Human Resources for Health最新文献

{"title":"Turnover intention among intensive care nurses and the influence of the COVID-19 pandemic: a scoping review.","authors":"Tanja Lesnik, Anna Hauser-Oppelmayer","doi":"10.1186/s12960-025-00992-7","DOIUrl":"10.1186/s12960-025-00992-7","url":null,"abstract":"<p><strong>Background: </strong>The shortage of nurses has been an ongoing issue for many decades. An important contributing factor is voluntary turnover. Especially in intensive care (ICU) and critical care units (CCU) with high workloads, high mortality rates and stressful working conditions, the phenomenon has serious consequences. In addition, the COVID-19 pandemic has exacerbated the problem. This review examines the factors influencing the intention to leave (ITL) and intention to stay (ITS) among intensive care and critical care nurses and the influence of the COVID-19 pandemic.</p><p><strong>Methods: </strong>A scoping review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). The databases PubMed, Wiley, Scopus, APA PsycNet and Web of Science were searched. In addition, a forward search using Google Scholar was carried out. Empirical studies reporting on factors influencing the intention to stay or leave among ICU nurses published from 2000 to 2022 were included. The factors were qualitatively coded in MAXQDA, resulting in an inductive coding frame.</p><p><strong>Results: </strong>Fifty-four studies, including 51 quantitative, one qualitative, and two mixed methods studies, were included in the review. The analysis of factors influencing the intention to either leave or stay in intensive care can be systematically classified into two categories: organisational factors and individual factors. The category of organisational factors encompasses factors, such as commitment and integration, leadership, professional collaboration and communication. Conversely, the category of individual factors comprises factors, such as professionalism, job satisfaction, mental health and social reasons. The pandemic has exacerbated certain aspects within individual and organisational factors, influencing the intention to leave intensive care. Notably, despite the significant impact of COVID-19, no \"new\" themes are directly attributable to it.</p><p><strong>Conclusions: </strong>The results can help practitioners meet future challenges (maintaining adequate staffing levels in view of the existing shortage of nurses). It is the responsibility of nursing and hospital management to capitalise on the insights of this review. Future research should focus on longitudinal, interventional and qualitative study designs to understand voluntary turnover among ICU nurses.</p>","PeriodicalId":39823,"journal":{"name":"Human Resources for Health","volume":"23 1","pages":"23"},"PeriodicalIF":3.9,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12080060/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080518","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The influencing factors of turnover intention among pediatric healthcare workers: a moderated mediation model.","authors":"Qingwen Jia, Wenkang Shi, Hao Yuan","doi":"10.1186/s12960-025-00989-2","DOIUrl":"https://doi.org/10.1186/s12960-025-00989-2","url":null,"abstract":"<p><strong>Background: </strong>Turnover intention (TI) is significant for stabilizing the pediatric healthcare workforce and ensuring sufficient pediatric healthcare human resources. This study focuses on the impact and potential mechanisms of person-organization fit (POF), hierarchical plateau (HP), and person-group fit (PGF) on TI.</p><p><strong>Methods: </strong>The data set was collected from the Children's Hospital of Hebei Province on the Wenjuanxing online platform using the convenience sampling method in September and October 2023. 546 questionnaires were collected, with 371 valid questionnaires (effective rate: 67.95%). Model 4 and Model 14 of the PROCESS macro (version 3.3) in SPSS were used to construct mediation and moderated mediation models, respectively, and the significance of mediation and moderation effects in the theoretical model was verified using the Bootstrap method (sample size = 5000).</p><p><strong>Results: </strong>The results of Model 4 indicate that POF has a negative impact on the HP ( B = -0.1414, p < 0.01) and TI (B = - 0.3616, p < 0.001), while the HP has a positive impact on TI ( B = 0.2528, p < 0.001), and HP can mediate the relationship between POF and TI (B = - 0.0358, 95% CI [- 0.0678, - 0.0049]). The results of Model 14 show that the POF has a negative impact on the HP ( B = -0.1414, p < 0.01) and TI (B = - 0.2827, p < 0.001), while the HP has a positive impact on TI ( B = 0.2747, p < 0.001), and index of moderated mediation shows that the PGF can moderate the indirect effect of POF on TI (Index = 0.0305, 95% CI [0.0020, 0.0582]).