Background
Methods
Review design
Search strategy and study selection
Study selection criteria
Search outcome
Framework for analysis
Author, year, country | Sample | Medical speciality | Design | Career phase | Research focus/question |
---|---|---|---|---|---|
Bornschein et al. 2006 [21], Germany | Inpatient and outpatient care physicians in Munich 59% male Age: <35 = 1163 36–45 = 815 46–55 = 321 56+ = 136 Mean age: 38 | Different specialities | N = 5,461/2,450 (RR 47%) Employed physicians Cross-sectional, Quantitative | All career stages | Assess the extent to which the German law on working hours is actually implemented in employed physicians |
Davidson et al. 1998 [12], UK | Physicians qualified in the NHS in 1977 Mid 40s | Different specialities | N = 3,135/2,398 (RR 78.1%) Cross-sectional, Quantitative | Mid-career | Determine the career destinations by 1995 of physicians who qualified in 1977 |
Davidson et al. 2001 [29], UK | Physicians qualified in the NHS in 1974 Mean age: 48 | Different specialities | N = 2,217/1,717 (RR 77.4%) Cross-sectional, Quantitative (open question) | Mid-career | Systematic information about retirement intentions and factors that influence them |
Estryn-Behar et al. 2011 [23], France | French hospital physicians and emergency physicians 57.5% and 62.4% male Age: <35 = 8.2% and 25% 35–44 = 33.8% and 47% 45–54 = 34.5% and 23.5% 55+ = 23.6% and 4.5% | Different specialities of French physicians and emergency physicians | N = 3,196 (RR 66%) from this a representative sample (N = 1,924) was randomly selected and compared to 538 emergency physicians Cross-sectional, Quantitative | All career phases | Analysis of working conditions, satisfaction and health on ITL and burnout for French physicians with separate analysis for emergency physicians |
Estryn-Behar et al. 2011 [28], France | French hospital physicians 57.5% male Age: <35 = 8.2% 35–44 = 33.8% 45–54 = 34.5% 55+ = 23.6% | Different specialities | N = 3,196 (RR 66%) from this a representative sample (N = 1,924) was randomly selected Cross-sectional, Quantitative | All career phases | Analysis of the risk factors for burnout and intention to leave the profession according to gender |
Fuss et al. 2008 [30], Germany | Physicians from two university hospitals in North Rhine-Westphalia 60.1% male Age: <34 = 126 35–44 = 98 45–54 = 44 55+ = 21 Mean age: 38.3 | Different specialties | N = 761/296 (RR 38.9%) Cross-sectional, Quantitative | All career phases | Investigation of predictors for work interfering with family conflict |
Goldacre et al. 1999 [37], UK | All physicians who qualified in the UK in 1996 and 1993 About 50% male Age: NS (junior physicians) | All specialties | In 1996, N = 3809/2926 (RR 76.8%) Longitudinal – comparison of 1996 and 1993 graduates Quantitative | Early career | To report the career intentions 1 year after qualification of physicians who qualified in the UK in 1996 |
Hann et al. 2010 [2], UK | Family physicians Male: NS Aged 50 and below | Family physicians | N = 2,000/1,174 (RR 67%) Longitudinal (5 years) – Secondary analysis, Quantitative | Mid-career | Does a family physician’s stated intention to leave his/her job predict whether or not he/she actually does leave? |
Heponiemi et al. 2009 [27], Finland | Random sample of physicians 40.8% male Aged 25 to 65 Mean age: 45.9 | All specialties | N = 5,000/2,841 (RR 57%) Final sample: 2650 Cross-sectional, Quantitative | All career phases | Examine whether job control moderates the association between stress indicators and intention to change profession |
von dem Knesebeck et al. 2010 [31], Germany | Hospital physicians working in surgical fields 60.2% male Age: NS (920 residents and 391 consultants/senior physicians) | Surgery, gynaecology and obstetrics | N = 3,648/1,311 (RR 53%) Nationwide survey Cross-sectional, Quantitative | All career phases | Analyses of psychosocial stress in the workplace with the aid of the demand–control model, the effort–reward imbalance model and selected additional indicators |
Moss et al. 2004 [20], UK | Graduates in 1999 at the end of the first postgraduate year <50% men Age of junior physicians: NS | Graduates from all medical schools | N = 4,221/2,727 (RR 64.6%) Analysed physicians = 1,326 Cross-sectional, Quantitative (open question) | Early career | Study reasons why junior physicians trained in UK consider leaving UK medicine |
Ochsmann 2012 [24], Germany | Junior physicians in Bavaria in their first or second postgraduate year 42% men Mean age: 28.9 | Different specialities | N = 1,494/792 (RR 53%) Analysed physicians = 637 Cross-sectional, Quantitative | Early career | Examine the association between workplace factors and thinking about leaving clinical care using a gender-stratified approach |
Pachulicz et al. 2008 [26], US | Emergency physicians that completed residency in 1979,1984, 1988 and 1993 Over 80% men Age at 2004: primarily over the age of 45 with 6% over 65 | Emergency physicians | 1,269 participants in 2004 Longitudinal – three waves, Quantitative ITL was measured in 2004 (T3) | Mid-and late career | Objective and subjective career successes were hypothesized to mediate the relationships between socio-demographic variables, human capital indices, individual difference variables and organizational sponsorship as inputs and intention to leave medicine as the output variable |
