title: Psychosocial stress factors and intention to leave job: differences between foreign-born and Finnish-born general practitioners.
abstract: OBJECTIVE
  Physicians' high dropout rate is a significant problem in primary care in many countries. One solution to this issue is to recruit internationally mobile physicians. This study explores the role of psychosocial factors in explaining intention to leave among GPs including potential differences between foreign-born and Finnish GPs.
  
  
  METHODS
  A cross-sectional questionnaire was sent to randomly-selected Finnish physicians (n = 7000) and all foreign-born physicians (n = 1297) living in Finland in the year 2010. The questionnaire was returned by 4333 physicians, of whom 832 were GPs. Of those 176 were foreign-born GPs.
  
  
  RESULTS
  Intention to leave was more common among foreign-born GPs (59%) than among Finnish GPs (52%). High job demands were associated with higher intention to leave from primary care both in foreign-born (OR 1.90) and Finnish GPs (OR 2.20). This association remained among foreign-born GPs after adjusted the model for the country of origin or the reason for migration (OR 1.80, 1.82). Lack of job control, patient-related stress, and stresses related to teamwork were associated with higher intention to leave only among Finnish GPs (ORs 0.45, 1.75 and 1.99).
  
  
  CONCLUSIONS
  There may be cultural differences in the psychosocial factors that enhance or prevent job involvement among physicians. Thus, novel thinking is needed in organizational development of GP work in order to better understand foreign-born physicians' specific needs in a target country. This study also suggests that lightening workload could help to attract more GPs, both foreign-born and Finnish, to primary care.
authors.affiliation: National Institute for Health and Welfare (THL), Service System Research Unit, Helsinki, Finland. hannamaria.kuusio@thl.fi
authors.forename: Hannamaria
authors.initials: H
authors.lastname: Kuusio
authors.forename: Tarja
authors.initials: T
authors.lastname: Heponiemi
authors.forename: Jukka
authors.initials: J
authors.lastname: Vänskä
authors.forename: Anna-Mari
authors.initials: AM
authors.lastname: Aalto
authors.forename: Juho
authors.initials: J
authors.lastname: Ruskoaho
authors.forename: Marko
authors.initials: M
authors.lastname: Elovainio
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004651:Employment / Q000523:psychology*; D005260:Female; D005387:Finland; D005551:Foreign Professional Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D058005:General Practitioners / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D033182:Intention; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013315:Stress, Psychological; D055815:Young Adult
keywords: Cross-cultural differences; Finland; high job control; high job demands; patient-related stress; primary care; professional migration; stresses related to teamwork