title: Health system reforms, violence against doctors and job satisfaction in the medical profession: a cross-sectional survey in Zhejiang Province, Eastern China.
abstract: OBJECTIVE
  To explore the factors influencing doctors' job satisfaction and morale in China, in the context of the ongoing health system reforms and the deteriorating doctor-patient relationship.
  
  
  METHODS
  Cross-sectional survey using self-completion questionnaires.
  
  
  METHODS
  The survey was conducted from March to May 2012 among doctors at the provincial, county and primary care levels in Zhejiang Province, China.
  
  
  RESULTS
  The questionnaire was completed by 202 doctors. Factors which contributed most to low job satisfaction were low income and long working hours. Provincial level doctors were most dissatisfied while primary care doctors were the least dissatisfied. Three per cent of doctors at high-level hospitals and 27% of those in primary care were satisfied with the salary. Only 7% at high-level hospitals were satisfied with the work hours, compared to 43% in primary care. Less than 10% at high levels were satisfied with the amount of paid vacation time (3%) and paid sick leave (5%), compared with 38% and 41%, respectively, in primary care. Overall, 87% reported that patients were more likely to sue and that patient violence against doctors was increasing. Only 4.5% wanted their children to be doctors. Of those 125 who provided a reason, 34% said poor pay, 17% said it was a high-risk profession, and 9% expressed concerns about personal insecurity or patient violence.
  
  
  CONCLUSIONS
  Doctors have low job satisfaction overall. Recruitment and retention of doctors have become major challenges for the Chinese health system. Measures must be taken to address this, in order to ensure recruitment and retention of doctors in the future. These measures must first include reduction of doctors' workload, especially at provincial hospitals, partly through incentivisation of appropriate utilisation of primary care, increase in doctors' salary and more effective measures to tackle patient violence against doctors.
authors.affiliation: Faculty of Medicine, Department of Family Medicine and Primary Care, The University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Dan
authors.initials: D
authors.lastname: Wu
authors.affiliation: Faculty of Social Sciences, Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Yun
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Faculty of Science, Department of Statistics and Actuarial Science, The University of Hong Kong, Hong Kong, Hong Kong.
authors.forename: Kwok Fai
authors.initials: KF
authors.lastname: Lam
authors.affiliation: UCL Institute of Global Health, University College London, London, UK.
authors.forename: Therese
authors.initials: T
authors.lastname: Hesketh
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D002681:China; D003430:Cross-Sectional Studies; D005260:Female; D018166:Health Care Reform; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D007588:Job Satisfaction; D008297:Male; D008503:Medical Staff / Q000523:psychology*; D008875:Middle Aged; D010817:Physician-Patient Relations; D011795:Surveys and Questionnaires; D014754:Violence / Q000706:statistics & numerical data*; D016526:Workload / Q000706:statistics & numerical data
keywords: China; doctors; health reform; job satisfaction; patient aggression