Relationships between physicians' psychological contract and job satisfaction, intention to leave medical practice, and professionalism: a cross-sectional survey in China.

BACKGROUND: Physician motivation to maintain public welfare has become the key for the New Public Hospital Reform in China. This study aimed to apply a different perspective, the psychological contract (a popular concept in business management research) and explore the correlations between physicians' psychological contract and their job satisfaction, intention to leave medical practice, and professionalism.

METHODS: A cross-sectional survey was conducted using a stratified sampling method in Shanghai, Hubei, and Gansu in China from June 10 to October 30, 2013. Anonymous, self-administered questionnaires were distributed in 123 public hospitals. We developed a scale on physicians' psychological contract including four dimensions (transactional, developmental, relational, and ideological responsibilities of hospitals), and it was proved to be valid and reliable. We designed the content on professionalism under the framework of the Medical Professionalism Project's Physician's Charter. A structural equation model was used for analysis.

FINDINGS: 2210 physicians participated in this survey and 1656 valid questionnaires were collected. The result showed that the fulfilment of hospital transactional, developmental, and relational responsibilities had significantly positive relationships with physicians' job satisfaction (standardised correlation coefficient 0·22 [p<0·001], 0·10 [p<0·05], 0·28 [p<0·001], respectively.), fulfilment of transactional and developmental responsibilities had notably negative relationships with intention to leave (-0·15 [p<0·001], -0·12 [p<0·01], respectively.), and fulfilment of ideological responsibilities had a remarkably positive correlation with professionalism (0·26 [p<0·001]).

INTERPRETATION: These findings suggest that the higher the standard of ethical rules and expectations that hospitals adhere to in practice, the higher the level of professionalism of physicians. They also indicate that the better the fulfilment of the psychological contract, the greater physicians' job satisfaction and lower intention to leave medical practice. The results could have implications for hospital management and health-care policy making. Study limitations were that data were based on self-reports, which may involve recall or report bias; and causal associations could not be established because of the study's cross-sectional nature.

FUNDING: This study was supported by the National Natural Science Foundation of China (Grant number 71203032), and the Shanghai Planning Project of Philosophy and Social Science (Grant number 2014EGL005).