Factors Affecting Physicians Turnover from Public Hospitals in Thailand.
Abstract
The recently increasing turnover rate of Thai physicians from public hospitals was a phenomenon of immense interest to public and policy makers. One of the major objectives of this study was to determine factors affecting the physicians turnover from public hospitals in Thailand leading to developing this research structural equation model. The hypotheses of the study were as follows: First, the socioeconomic factors such as age, sex, hometown, income, and family, have positive influence on the physicians turnover. Second, the job characteristic, for instance, work load and routine task, have positive influence on the resignation. Third, the lack of work-related motivation - pay and promotion inequity, continuing education opportunity may have causal link leading to the turnover. Fourth, the government initiated policy and public health administration system exhibits significant impact for the physicians to quit their jobs. Fifth, the overall job satisfaction has negative effect on the resignation. Lastly, the organization commitment yield negative influence on the turnover. The statistical techniques employed for the hypotheses testing were chi-square, t-test, multiple regression analysis, Pearson's Product Moment correlation analysis, and LISREL.
The respondents of this study were a number of 1 105 physicians who resigned from public hospitals during January 1,200 1 - May 15,2003. A total number of 958 questionnaires was sent out to all resigning physicians whose addresses could be identified by the Medical Council of Thailand. The number of 3 12 out of 958 questionnaires was returned with the response rate at 32.57%. However, only 278 questionnaires (29.02%) had adequate information for further data analysis.
Data analysis revealed that, the socioeconomic factors and the government policy were not considered as significance causes on the turnover. However, problems related to job characteristics, the lack of work-related motivation, job satisfaction, and their organization commitment factors did produce causal effects leading to the resignation.
The structure equation nod el for physicians turnover has been constructed and tested using LISREL. The analysis showed that most of the factors have positive effects to the physician reassignment. The goodness of fit index-chi-square of 2.21 8 (p=0.330, df=2, GFI=0.998) confirmed the model-data fit. The causal effect of organizational commitment was the strongest to turnover (r=0.698). Socioeconomic factors (F-0.049) had negative effect to organization commitment while motivation (~0.515a)n d job satisfaction (r=O. 1 12) had positive effects. Socioeconomic factors (~0.275a)n d motivation (~0.185)exhibited positively to job satisfaction, but job characteristic (I=-0.280) and policy (I-=-0.039) negatively influence job satisfaction.
The results of this study led to the conclusion that job satisfaction and organizational commitment were the strongest determining factors of the physicians turnover. In addition, the result of open-end questions and preliminary interviews of resigning physicians strongly confirmed in accordance to the empirical findings.