Rittenhouse et al. 2004 [33], US | Specialist physicians practising in large urban counties in California 89.8% male Age: <55 years = 62.8%, 55–64 years = 27.3% 65+ years = 9.9% | Different specialities | N = 1,492/978 (RR 66%) Longitudinal (3 years), Quantitative | All career phases | To validate physicians’ self-reported intention to leave clinical practice and the Masterfile practice status variable as measures of physician attrition and to determine predictors of ITL and actual departure from clinical practice |
Scott et al. 2006 [25], UK | Representative sample of English and Scottish GPs 68% male Age in %: <35 = 0.14 35–39 = 0.19 40–44 = 0.21 45–49 = 0.18 50–54 = 0.17 55–59 = 0.09 60+ = 0.02 | General practitioners | N = 4,421/2,781 (RR 62.9%) 1,968 questionnaires were available for analysis (44%). Cross-sectional, Quantitative | All career phases | Clarify the relationships between ITL, overall job satisfaction, domains of job satisfaction and personal and job characteristics by using a structural recursive model |
Sibbald et al. 2003 [22], UK | Random sample general practitioner principals Male = 68.7% in 1998 and 70.6% in 2001 Age 1998 (2001): ≤35 = 113 (151) 36–40 = 187 (242) 41–45 = 195 (275) 46–50 = 125 (208) 51–55 = 102 (194) 56–60 = 53 (76) 61–65 = 15 (13) Mean age: 43.75 (44.35) | General practitioners | Sample 1998: 2,064/974 (RR 47%) Sample 2001: 2,000/1,332 (RR 67%) Final sample 790 in 1998 and 1,159 in 2001 Longitudinal, Quantitative | All career phases | Measure GPs’ intentions to quit direct patient care, to assess changes between 1998 and 2000 and to investigate associated factors, notably job satisfaction |
Williams et al. 2001 [32], US | Clinically active physicians working in patient care in office or hospital settings aged <57 years 66.7% male Mean age: 43.7 | Different specialities | N = 5,704/2,325 (adjusted RR 52%) Final sample 1,735 Cross-sectional, Quantitative | All career phases | Analysing a conceptual model of physician stress that explores its relationship with job satisfaction, physical and mental health and four types of withdraw intentions |
Author, year, country | Sample size | Questionnaires/ instruments/scales | Measurement of ITL | Percentage of ITL |
---|---|---|---|---|
Bornschein et al. 2006 [21]c, Germany | 2,450 | Questionnaire about working hours and working conditions developed by authors | “Do you thinking about giving up medical practice in in- or out-patient care?” Three-point scale (“yes”, “I have thought about it”, “no”) | Overall ITL = 53.7%, 13.8% intended to quit their job and 39.8% had thought about quitting their job |
Davidson et al. 1998 [12]a, UK | 2,398 | Questionnaire developed by authors | “Do you intend to practise in the NHS until normal retirement age?” Five-point scale (yes-definitely to no-definitely not) | 1,714 physicians worked in the NHS: 22.9% of the NHS physicians did not intend to work until normal retirement age and 11.5% were undecided |
Davidson et al. 2001 [29]a, UK | 1,717 | Questionnaire developed by authors | “Do you intend to practise in the NHS until normal retirement age for your current post?” Five-point scale (“yes, definitely” to “no, definitely not”) | 1,427 physicians worked in the NHS: 25.2% of the NHS physicians definitely did not plan to continue until normal retirement age, 26% would probably not and 13.9% were undecided |
Estryn-Behar et al. 2011 [23]b, France | 538 | Questionnaire from the NEXT study group adapted for physicians; focus on burnout, work–family conflict, satisfaction with pay scale, quality of teamwork, interpersonal relations within team, influence at work, quantitative demands, health | “How often during the course of the past year have you thought about giving up the medical profession?” Primarily over the age of 45-point scale (“never” to “every day”) | 21.4% of the emergency physicians considered leaving the profession with answers of “sometimes in a month” or “more often” |
Estryn-Behar et al. 2011 [28]b, France | 1,924 | Questionnaire from the NEXT study group adapted for physicians; focus on burnout, work–family conflict, satisfaction with pay scale, quality of teamwork, interpersonal relations within team, influence at work, quantitative demands, health | “How often during the course of the past year have you thought about giving up the medical profession?” Five-point scale (“never” to “every day”) | 17.4% of French hospital physicians considered leaving the profession with answers of “sometimes in a month” or “more often” |
Fuss et al. 2008 [30]b, Germany | 296 | Copenhagen Psychosocial Questionnaire (COPSOQ), work interfering with family conflict scale (WIF), items on hospital-specific work organization developed by the authors | “How often during the past 12 months have you thought about giving up your profession?” Five-point scale (“never” to “every day” – transformed to a range from 0 to 100) | Mean score = 18.6 |