</p><p><strong>Conclusions: </strong>This study constructed a moderated mediation model and found that POF can negatively affect the TI of pediatric healthcare workers, the HP can mediate the relationship between POF and TI, and PGF can moderate the second part of this mediating process. This emphasizes the important role of employee fit with the organization and group, as well as the significant impact of employee career development on TI.</p>","PeriodicalId":39823,"journal":{"name":"Human Resources for Health","volume":"23 1","pages":"22"},"PeriodicalIF":3.9,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12076966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144080275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health workforce issues and recommended practices in the implementation of Universal Health Coverage in the Philippines: a qualitative study.","authors":"Veincent Christian F Pepito, Arianna Maever Loreche, Ruth Shane Legaspi, Ryan Camado Guinaran, Theo Prudencio Juhani Z Capeding, Madeline Mae Ong, Manuel M Dayrit","doi":"10.1186/s12960-025-00988-3","DOIUrl":"https://doi.org/10.1186/s12960-025-00988-3","url":null,"abstract":"<p><strong>Background: </strong>The transition towards Universal Health Coverage (UHC) in a devolved healthcare system such as the Philippines is beset by health workforce issues considering that it is among the world's leading source countries for health workers. This study aims to document health workforce issues and recommended practices in the implementation of UHC in the Philippines.</p><p><strong>Methods: </strong>We conducted focus group discussions and key informant interviews with health policymakers and UHC implementers in the national, regional, and local levels. Participants included local chief executives, healthcare facility administrators, and healthcare providers at tertiary, secondary, and primary levels, as well as patients. We transcribed and translated the focus group discussions and key informant interviews and analyzed it thematically.</p><p><strong>Results: </strong>Workforce factors at entry, current employment, and exit hinder the implementation of UHC. Factors at entry include: poor preparation of graduates in school for implementing UHC; difficulty in recruitment due to restrictive government hiring policies; and government budget caps for personnel services. Factors at the current employment include: poor working conditions; uncompetitive salaries; lack of trained personnel for financial management; exorbitant fees for trainings; lack of job security for nationally deployed personnel; and lack of integration of some barangay health workers and community health volunteers. Factors at exit include the pull of migration overseas and poor crisis management. Some recommended practices to recruit and retain health workforce include scholarships and return service programs; free tuition for dependents of health workers; opportunities for postgraduate degrees and specialist training overseas, and onboarding UHC training for new hires.</p><p><strong>Conclusions: </strong>To address the health workforce issues hindering the effective implementation of UHC in the Philippines, there is a need for reforms in the country's healthcare sector and beyond. Specifically, there is a need to revisit the country's Local Government Code, integrate further health professions education institutions and healthcare facilities, implement reforms in its basic, higher, and health education, and the civil service, revisit training costs, and training programs for specialists, and design and implement more sustainable and equitable bilateral labor agreements to keep health workforce in the Philippines and engage them as partners for optimal implementation of UHC in the country.</p>","PeriodicalId":39823,"journal":{"name":"Human Resources for Health","volume":"23 1","pages":"21"},"PeriodicalIF":3.9,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12020071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of an impact evaluation framework and planning tool for field epidemiology training programs.","authors":"James A Flint, Michelle Jack, David Jack, Rachel Hammersley-Mather, David N Durrheim, Martyn D Kirk, Tambri Housen","doi":"10.1186/s12960-025-00974-9","DOIUrl":"https://doi.org/10.1186/s12960-025-00974-9","url":null,"abstract":"<p><strong>Background: </strong>Despite the growth and diversification of Field Epidemiology Training Programs (FETPs) globally, there are few published evaluations. Those that have been published largely focus on program processes and outputs, with some including short-medium-term outcomes and very few focusing on sustained impact. This paper describes the process of developing an FETP impact evaluation framework and FETP impact evaluation planning tool to facilitate FETP impact evaluations. The impact framework was developed to be simple, flexible and efficient.