title: Work hours and turnover intention among hospital physicians in Taiwan: does income matter?
abstract: Physician shortage has become an urgent and critical challenge to many countries. According to the workforce dynamic model, long work hours may be one major pressure point to the attrition of physicians. Financial incentive is a common tool to human power retention. Therefore, this large-scale physician study investigated how pay satisfaction may influence the relationship between work hours and hospital physician's turnover intention.
  
  
  
  Data were obtained from a nationwide survey of full-time hospital staff members working at 100 hospitals in Taiwan. The analysis sample comprised 2423 full-time physicians. Dependent variable was degree of the physicians' turnover intention to leave the current hospital. The pay satisfaction was assessed by physicians themselves. We employed ordinal logistic regression models to analyze the association between the number of work hours and turnover intention. To consider the cluster effect of hospitals, we used the "gllamm" command in the statistical software package Stata Version 12.1.
  
  
  
  The results show that 351 (14.5%) of surveyed physicians reported strong intention to leave current hospital. The average work hours per week among hospital physicians was 59.8 h. As expected, work hours exhibited an independent relationship with turnover intention. More importantly, pay satisfaction could not effectively moderate the positive relationship between work hours and intentions to leave current hospital.
  
  
  
  The findings show that overtime work is prevalent among hospital physicians in Taiwan. Both the Taiwanese government and hospitals must take action to address the emerging problem of physician high turnover rate. Furthermore, hospitals should not consider relying solely on financial incentives to solve the problem. This study encouraged tackling work hour problem, which would lead to the possibility of solving high turnover intention among hospital physicians in Taiwan.
authors.affiliation: International Health Program, School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
authors.forename: Yu-Hsuan
authors.initials: YH
authors.lastname: Tsai
authors.affiliation: Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Nicole
authors.initials: N
authors.lastname: Huang
authors.affiliation: Institute of Community Health Care, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Li-Yin
authors.initials: LY
authors.lastname: Chien
authors.affiliation: Research & Development, Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan.
authors.forename: Jen-Huai
authors.initials: JH
authors.lastname: Chiang
authors.affiliation: Health Promotion Administration, Ministry of Health & Welfare, Taipei, Taiwan. shuti.chiou@gmail.com.|School of Medicine, National Yang-Ming University, Taipei, Taiwan. shuti.chiou@gmail.com.|Taoyuan General Hospital, Ministry of Health & Welfare, 1492, Jhongshan Rd., Taoyuan District, Taoyuan City, 33004, Taiwan. shuti.chiou@gmail.com.
authors.forename: Shu-Ti
authors.initials: ST
authors.lastname: Chiou
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D033182:Intention; D007588:Job Satisfaction; D016015:Logistic Models; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology / Q000706:statistics & numerical data* / Q000600:supply & distribution; D008875:Middle Aged; D010563:Personnel Turnover / Q000706:statistics & numerical data*; D012456:Salaries and Fringe Benefits; D011795:Surveys and Questionnaires; D013624:Taiwan; D016526:Workload / Q000706:statistics & numerical data*
keywords: Hospital physicians; Pay satisfaction; Turnover intention; Work hours