Physician turnover in China, 2011-2021: a nationwide longitudinal study

There have been a globally paucity of comprehensive quantitative studies on the physician turnover trends. This study aimed to investigate the trajectory and magnitude of Chinese physician turnover, as well as its influencing factors.

We established a retrospective cohort by combining annual physician surveillance data and annual medical institution report data between 2011 and 2021. Turnover was defined as physicians who changed their practice institution at least once between 2011 and 2021. We reported the national annual turnover rate, net turnover rate of different regions and types of healthcare institutions. The direction of turnover across provinces and institutions was exhibited using Sankey diagrams. A time-dependent Cox regression analysis was used to examine the factors that influence physician turnover.

This study included 3.7 million physicians, with 19.4% changing practice institutions between 2011 and 2021. The national annual turnover rate has risen from 1.6% to 4.4%. The majority of turnover occurred within provinces and the same type of healthcare institutions. Eastern regions and urban areas experienced net turnover inflow. Factors that increased the likelihood of physician turnover include: being younger, male, more educated, having senior professional titles, having non-permanent employment contracts, working in rural, non-hospital, or private institutions, and working in institutions with relatively low revenue or high workload.

This study suggests that the physician turnover rate is rising in China. Polices should pay more attention to physician retention in less-developed regions. The underlying causes of physician turnover should be thoroughly investigated. Continuous monitoring of physician turnover is critical to leverage its potential positive impact on revitalizing the healthcare system and to avoid its possible negative impact on equal geographic distribution of physicians.