</p><p><strong>Methods: </strong>A theory of change process for an FETP in Papua New Guinea formed the basis of the impact evaluation framework. With support from independent impact evaluation experts, the framework was developed using an iterative approach. A review of the literature and technical input from FETP representatives underpinned its development. A simple planning tool was developed to help operationalise the impact framework.</p><p><strong>Results: </strong>The final FETP impact evaluation framework consists of a high-level summary framework and a detailed operational framework. The high-level framework follows the flow of outputs, outcomes and impacts for trainees, graduates, the public health systems, and communities. The detailed FETP Impact Evaluation Framework includes activities, enablers and barriers, and output, outcome and impact indicators. The FETP Impact Evaluation Planning Tool consists of five steps using a theory-based approach.</p><p><strong>Conclusions: </strong>The long history and global growth of the FETP model suggest success and imply impact, yet few published papers provide necessary backing evidence. There is growing interest across the FETP community and funders to understand the longer-term changes that FETPs contribute to. We developed an impact framework and planning tool specifically designed to support FETP impact evaluation. The framework and tool are intended to be used by FETP staff with no prior evaluation experience. The evaluation approach is intentionally flexible, allowing contextual application and integration with established quantitative and qualitative evaluation methods.</p>","PeriodicalId":39823,"journal":{"name":"Human Resources for Health","volume":"23 1","pages":"20"},"PeriodicalIF":3.9,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11995554/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144041096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anaesthetic practices at Gulu Regional Referral Hospital in Northern Uganda, who does what and where? A retrospective study.","authors":"N Kutschke, J Lampe, O Hoepfner, D L Kitara, A Schuster","doi":"10.1186/s12960-025-00987-4","DOIUrl":"https://doi.org/10.1186/s12960-025-00987-4","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Hospitals such as the Gulu Regional Referral Hospital (GRRH) in northern Uganda, like many other regions of sub-Saharan Africa, lack the anaesthetists needed to provide adequate analgesia during surgical procedures. The GRRH has not employed any anaesthesiologist for many years. Instead, anaesthesia is carried out by non-physician anaesthetic officers (AO) and other healthcare workers (HWs). In this setting, peripheral regional anaesthesia (pRA) is a safe and resource-efficient alternative that HWs and AOs could use. The study aimed to evaluate surgical procedures, anaesthetic practices, and staffing at Gulu Regional Referral Hospital in Northern Uganda. The objective was to identify the appropriate audience for pRA training and the corresponding training content.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A retrospective review was conducted on surgical procedures and their anaesthetic management in three departments of GRRH during 2019. The possibility of performing pRA was determined based on the surgical site, infection status, and the type of surgical procedure being performed. A pRA was considered adequate when conditions for pRA were met and pRA was carried out. Chi-square test was used to compare categorical data. A bivariable logistic regression analysis was performed to identify the factors associated with the administration of peripheral regional anaesthesia and the qualifications of medical staff.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 804 procedures were recorded [67% in accident and emergency (A&E), 31% in operating room (OR), and 2% on the surgical ward]. Anaesthesia was recorded in 82% of cases. Of these, 86% were documented in regional and local anaesthesia. Anaesthetic officers carried out anaesthesia in 20% of all cases and in all cases in the operating room. HWs with more than 2 years of training performed adequate pRA more frequently than HWs with less than 1 year of experience [Odds ratio (OR) = 2.586; 95% CI 1.336-5.005; p = 0.005]. The last group, however, performed significantly more procedures in A&E than in other departments (89%, p &lt; 0.001). Of the 209 procedures that could have been performed with pRA, 85 were found to be inadequately anaesthetised. 