双重交换关系,交换失衡会强化离职意图。
样本符合基层医生群体特征:性别上男性占59.58%,女性占40.42%;年龄以41~50岁群体占比最高,为34.58%;学历以大专与本科为主,分别占44.91%、44.76%;工作年限7年以上占比75.59%;职称以医师、主治医师为主,分别占32.78%、28.59%;居住区域乡镇占比77.25%。见表1。
多元回归分析显示,模型调整后R2=0.351(F =52.464,P<0.01),所有因素对离职意图影响显著(P<0.05),且呈负相关,与研究假设H1~H7一致,标准化系数Beta排序:工作强度(-0.147)>人际关系(-0.135)>薪酬待遇(-0.127)>职业发展(-0.123)>工作环境(-0.116)>家庭选择(-0.110)> 政策管理(-0.092)。见表2。
SEM验证显示模型拟合良好,卡方自由度比(chi-square divided by degrees of freedom,χ2/v)=1.303(<3),拟合优度指数(goodness of fit index,GFI)=0.951(>0.9),比较拟合指数(comparative fit index,CFI)=0.992(>0.9),近似均方根误差(root mean square error of approximation,RMSEA)=0.021(<0.05),所有路径均显著(P<0.05),路径系数排序与回归分析一致,进一步验证研究假设。见表3、图1。
本研究实证结果表明,工作强度、人际关系、薪酬待遇、职业发展、工作环境、家庭选择、政策管理7个因素均对基层医生离职意图呈显著负向影响,且作用强度存在差异,这与多理论整合分析框架的预期一致。工作强度是影响离职意图的首要因素(Beta=-0.147),这一结果契合社会交换理论的“成本-收益” 逻辑。基层医生面临医疗学习、值班事务、管理考核三重压力,工作成本显著高于收益感知,交换失衡直接强化离职意图。人际关系的影响次之(Beta=-0.135),符合双因素理论中激励因素的作用机制,医患关系脆弱化与内部竞争内卷化导致激励缺失,降低工作满意度。薪酬待遇(Beta=-0.127)与职业发展(Beta=-0.123)的影响体现了期望理论的核心观点,薪酬效价不足、职业发展期望值低,导致 “付出-回报” 感知失衡,削弱工作动机。工作环境(Beta=-0.116)作为保健因素,其缺失直接引发不满,成为离职的重要诱因。
问题表现:基层医生角色压力超载[12],白天承担诊疗任务并应对医疗风险,晚上需自主学习提升,值班常通宵值守;非医疗事务(迎检、填表)占用时间过多,DRG 付费改革要求兼顾质量与成本控制,科室管理者还需承担行政工作,多维度考核加剧心理负荷。
对策建议:(1)剥离非医疗事务。明确医疗与行政岗位职责边界,由行政专员承接迎检、填表等事务,减少医生非医疗工作时长。(2)优化 DRG 政策适配性。卫生行政部门制定基层版 DRG 实施指南,简化核算流程,建立医保扣款申诉机制。(3)强化信息化支撑。推进基层机构信息化建设,实现“数据多跑路、医生少跑腿”,解放重复性劳动[13]。(4)合理配置人力资源。根据服务人口、门诊量动态调整排班,避免一人多岗,保障休息时间。
问题表现:医患关系脆弱化,患者对医疗不确定性认知不足,易因诊疗效果未达预期引发冲突,部分患者存在医闹倾向,医生安全感下降;内部竞争内卷化,职称晋升、干部提拔名额有限且评价标准不透明,同事协作氛围弱化。
对策建议:(1)加强医患沟通与教育。开展人文医学培训提升医生共情与沟通能力,向患者普及医疗风险常识及医闹法律后果,完善第三方调解机制。(2)建立透明公平的评价体系。制定统一的职称晋升、干部提拔标准,以临床能力、服务质量、患者满意度为核心指标,实行量化评分与公示制度[14]。(3)促进同事协作。开展内部学术沙龙、科室协作项目,倡导共同进步,减少内卷化竞争。
问题表现:仅40.12%的医生认为薪酬待遇达到预期,主要问题包括绝对薪酬偏低(大幅低于市县级医院)、福利保障不足(部分机构未按规定缴纳公积金、职业年金)、收入增长缓慢(与物价上涨、工作年限脱钩)。
