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Open Access
Article
Publication date: 27 February 2024

Siva Shaangari Seathu Raman, Anthony McDonnell and Matthias Beck

Society is critically dependent on an adequate supply of hospital doctors to ensure optimal health care. Voluntary turnover amongst hospital doctors is, however, an increasing…

Abstract

Purpose

Society is critically dependent on an adequate supply of hospital doctors to ensure optimal health care. Voluntary turnover amongst hospital doctors is, however, an increasing problem for hospitals. The aim of this study was to systematically review the extant academic literature to obtain a comprehensive understanding of the current knowledge base on hospital doctor turnover and retention. In addition to this, we synthesise the most common methodological approaches used before then offering an agenda to guide future research.

Design/methodology/approach

Adopting the PRISMA methodology, we conducted a systematic literature search of four databases, namely CINAHL, MEDLINE, PsycINFO and Web of Science.

Findings

We identified 51 papers that empirically examined hospital doctor turnover and retention. Most of these papers were quantitative, cross-sectional studies focussed on meso-level predictors of doctor turnover.

Research limitations/implications

Selection criteria concentrated on doctors who worked in hospitals, which limited knowledge of one area of the healthcare environment. The review could disregard relevant articles, such as those that discuss the turnover and retention of doctors in other specialities, including general practitioners. Additionally, being limited to peer-reviewed published journals eliminates grey literature such as dissertations, reports and case studies, which may bring impactful results.

Practical implications

Globally, hospital doctor turnover is a prevalent issue that is influenced by a variety of factors. However, a lack of focus on doctors who remain in their job hinders a comprehensive understanding of the issue. Conducting “stay interviews” with doctors could provide valuable insight into what motivates them to remain and what could be done to enhance their work conditions. In addition, hospital management and recruiters should consider aspects of job embeddedness that occur outside of the workplace, such as facilitating connections outside of work. By resolving these concerns, hospitals can retain physicians more effectively and enhance their overall retention efforts.

Social implications

Focussing on the reasons why employees remain with an organisation can have significant social repercussions. When organisations invest in gaining an understanding of what motivates their employees to stay in the job, they are better able to establish a positive work environment that likely to promote employee well-being and job satisfaction. This can result in enhanced job performance, increased productivity and higher employee retention rates, all of which are advantageous to the organisation and its employees.

Originality/value

The review concludes that there has been little consideration of the retention, as opposed to the turnover, of hospital doctors. We argue that more expansive methodological approaches would be useful, with more qualitative approaches likely to be particularly useful. We also call on future researchers to consider focussing further on why doctors remain in posts when so many are leaving.

Details

Journal of Health Organization and Management, vol. 38 no. 9
Type: Research Article
ISSN: 1477-7266

Keywords

Article
Publication date: 6 February 2024

Radhika Gore

The institutional conditions of primary care provision remain understudied in low- and middle-income countries. This study analyzes how primary care doctors cope with medical…

Abstract

Purpose

The institutional conditions of primary care provision remain understudied in low- and middle-income countries. This study analyzes how primary care doctors cope with medical uncertainty in municipal clinics in urban India. As street-level bureaucrats, the municipal doctors occupy two roles simultaneously: medical professional and state agent. They operate under conditions that characterize health systems in low-resource contexts globally: inadequate state investment, weak regulation and low societal trust. The study investigates how, in these conditions, the doctors respond to clinical risk, specifically related to noncommunicable diseases (NCDs).

Design/methodology/approach

The analysis draws on year-long ethnographic fieldwork in Pune (2013–14), a city of three million, including 30 semi-structured interviews with municipal doctors.

Findings

Interpreting their municipal mandate to exclude NCDs and reasoning their medical expertise as insufficient to treat NCDs, the doctors routinely referred NCD cases. They expressed concerns about violence from patients, negative media attention and unsupportive municipal authorities should anything go wrong clinically.

Originality/value

The study contextualizes street-level service-delivery in weak institutional conditions. Whereas street-level workers may commonly standardize practices to reduce workload, here the doctors routinized NCD care to avoid the sociopolitical consequences of clinical uncertainty. Modalities of the welfare state and medical care in India – manifest in weak municipal capacity and healthcare regulation – appear to compel restraint in service-delivery. The analysis highlights how norms and social relations may shape primary care provision and quality.