79% (67) of these were performed in the emergency department. In 45% of cases with inadequate anaesthesia, patients received local anaesthesia instead of appropriate pRA. Pain control was absent in 18% of cases, and 20% of cases received presumably unnecessary general anaesthesia or sedation. In 17% of cases, additional administration of ketamine and/or midazolam was required due to insufficient pRA.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;The data show that pRA procedures are already used at GRRH, especially by HWs with high level of training in the OR. In A&E, which is primarily staffed by doctors with less than 1-year training, there is a potential to increase the administration of adequate pain relief by implementing simple nerve blocks into routin","PeriodicalId":39823,"journal":{"name":"Human Resources for Health","volume":"23 1","pages":"19"},"PeriodicalIF":3.9,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11995501/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Examining the relationship between nurse psychological capital and job burnout: a multilevel analysis across nurse, nurse leader, and nurse family perspectives.","authors":"Mengjie Xia, Junqiang Wang, Zhibin Wang, Dongjun Bi, Huiping Mao, Xiaohong Liu, Lili Feng, Chen Lili, Xiaoting Yan, Fang Huang, Rusli Nordin, Zainooriah Dato' Hj Zakaria","doi":"10.1186/s12960-025-00986-5","DOIUrl":"10.1186/s12960-025-00986-5","url":null,"abstract":"<p><strong>Background: </strong>Nurse job burnout is a critical issue affecting medical quality and safety. Psychological capital (PsyCap) is associated with enhanced career satisfaction and reduced work stress. This study evaluates the relationship between nurses' PsyCap and job burnout, while considering leadership and family as contextual factors.</p><p><strong>Methods: </strong>A cross-sectional study design was used, collecting data from 499 nurses via validated questionnaires. Statistical analyses, including descriptive statistics, correlation, and multiple regression, were conducted to assess the relationship between PsyCap and job burnout. Leadership and family were included as contextual variables in hierarchical regression models to evaluate their indirect influences.</p><p><strong>Results: </strong>Among nurses, 63.9% experienced mild to moderate burnout. The average PsyCap score was 107.88 ± 20.55. PsyCap showed a significant negative correlation with burnout dimensions (correlation coefficients: -0.43 to -0.53, p < 0.01). Higher PsyCap significantly predicted lower job burnout (β = -0.44, p < 0.01). Leadership and family influences had minor but noteworthy indirect effects on this relationship.</p><p><strong>Conclusion: </strong>The results of this study suggest that higher levels of nurses' PsyCap are associated with lower levels of job burnout. While these findings highlight PsyCap's potential role in mitigating burnout, further research is needed to confirm causal relationships and assess the effectiveness of interventions aimed at enhancing PsyCap and supportive environments.</p>","PeriodicalId":39823,"journal":{"name":"Human Resources for Health","volume":"23 1","pages":"18"},"PeriodicalIF":3.9,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11951840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744142","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Factors influencing medical disputes among village doctors from seven provinces in China: a cross-sectional study.","authors":"Zijian Qi, Guiyuan Li, Wenxin Yu, Chunxia Miao, Wenjun Yan, Wei Wang, Xiuyin Gao, Qingzhi Wang","doi":"10.1186/s12960-025-00984-7","DOIUrl":"10.1186/s12960-025-00984-7","url":null,"abstract":"<p><strong>Background: </strong>Medical disputes, with the progress of economic development and the improvement of people's awareness of rights protection, are becoming increasingly intense. This phenomenon may have a negative impact on doctors and the medical system, especially village doctors who are responsible for guarding the health of rural people. Therefore, it is urgent to explore the factors that affect the medical dispute experience of village doctors.</p><p><strong>Methods: </strong>A cross-sectional study was conducted and 1977 village doctors recruited from seven provinces in China during May to June 2023. Multivariate logistic regression with propensity score matching (PSM) was performed to explore the association of post competency and medical disputes.</p><p><strong>Results: </strong>Among the 1977 village doctors, 208 (10.5%) had experienced medical disputes. Village doctors with high post competency (OR = 0.951, 95%CI: 0.930, 0.972), proficient western medicine (OR = 0.340, 95%CI: 0.164, 0.704), neutral occupational satisfaction (OR = 0.344, 95%CI: 0.216, 0.550), and neutral or high satisfying doctor-patient relationship (DPR) (OR = 0.401, 95%CI: 0.240, 0.668; OR = 0.200, 95%CI: 0.113, 0.355) had a decreased likelihood for medical disputes. Village doctors with high income (OR = 4.928, 95%CI: 2.039, 11.911) had an increased likelihood for medical disputes.