Goldacre et al. 1999 [37]a, UK | 2,926 | Postal questionnaire developed by authors | “Apart from temporary visits abroad, do you intend to practise medicine in the UK for the foreseeable future?” If you did not answer “Yes, definitely”, are you: (a) considering practising medicine abroad? (b) considering leaving medicine but remaining in the UK? (c) considering leaving medicine and leaving the UK? Five-point scale (“yes, definitely” to “no, definitely not”) | 9.4% of the UK-based qualifiers in 1996 and 6.8% of overseas-based respondents expressed the possibility that they might leave medicine (“yes, probably” and higher) |
Hann et al. 2010 [2]a, UK | 1,174 | Data from the national survey of family physicians 2001 on ITL and job satisfaction and data from the annual census of physicians in the NHS for actually leaving | “Likelihood that they would leave direct patient care within the next 5 years” Five-point scale (“none” to “high”) | 139 (11.8%) rated the likelihood of ITL within next 5 years as “likely” or “high” |
Heponiemi et al. 2009 [27]c, Finland | 2,650 | Job control from Job Content Questionnaire, psychological distress from General Health Questionnaire, sleeping problems from Jenkins sleep problem scale | “If it were possible would you like to change to another profession with a similar salary?” Three response categories (“no”, “perhaps”, “yes”) | Not specified (in the regression analysis, the ITL measure was used as an ordinal variable which represents a higher level of ITL) |
von dem Knesebeck et al. 2010 [31]b, Germany | 1,311 | Effort–reward–imbalance questionnaire, Job Content Questionnaire (JCQ), two items on the shift of stress from work to private life, two items for quality of patient care | “How often in the preceding 12 months they had thought of giving up their profession” Five-point scale (“never”, “several times a year, … month, … week”, to “every day”) | 20.7% of the hospital physicians surveyed thought about giving up their profession at least a few times per month |
Moss et al. 2004 [20]c, UK | 1,326 | Questionnaire developed by authors, main question “Specifying main reasons for considering leaving” | “Considering leaving medicine but remaining in the UK” and “considering leaving medicine and the UK” were grouped to “considering leaving medicine” Five-point scale (“yes, definitely” to “no, definitely not”) | 42 of the 1326 physicians analysed (3.2%) were “probably not” or “definitely not” going to continue to practise medicine |
Ochsmann 2012 [24]b, Germany | 637 | Questionnaire developed by authors on demographic background, medical education, current workplace factors and health-related questions | “During the last 12 months I thought about giving up clinical practice…” Five-point scale (“never” to “every day”) | 52.3% thought about leaving clinical practice: 16 (2.5%) “every day”, 50 (7.8%) “a few times per week”, 98 (15.4%) “a few times per month”, 169 (26.5%) “a few times per year” and 304 (47.7%) “never”. |
Pachulicz et al. 2008 [26]a, US | 1,269 | American Board of Emergency Medicine (ABEM) Longitudinal Study of Emergency Physicians (LSEP) | Intention to leave medicine: “Whether or not they hoped to leave medical practice for another career in the next 5 years” (1 = “yes”, 0 = “no”) | Not specified |
Rittenhouse et al. 2004 [33]a, US | 978 | Survey of specialist physicians in urban California (1998); the American Medical Association (AMA) Physician Masterfile (2001); and direct ascertainment of physician practice status (2001) Main study items: career intention, career satisfaction, practice setting, practice experience | “Three years from now, do you think that you will be: (1) still practicing medicine and seeing patients; (2) still working in medicine but no longer seeing patients; (3) working in a career other than medicine; (4) retired.” | Intention to leave clinical practice = 8.8%: 5% intended to be still working in medicine but no longer seeing patients 3.8% intended to be working in a career other than medicine (12.8% intended to retire) |
Scott et al. 2006 [25]a, UK | 1,968 | Questionnaire developed by authors | “Likelihood of leaving direct patient care within five years” (1 = “none”, 5 = “high”) | Mean score 2.15 (standard deviation 1.36) |
Sibbald et al. 2003 [22]a, UK | 790 in 1998, 1,159 in 2001 | National postal surveys on overall job satisfaction, intention to leave direct patient care and physicians’ personal and practice characteristics | “Likelihood of leaving direct patient care (primary or hospital) within five years” Five-point scale (“none” to “high”) | Scores of 4 and 5 were determined as ITL Intending to quit direct patient care in the next 5 years rose from 14% in 1998 to 22% in 2001 |
Williams et al. 2001 [32]a, US | 1735 | Perceived stress scale, global job satisfaction, single item for physical health, mental health three-item measure (anxiety, depression and burnout) | Likelihood of “leaving the practice of direct patient care within 5 years” Five-point likelihood scale (3 = “moderate”) | 18.5% of the physicians expressed a “moderate” or greater likelihood of leaving direct patient care |