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.