Details

International Journal of Sociology and Social Policy, vol. ahead-of-print no. ahead-of-print
Type: Research Article
ISSN: 0144-333X

Keywords

Article
Publication date: 27 January 2012

Jayne Greening

This article aims to review some of the literature relating to the concept of effective engagement of doctors with health service redesign and delivery and discuss the relevance…

903

Abstract

Purpose

This article aims to review some of the literature relating to the concept of effective engagement of doctors with health service redesign and delivery and discuss the relevance in light of recent developments from the Academy of Medical Royal Colleges.

Design/methodology/approach

This article is a literature overview and personal reflection. It contains elements of personal reflection on the recent historical policy changes that have the potential to lead to frontline changes in the development of managerial training for doctors and how this could benefit healthcare systems

Findings

For services to be effective doctors need to be engaged in their design. Historically the engagement of doctors in this process has been haphazard and often taken on by doctors who have been provided with little management training. This has led to internal and external conflict and possibly been a contributing factor to lack of clinical engagement. The recent suggestions by the Academy of Medical Royal Colleges and NHS Institute for Innovation and Improvement around mandatory management training for doctors throughout all stages of their training as doctors has the potential to improve effective clinical engagement of doctors in service redesign and delivery and therefore their potential for success.

Originality/value

This paper has been written by a consultant psychiatrist who is involved with frontline delivery of services, medical management and training of doctors and medical students.

Details

Leadership in Health Services, vol. 25 no. 1
Type: Research Article
ISSN: 1751-1879

Keywords

Article
Publication date: 1 October 1996

John Øvretveit

Notes that medical participation in organization‐wide quality programmes and leadership of quality is commonly viewed as the key to a successful programme. Reviews and reports…

524

Abstract

Notes that medical participation in organization‐wide quality programmes and leadership of quality is commonly viewed as the key to a successful programme. Reviews and reports research into doctors’ involvement in such programmes as distinct from doctors’ involvement in medical quality activities. Reveals the lack of systematic evidence on the subject, suggests areas for future research, and summarizes what is known. Gives recommendations based on reported research and experience for quality training for doctors and how medical managers might engage their colleagues and other professions in quality programmes.

Details

Journal of Management in Medicine, vol. 10 no. 5
Type: Research Article
ISSN: 0268-9235

Keywords

Open Access
Article
Publication date: 6 October 2015

Erwin Loh

The purpose of this paper is to review the current literature and summarises the benefits and limitations of having doctors in health management roles in today’s complex health…

9276

Abstract

Purpose

The purpose of this paper is to review the current literature and summarises the benefits and limitations of having doctors in health management roles in today’s complex health environment.

Design/methodology/approach

This paper reviews the current literature on this topic.

Findings

Hospitals have evolved from being professional bureaucracies to being managed professional business with clinical directorates in place that are medically led.

Research limitations/implications

Limitations include the difficulty doctors have balancing clinical duties and management, restricted profession-specific view and the lack of management competencies and/or training.

Practical implications

The benefits of having doctors in health management include bottom-up leadership, specialised knowledge of the profession, expert knowledge of clinical care, greater political influence, effective change champions to have on-side, frontline leadership and management, improved communication between doctors and senior management, advocacy for patient safety and quality, greater credibility with public and peers and the perception that doctors have more power and influence compared to other health professionals can be leveraged.

Originality/value

Overall, there are more benefits than there are limitations to having doctors in health management but there is a need for more management training for doctors.

