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Open Access Research article

The impact of training and working conditions on junior doctors’ intention to leave clinical practice

Christiane Degen12*, Matthias Weigl3, Jürgen Glaser4, Jian Li1 and Peter Angerer1

Author Affiliations

1 Institute of Occupational Medicine and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany

2 University Research and Applied Science, German Hospital Institute, Düsseldorf, Germany

3 Institute and Outpatient Clinic for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany

4 Institute of Psychology, University of Innsbruck, Innsbruck, Austria

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BMC Medical Education 2014, 14:119  doi:10.1186/1472-6920-14-119

Published: 18 June 2014

Abstract

Background

The shortage of physicians is an evolving problem throughout the world. In this study we aimed to identify to what extent junior doctors’ training and working conditions determine their intention to leave clinical practice after residency training.

Methods

A prospective cohort study was conducted in 557 junior doctors undergoing residency training in German hospitals. Self-reported specialty training conditions, working conditions and intention to leave clinical practice were measured over three time points. Scales covering training conditions were assessed by structured residency training, professional support, and dealing with lack of knowledge; working conditions were evaluated by work overload, job autonomy and social support, based on the Demand–Control–Support model. Multivariate ordinal logistic regression analyses with random intercept for longitudinal data were applied to determine the odds ratio of having a higher level of intention to leave clinical practice.

Results

In the models that considered training and working conditions separately to predict intention to leave clinical practice we found significant baseline effects and change effects. After modelling training and working conditions simultaneously, we found evidence that the change effect of job autonomy (OR 0.77, p = .005) was associated with intention to leave clinical practice, whereas for the training conditions, only the baseline effects of structured residency training (OR 0.74, p = .017) and dealing with lack of knowledge (OR 0.74, p = .026) predicted intention to leave clinical practice.

Conclusions

Junior doctors undergoing specialty training experience high workload in hospital practice and intense requirements in terms of specialty training. Our study indicates that simultaneously improving working conditions over time and establishing a high standard of specialty training conditions may prevent junior doctors from considering leaving clinical practice after residency training.

Keywords:
Intention to leave clinical practice; Postgraduate residency training; Training conditions; Working conditions