Primary Healthcare Physicians' Work Pressure and Turnover Intent Before, During, and After the COVID-19 Pandemic

Katica Tripković, Milena Šantrić-Milićević

Keywords: primary healthcare, work pressure, turnover intent

Background:

A ‘quintupled’ healthcare workforce crisis has culminated across Europe during the COVID-19 pandemic-induced demand for healthcare services, necessitating proficient strategic healthcare management. Even in the economically advanced public primary healthcare system of Belgrade (Serbia), there are persistent challenges in recruiting and retaining sufficient primary healthcare physicians (PHCPs).

Research questions:

o investigate the prevalence of work pressure among Belgrade PHCPs and its association with turnover intent before (2019), during (2021), and after the COVID-19 pandemic (2023).

Method:

With a robust cross-sectional design we estimated the age and sex prevalence of work pressure (WP at a 5-point Likert scale, from 1=none to 5= very high) and turnover intention (TI: yes vs. no) among PHCPs from 15 primary healthcare centers in 2019 (n=910), 2021 (n=900), and 2023 (n=931). We obtained data from the electronic databases of the Belgrade Public Health Institute, which conducts standardized annual surveys of public PHCPs. Univariate and multivariate logistic regression Odds Ratio with corresponding 95% Confidence Interval (OR 95% CI) are externally valid, given the response rates: 87.2% in 2019, 83.4% in 2021, and 82.9% in 2023.

Results:

The annual prevalence of both reported PHCPs’ high and very high WP (the highest in 2021: 51.7%) and positive TI (peaking at 32.0%) varied annually (p<0.01 and p<0.01). In all observed years, the highest OR, 95% CI for high and very high WP was in 2023 for female PHCPs (1.96, 1.35-2.84), aged 35-54 years (1.74, 1.13-2.69), 54 years or older (1.80, 1.13-2.88), managers (1.88, 1.22-2.89), and with positive TI (3.99, 2.92-5.45).

Conclusions:

Our findings, which reveal that almost every second PHCP in Belgrade reported high or very high work pressure before, during, and after the pandemic, while almost every third reported turnover intent, underscore the critical need for effective work pressure management. This management must combat turnover intent and be tailored to age and gender characteristics.

Points for discussion:

No significant association was found between work pressure and dual practice due to various reasons.

Which kind of management training would be helpful to balance the workload among PHCPs?

Reinforcing physicians' requirements planning skills is beneficial for managers to efficiently tailor the skill mix to the specific needs of primary healthcare centers, at present and in the foreseeable future.

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