Details

Journal of Work-Applied Management, vol. 7 no. 1
Type: Research Article
ISSN: 2205-2062

Keywords

Article
Publication date: 1 October 1994

Allan Bruce and Sandra Hill

Based upon empirical research conducted in 1993, attempts to illustratethe implications of efforts to bring doctors into management. Itaddresses in particular the role of key…

530

Abstract

Based upon empirical research conducted in 1993, attempts to illustrate the implications of efforts to bring doctors into management. It addresses in particular the role of key appointments such as the medical director and clinical directors and the perceptions of these roles. Doctors continue to demonstrate themselves to be reluctant managers and this continues to pose problems for the aspirations contained in Working for Patients. Crucial questions must be asked about whether management represents a productive use of doctors′ time and whether the NHS can afford premium rates for largely inexperienced managers. Identifies changes that have taken place to date and indicates that doctors are, for the most part, still lukewarm about a career in medical management.

Details

Journal of Management in Medicine, vol. 8 no. 5
Type: Research Article
ISSN: 0268-9235

Keywords

Article
Publication date: 1 March 2005

Thomas Plochg and Niek S. Klazinga

To explore theoretically the reasons for the modest uptake of clinical governance practices by taking the literature on the origin of tensions between doctors and managers as the…

2112

Abstract

Purpose

To explore theoretically the reasons for the modest uptake of clinical governance practices by taking the literature on the origin of tensions between doctors and managers as the starting‐point.

Design/methodology/approach

The approaches of doctors and managers to the division and coordination of medical work are analysed theoretically from a twofold perspective that combines insights from sociologists' theories on “professionalism” and administrative scientists' theories on “management science”.

Findings

The combined perspective theoretically explains the problems between doctors and managers that frustrate the uptake of clinical governance practices. By inference from this theoretical analysis, a twofold agenda for a constructive dialogue is proposed. Doctors and managers must develop a shared vision of the division and coordination of medical work as well as discussing the values, norms and goals underlying patient care. It is questionable, however, whether this agenda is currently adequately addressed.

Originality/value

This paper provides a theoretical underpinning for the dialogue between doctors and managers. It may be enlightening for all doctors and managers working in the field.

Details

Clinical Governance: An International Journal, vol. 10 no. 1
Type: Research Article
ISSN: 1477-7274

Keywords

Book part
Publication date: 27 October 2005

Janice McCabe

Medicalization is the increasing social control of the everyday by medical experts. It is a key concept in the sociology of health and illness because it sees medicine as not…

Abstract

Medicalization is the increasing social control of the everyday by medical experts. It is a key concept in the sociology of health and illness because it sees medicine as not merely a scientific endeavor, but a social one as well. Medicalization is a “process whereby more and more of everyday life has come under medical dominion, influence, and supervision” (Zola, 1983, p. 295); previously these areas of everyday life were viewed in religious or moral terms (Conrad & Schneider, 1980; Weeks, 2003). More specifically, medicalization is the process of “defining a problem in medical terms, using medical language to describe a problem, adopting a medical framework to understand a problem, or using a medical intervention to ‘treat’ it” (Conrad, 1992, p. 211). Sociologists have used this concept to describe the shift in the site of decision-making and knowledge about health from the lay public to the medical profession.

Details

Sociological Studies of Children and Youth
Type: Book
ISBN: 978-0-76231-256-6

Book part
Publication date: 12 October 2011

Scott V. Savage

Using data from the General Social Survey (2002), structural equation modeling is employed to examine the intersections and relationships between various socio-demographic and…

Abstract

Using data from the General Social Survey (2002), structural equation modeling is employed to examine the intersections and relationships between various socio-demographic and contextual variables, patient trust, and patient preference for behaviors that indicate a desire to be an active health care participant. In so doing, a gap in the literature is addressed by uniting previous research on patient trust with research on patient participation. Findings reveal that patient trust in doctors and various socio-demographic and contextual variables are associated with people wanting to participate in the health care process by learning about medical issues on their own and by contributing to medical decisions. Results also shed new light on past research, which finds a relationship between various socio-demographic variables and patient trust. Specifically, they highlight the importance of distinguishing between patient trust in doctors and patient trust in the broader health care institution and the economic pressures it exerts on doctors. A discussion of what these findings might mean for our understanding of the doctor-patient relationship and the delivery of health care concludes the chapter.

Details

Access to Care and Factors that Impact Access, Patients as Partners in Care and Changing Roles of Health Providers
Type: Book
ISBN: 978-0-85724-716-2

Keywords

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