The impact of training and working conditions on junior doctors' intention to leave clinical practice

Background: The shortage of physicians is an evolving problem throughout the world. In this study we aimed to identify to what extent junior doctors' training and working conditions determine their intention to leave clinical practice after residency training. Methods: A prospective cohort study was conducted in 557 junior doctors undergoing residency training in German hospitals. Self-reported specialty training conditions, working conditions and intention to leave clinical practice were measured over three time points. Scales covering training conditions were assessed by structured residency training, professional support, and dealing with lack of knowledge; working conditions were evaluated by work overload, job autonomy and social support, based on the Demand-Control-Support model. Multivariate ordinal logistic regression analyses with random intercept for longitudinal data were applied to determine the odds ratio of having a higher level of intention to leave clinical practice. Results: In the models that considered training and working conditions separately to predict intention to leave clinical practice we found significant baseline effects and change effects. After modelling training and working conditions simultaneously, we found evidence that the change effect of job autonomy (OR 0.77, p = .005) was associated with intention to leave clinical practice, whereas for the training conditions, only the baseline effects of structured residency training (OR 0.74, p = .017) and dealing with lack of knowledge (OR 0.74, p = .026) predicted intention to leave clinical practice. Conclusions: Junior doctors undergoing specialty training experience high workload in hospital practice and intense requirements in terms of specialty training. Our study indicates that simultaneously improving working conditions over time and establishing a high standard of specialty training conditions may prevent junior doctors from considering leaving clinical practice after residency training

Impact of social factors on health status and help seeking behavior among migrants and Germans

Several studies show significant differences between Germans and migrants in health status, help-seeking behavior and utilization of health care facilities. Social factors are potential determinants partially explaining these differences. The main objective of the present cross-sectional study is to study the impact of social factors on health status and health care utilization including preventive services among Germans and migrants in the German health care system. A survey was conducted among 565 adults (mostly parents; 49% migrants, 51% Germans) accompanying their children at the compulsory medical school entry examination. The survey aimed at the self-reported health status of the adults, the help-seeking behavior, social and demographic variables as well as factors describing the ethnic background and the process of migration. As a result we found a statistically significant lower level of health care utilization for migrants compared to Germans whereas the self-reported health status was similar between Germans and migrants and not dependant on social factors. Social factors accounted for differences in health care utilization including the use of preventive services among both groups (Germans and migrants). Despite the ethnic background, a low social class was significantly associated with a decreased use of health care facilities among Germans and migrants compared to adults from a high social class. Further studies are needed to identify certain obstacles to utilizing the German health care system by adults from a low social class. Public health interventions could be suitable for addressing these difficulties.Angela Keller and Bernhard T. Baun