Overall job satisfaction

The overall job satisfaction of graduates of the “Rural Oriented Medical Students Training Project” was 2.81 ± 0.687 in Jiangsu. This score was slightly lower than physicians in western provinces of China [15] and the Shandong province [16], and was much lower than their counterparts in Australia and the US [5, 17]. The present study exhibited that 34.0% of graduates were considering quitting their job. This was similar to the 34.03% turnover intention rate reported by a survey for rural doctors in central China [18].

Graduates of the “Rural Oriented Medical Students Training Project” reported the highest levels of satisfaction in occupational ecology (3.33 ± 0.673) and the lowest levels in the internal environment (2.81 ± 0.687). This finding was concurrent with that of a Polish study [19], which exhibited a high level of inherent dimension and a low level of personal dimension in similar items.

Factors associated with satisfaction

Satisfaction is affected by multiple factors. Income can be a major contributor to dissatisfaction. Compared with their counterparts in the United States, Chinese rural doctors have a much lower income with almost similar work hours [20]. In the national range, wages vary widely with the local economic level. The average annual income of rural physicians in Shanghai was 43,400 RMB [21] (3600 RMB per month), whereas 70% of rural physicians earned less than 2000 RMB per month in the Henan Province [22]. The salary of rural doctors in the Jiangxi and Guangxi Provinces was approximately 1500 RMB per month, whereas in the Qinghai Province was approximately 3500 RMB [23]. In the present study, nearly 60% of rural physicians in Jiangsu earned a monthly income of 3000–6000 RMB, which matched middle- and upper-class salaries nationwide.

The living cost in rural areas is lower than that in urban areas; however, the gap gradually decreases. Additionally, young people in China, including people who worked in rural areas, tend to buy houses downtown. Thus, the commute between town and country also increased the living cost. This could be stressful, especially when the doctors got married or had children. The present study exhibited that an income of 3000–6000 RMB per month was positively linked to the internal environment, life satisfaction, and total satisfaction compared with an income of < 3000 RMB, whereas an income of ≥6000 RMB per month played positive roles in most dimensions of satisfaction except stress. Low income was directly linked to the retention rates of rural physicians. “Higher salary for the same work” was the promise of some rural hospitals. This could attract the project graduate physicians when the workplace is remote or the working environment is poor. The graduates in central and southern Jiangsu were more satisfied with the internal environment than their northern counterparts. When we designed this survey, we divided Jiangsu into three areas according to the economic level, which strongly linked to salary, physician well-being, and rural hospital infrastructure. A lack of highly specialized equipment and a lower financing level might pose barriers to providing complex care [19].

Attending doctors were more satisfied with their internal environment, life satisfaction, competency, occupational ecology, and total satisfaction than residents among graduates of the “Rural Oriented Medical Students Training Project”. This finding is concurrent with that of a Polish study [19]. Studies exhibited the link between satisfaction, age, and length of employment [15, 16, 19, 24]. While professional rank was correlated with age and length of employment, age was not an independent factor of satisfaction, it linked to many factors. This could explain why age did not enter the multiple regression model in the present study. Age, personal qualities, and hard work also play a significant role in attaining a high professional rank. A higher proportion of the project graduates attended outpatient and home visits compared with their counterparts. This explains why attending doctors are more satisfied with competency and occupational ecology. They have their group of patients through years of accumulation, and their patients also recognize their professional services. The critical point for policymakers is to improve the attraction of a rural place and increase the retention rate. “Title promotion” can be used as one of the solutions..

The work hours of rural physicians in Jiangsu were roughly the same as their counterparts in Europe and the US [19, 25]. According to the present study, 55.3% of graduates of the “Rural Oriented Medical Students Training Project” serviced no more than 60 patients per week; however, 36.3% worked for more than 50 h per week. A positive correlation between moderate work hours per week (40–50 h) and high satisfaction on competency, stress, and total satisfaction, higher weekly working hours (≥ 50 h) were positively linked with total satisfaction and satisfaction on work stress. This finding contradicts with other studies [15, 19]. One possible explanation for this is that graduates of the “Rural Oriented Medical Students Training Project” comprised a younger population. Thus, they are on a rising period of their career. Working hours accumulate working experience and reflect the value of their job, which also builds professional confidence. Lu et al. [24] mentioned that the retention rate of rural physicians could be affected by recognition of their work.

Public health physicians (PHP) of the graduates of the “Rural Oriented Medical Students Training Project” were more satisfied with occupational ecology and work stress. In China, PHP is mainly responsible for treating infectious diseases and public health emergencies, healthcare of children aged 0–6 years, older adults over 60 years of age, pregnant women, and psychiatric patients [26]. The work content of PHP is relatively fixed. Compared with clinical physicians, PHP exhibited a moderate workload, closer patient-doctor relationships, and a better work reputation.

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