</p><p><strong>Conclusions: </strong>Village doctors who perceived themselves to have high service competency, high occupational satisfaction, and satisfaction with doctor-patient relationships were less likely to encounter medical disputes. The government and relevant organizations should intensify the training of village doctors, enhance their service competency and hospital facilities, foster harmonious doctor-patient relationships, and facilitate the advancement of primary public health services.</p>","PeriodicalId":39823,"journal":{"name":"Human Resources for Health","volume":"23 1","pages":"17"},"PeriodicalIF":3.9,"publicationDate":"2025-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11905589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143626406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Profile of Chief Medical Officers and performance of health zones in crisis contexts: a cross-sectional study in three provinces of the Eastern Democratic Republic of Congo.","authors":"Rosine Bigirinama, Jean-Corneille Lembebu, Christian Chiribagula, Pacifique Mwene-Batu, Denis Porignon, Abdon Mukalay, Albert Mwembo, Ghislain Bisimwa","doi":"10.1186/s12960-025-00982-9","DOIUrl":"10.1186/s12960-025-00982-9","url":null,"abstract":"<p><strong>Context: </strong>In crisis-affected health systems, the performance of health zones (also known as health districts) is challenged by recurrent armed conflicts and state fragility. The profiles of health zone managers and contextual factors can significantly influence the zones' ability to effectively respond to population health needs. This study explores these interactions to identify key factors associated with health zones performances in three provinces of Eastern Democratic Republic of Congo (DRC), a region that has endured over three decades of conflict.</p><p><strong>Methods: </strong>This mixed-methods study was conducted between October 2022 and April 2024, using data covering the period from 2017 to 2022. In the DRC, health zones are managed by Chief Medical Officers (CMOs). We assessed the functionality and performance of health zones using key indicators related to primary healthcare delivery and management. Data on CMO profiles and the operational contexts of their health zones were analyzed to identify factors influencing functionality and performance, through multivariate regressions (p < 0.05). In addition, 17 individual interviews with key health system actors were analyzed thematically to capture perceptions on CMO performance and stability.</p><p><strong>Results: </strong>CMOs with training in primary healthcare management and extensive professional experience were statistically associated with higher health zone performance. Conversely, instability among CMOs, due to frequent rotations driven by political influences and weak collaboration between decision-making bodies, negatively impacted performance. However, support from international and faith-based partners was associated with improved health zone performance.</p><p><strong>Conclusions: </strong>This study highlights the importance of investing in capacity-building for health managers to strengthen health systems and improve resilience in crisis settings. Establishing robust governance frameworks that promotes transparency in the recruitment and management of health managers, and ensure stability in human resources, is critical for maintaining and improving health system performance.</p>","PeriodicalId":39823,"journal":{"name":"Human Resources for Health","volume":"23 1","pages":"16"},"PeriodicalIF":3.9,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11899190/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143606647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evolution of physician resources in China (2003-2021): quantity, quality, structure, and geographic distribution.","authors":"Yu Xiao, Zhou Zhang, Chun-Mei Xu, Jian-Ying Yu, Ting-Ting Chen, Shu-Wan Jia, Na Du, Shao-Yi Zhu, Jing-Hui Wang","doi":"10.1186/s12960-025-00983-8","DOIUrl":"10.1186/s12960-025-00983-8","url":null,"abstract":"<p><strong>Introduction: </strong>Physicians are an indispensable part of the healthcare system, crucial for maintaining public health. Since the issues in market-oriented healthcare reform emerged in 2003, China has implemented a series of healthcare system reforms to improve the equitable distribution of medical resources. The impact of these reform measures on the physician workforce has yet to be systematically assessed.