Reactions of salaried physicians to hospital decline

To examine the Exit, Loyalty, Voice, and Neglect (ELVN) reactions of full-time salaried physicians to the decline of their employing hospital, and to explore factors possibly associated with the choice of reactions.

The study analyzes data collected in a larger survey of work attitudes of 703 hospital physicians, constituting a representative national sample of (every tenth) salaried hospital physicians in Israel.

Data were collected through a self-administered mail questionnaire with return envelopes attached.

A survey design was used. Survey questionnaires included composite measures of the ELVN reaction as well as of the main predictors of reaction choice: job satisfaction, hospital commitment, job investment, alternatives, tenure, and managerial and senior positions.

The reactions of salaried physicians to hospital decline include the whole range of ELVN reactions. The choice of each reaction was found associated with a different set of disposition, situation, and position predictors.

The ELVN typology is relevant for examining physicians' reactions to hospital decline, which appear to extend beyond the simple stay/leave dichotomy commonly used. The reactions of Exit, Loyalty, Voice, and Neglect are different in nature, and appear to reflect the different sets of circumstances that salaried physicians may face. Implications of these results for coping with hospital decline, hospital-physician relationships, and integration strategies are discussed.