对策建议:(1)拓宽收入来源。医共体上级医院派遣专家到基层坐诊、带教,帮助开展适宜技术,扩大业务范围,通过业务量增长提升薪酬。(2)优化医保扣款管理。组织DRG培训提升成本控制能力,将医保扣款率纳入科室考核,对表现优异者给予奖励。(3)完善福利保障。政府增设基层人才保留专项基金,落实薪酬倾斜政策,按规定缴纳公积金、职业年金,增强薪酬综合效价[15]。
问题表现:晋升路径受限,基层医生仅能参评“基层医师系列”,其薪酬与社会认可度低于“普通医师系列”,且高级职称评定标准脱节、名额稀缺[16];职业理想与现实脱节,部分医生希望成为专科医生但基层以全科医疗为主;编制稀缺导致无编医生身份认同感不足[17];培训机会不足,人员紧张难以抽出时间进修。
对策建议:(1)打通晋升转化渠道。允许“基层医师系列”医生通过临床能力考核和学术成果认定转化为“普通医师系列”,缩小薪酬差距,修改高级职称评定标准(从重论文转向重绩效),增加名额。(2)精准匹配专业需求。定向安排医生到医共体上级医院进修,支持基层建设特色专科门诊。(3)建立阶梯式培训体系。每个科室多储备医务人员,确保外出培训不影响正常工作,制定系统培训计划提升专业能力与职业期望值[18]。
问题表现:仅22%的医生对工作环境感到满意,基础设施不足(停车场狭小、病房拥挤)、医疗设备落后(部分缺乏基本诊疗设备)等问题突出,无法满足诊疗与就医需求。
对策建议:(1)加大基础设施投入。统筹上级部门、医共体与基层机构资金,扩建停车场,改造病房以提高双人间、单人间比例。(2)完善医疗设备配置。配齐 CT、心电图机等基本设备,建立医共体设备共享机制,保障诊疗需求[19]。
本研究的创新点在于首次将双因素理论、期望理论与社会交换理论整合纳入基层医生离职研究,突破了现有研究理论单一化、经验化的局限,构建了多理论整合的分析框架,清晰阐释了影响因素作用于离职意图的内在逻辑。实证研究明确了7个核心影响因素的作用强度排序,为实践提供了优先级指导,避免了对策制定的盲目性。
本研究存在一定局限:样本虽覆盖东、中、西部,但未涵盖所有省份,代表性仍可提升;未针对年轻医生、高职称医生等不同群体进行差异化分析。未来可扩大样本覆盖范围,重点探索不同群体的离职意图差异及影响机制,为制定更具针对性的人才稳定对策提供支撑。
本研究通过混合研究方法证实,工作强度、人际关系、薪酬待遇、职业发展、工作环境、家庭选择、政策管理 7 个因素均对基层医疗卫生机构医生离职意图呈显著负向影响,且作用强度依次递减。基于多理论视角提出的“降低工作成本、强化激励因素、提升效价与期望值、补齐保健因素”等对策,具有较强的可操作性。研究结果可为卫生行政部门优化基层人才政策、基层医疗卫生机构稳定医生队伍提供科学依据,有助于提升基层医疗服务质量,为医共体建设筑牢人才根基。

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2026年第53卷第9期
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doi: 10.20043/j.cnki.MPM.202510089
  • 接收时间:2025-10-08
  • 首发时间:2026-11-02
  • 出版时间:2026-05-10
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  • 收稿日期:2025-10-08
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    1.四川省内江市第一人民医院,四川 内江 641000
    2.中国社会科学院财经战略研究院,北京 100006

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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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