</p><p><strong>Methods: </strong>Data were sourced from the China Health Statistics Yearbook from 2003 to 2021. We conducted a detailed descriptive statistical analysis of physicians' quantity, quality, and structure. The Gini coefficient was calculated to evaluate national physician distribution equity, and the Theil index was further used to analyze interprovincial and intraprovincial inequality trends in the physician workforce. Global Moran's I and hotspot analysis were employed to examine the spatial heterogeneity and clustering of physician labor.</p><p><strong>Results: </strong>The number of physicians increased from 1.87 million in 2003 to 4.29 million in 2021, with an average annual growth rate of 4.72%. The male-to-female ratio changed from 1:0.69 to 1:0.92. The main educational level of physicians elevated to a bachelor's degree (45.9%). However, the proportion of young doctors (< 35 years) declined from 41.1 to 26.0%. The Gini coefficient decreased from 0.140 in 2003 to 0.071 in 2021, and the Theil index dropped from 0.091 to 0.057. Decomposition of the Theil index revealed that overall differences in physician distribution primarily stemmed from intraprovincial inequality rather than interprovincial inequality. Global Moran's I decreased from 0.304 in 2003 to 0.109 in 2015 and then increased to 0.444 in 2021. Hotspot analysis showed uneven physician distribution, with high-value clusters in northern regions and low-value clusters in southern regions.</p><p><strong>Conclusions: </strong>Over the past 19 years, despite improvements in the quantity and quality of physicians, the decline in young physicians and worsening regional disparities pose challenges.</p>","PeriodicalId":39823,"journal":{"name":"Human Resources for Health","volume":"23 1","pages":"15"},"PeriodicalIF":3.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11889850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143587564","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A hole in the bucket? exploring England's retention rates of recently qualified GPs.","authors":"William L Palmer, Lucina Rolewicz, Victoria Tzortziou Brown, Giuliano Russo","doi":"10.1186/s12960-025-00980-x","DOIUrl":"10.1186/s12960-025-00980-x","url":null,"abstract":"<p><strong>Background: </strong>As the senior medics within primary care services, general practitioners (GPs) have a pivotal role within the National Health Service (NHS). Despite several commitments made by government to increase the number of GPs in England, the level has consistently fallen. Much attention has been paid to recruitment of trainee GPs and overall retention, whereas this study sought to examine the specific transition from ending training to joining the NHS.</p><p><strong>Methods: </strong>The study used aggregated, published administrative data to examine rates at which 14,302 doctors leaving their third year of specialty training (GP ST3s) became fully qualified GPs in NHS practices between 2018 and 2023. We separately analysed average levels of part-time working of those joining the NHS from 21,293 fully qualified joiners in England between 2017 and 2023. We calculated joiner and participation rates and used generalised linear mixed-effects models to explore possible demographic, period and cohort effects.</p><p><strong>Results: </strong>Of those doctors leaving their third year of training since 2018, around a third (34.3%) were recorded as having taken up a fully qualified GP role in NHS general practices 6 months after finishing training, rising to 47.5% within 1 year, and 62.2% within 2 years. Average estimated participation rates of joiners seemed to remain consistent at about 65-69% of a full-time contract between 2017 and 2023. Joiner rates were lower for doctors with a primary medical qualification from outside the UK and, over a 2-year timeframe, both UK and non-UK trained male GP ST3s. Our statistical modelling suggests that there is a significant 'period effect' in connection to the recent Covid-19 pandemic, with apparent differences in the likelihood of GP ST3s joining the NHS in a fully qualified role at certain points in time, and an effect among some cohorts, with doctors who left specialty training in specific periods having significantly different joiner rates.</p><p><strong>Conclusion: </strong>The GP pipeline is expanding, but we find no evidence that retention of newly trained GPs is improving. We discuss possible factors for such attrition, from barriers to hiring new doctors, to their diminishing interest in joining the NHS. The data do not capture all destinations of GP ST3s, and more work is needed to further explore the changing career behaviours of subsequent cohorts and demographics of doctors completing GP training.</p>","PeriodicalId":39823,"journal":{"name":"Human Resources for Health","volume":"23 1","pages":"14"},"PeriodicalIF":3.9,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11874689/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143543866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}