Workload and job satisfaction of rural doctors during the new healthcare reform in China: a cross-sectional mixed methods study

Abstract

Background With the integration of urban and rural health insurance, the demand for health services from rural residents increases rapidly, which in turn, bring heavier workload for doctors from county public hospitals (CPHs). Meanwhile, township healthcare centers (THCs) are required to provide more additional public health services under the integration of public health and primary care, which also brings challenges for its doctors’ workload. As a result, Chinese rural doctors from both CPHs and THCs have to cope with heavier workload that may have an adverse effect on their job satisfaction. This study sought to investigate the association between the workload and their job satisfaction during the new healthcare reform in China. Methods A cross-sectional survey using mixed methods targeting Chinese rural doctors from both CPHs and THCs in three provinces of Gansu (the west province of China), Shanxi (the middle province of China), and Shandong (the east province of China) was conducted. Correlation analyses of three dimensions of workload and job satisfaction were performed. The association between workload and job satisfaction was estimated using discrete choice regression and the detail parts of workload were analyzed using qualitative data collected from interviews with some agency administrators and representatives from the respondents. Results Of the 849 rural doctors enrolled, 52.18% thought that the proportion of time spent on non-medical activities (PT) was too high; 78% reported that they worked more than 8 hours in a working day; up to 40% of rural doctors from county public hospitals (CPHs) reported unaffordable clinical visit number per day (CV), which was significantly higher than that from township healthcare centers (THCs). Both of the proportion of time on non-medical issues and working hours (WH) were significantly and negatively associated with the job satisfaction of rural doctors. However, the effects of clinical visit number were mixed, with a significantly negative association with the job satisfaction of doctors from CPHs rather than from THCs. Qualitative analysis indicated that non-medical activities constituted the main source of Chinese rural doctors workload, in terms of a performance assessment criteria for doctors from CPHs and public health services for doctors from THCs. Conclusion The workload, dominated by non-medical activities, working hour and clinical visit number, are non-negligible factors that negatively associated with Chinese rural doctors’ job satisfaction in the healthcare reform setting. The growing number of patients towards CPHs and the additional public health service imposed on the THC doctors were the main source for the workload that worsened rural doctors’ job satisfaction. Policy makers should consider some feasible measures to reduce non-medical activities for rural doctors so that they could dedicated their limited energy and time to the medical service.