Physicians' intention to leave direct patient care: an integrative review.
BACKGROUND
In light of the growing shortage of physicians worldwide, the problem of physicians who intend to leave direct patient care has become more acute, particularly in terms of quality of care and health-care costs.


METHODS
A literature search was carried out following Cooper's five-stage model for conducting an integrative literature review. Database searches were made in MEDLINE, PsycINFO and Web of Science in May 2014.


RESULTS
A total of 17 studies from five countries were identified and the study results synthesized. Measures and percentages of physicians' intention to leave varied between the studies. Variables associated with intention to leave were demographics, with age- and gender-specific findings, family or personal domain, working time and psychosocial working conditions, job-related well-being and other career-related aspects. Gender differences were identified in several risk clusters. Factors such as long working hours and work-family conflict were particularly relevant for female physicians' intention to leave.


CONCLUSIONS
Health-care managers and policy-makers should take action to improve physicians' working hours and psychosocial working conditions in order to prevent a high rate of intention to leave and limit the number of physicians actually leaving direct patient care. Further research is needed on gender-specific needs in the workplace, the connection between intention to leave and actually leaving and measures of intention to leave as well as using qualitative methods to gain a deeper understanding and developing validated questionnaires.
Institute of Occupational Medicine and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany. christiane.degen@uni-duesseldorf.de.
Christiane
C
Degen
Institute of Occupational Medicine and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany. jian.li@uni-duesseldorf.de.
Jian
J
Li
Institute of Occupational Medicine and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany. peter.angerer@uni-duesseldorf.de.
Peter
P
Angerer
D000367:Age Factors; D002321:Career Choice; D005260:Female; D006801:Humans; D033182:Intention; D007588:Job Satisfaction; D008297:Male; D010563:Personnel Turnover; D010820:Physicians / Q000523:psychology*; D012737:Sex Factors; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000523:psychology; D013997:Time Factors; D017132:Workplace / Q000523:psychology*