Occupational Identity, Job Satisfaction and Their Effects on Turnover Intention among Chinese Pediatricians: A Cross-sectional Study

doi:10.21203/rs.2.20760/v1

Objectives

This study contributes to research on the paediatrician shortage by examining occupational identity, job satisfaction and their effects on turnover intention among pediatricians in China.

Methods

This study employed a multi-stage stratified random sampling method to conduct a questionnaire survey. Of the 4906 survey recipients, valid data were collected from 4198 of the respondents (85.6%). Participants were from seven regions of China (south, central, north, east, northwest, southwest, northeast). Pediatricians who volunteered and provided informed, written consent participated.We analysed the collected data with descriptive analyses, one-way analysis, and pearson correlation analysis in SPSS 23.0; common method bias in AMOS 24.0; and mediating effect analysis in SPSSMARO.

Results

There were significant differences among the respondents in terms of TI based on age, education, marital status, region, type and grade of practice setting, professional title, years in practise, workload, rest days, and monthly income. Occupational identity and job satisfaction were both negatively related to turnover intention, and occupational identity was positively correlated with job satisfaction(r1=-0.601, p<0.001; r2=-0.605, p<0.001). And the result also showed that job satisfaction plays a mediating role in the association between occupational identity and turnover intention among Chinese pediatricians.

Conclusions

To reduce turnover intention among pediatricians in China, it is crucial to focus on three aspects: work condition, workload and salary. We suggest healthcare managers should increase investment in pediatric, carry out reforms on salary mechanism and pay more attention to female and young pediatricians.

Health Policy

Health Economics & Outcomes Research

Pediatricians

Occupational Identity

Job Satisfaction

Turnover Intention

Since the reform of the health system in China, infant mortality has decreased from 50.2‰ in 1991 to 6.1‰ in 2018 and other child health indicators have improved considerably ¹. Although pediatric services in China has improved, the child health system in China is in danger of collapse due to a shortage of pediatricians. According to China national statistics, in 2017, there were only 0.63 registered pediatricians younger than 65 years of age per 1000 children ². A survey about characteristics and workload of pediatricians in China shows that the distribution of pediatricians was extremely skewed (Gini coefficient 0.61) and they have been burdened with a greater workload in 2016 ³. At the same time, the universal two-child policy implemented on January 1, 2016, which aims to address the country's population aging trend, exacerbates the shortage of pediatrician in China ⁴⁻⁷. Moreover, pediatricians have one of the highest rates of turnover among physician specialists ⁷. According to the China Pediatric Resources White Paper, from 2011 to 2014, 14310 pediatricians left their position, accounting for 10.7% of pediatricians overall ⁸. Shortage of pediatricians and high turnover rate make China's pediatric health care system facing challenges.

OI is also referred to as vocational, work, occupational, or career identity and is related to the conscious awareness of oneself as a worker ⁹. OI, a vocational-psychology term, is defined as a social construction or an internal psychological process ¹⁰. In a change-filled professional environment, OI helps people adapt to new opportunities ¹¹, therefore, OI is considered a contributor to professional emotions and career choices. Early research explored OI among healthcare workers. Wu ¹² and Zhao ¹³ revealed that OI was associated with education, type of practice setting and salary among healthcare workers in China, and a study conducted by Selma et al. ¹⁴ demonstrated that OI was correlated with job satisfaction and intention to leave the profession among nurses in Turkey. Similarly, in a study, Zhang et al. ¹⁵ confirmed that OI was a strong predictor of TI among township health inspectors in China.

Job satisfaction refers to the extent to which people like (satisfaction) or dislike (dissatisfaction) their jobs ¹⁶. It is an attitude or emotional response to one’s tasks and to the physical and social conditions of the workplace ¹⁷. In fact, job satisfaction is related to many factors. Manojlovich ¹⁸ has verified that factors in the practice environment contributed both directly to nursing job satisfaction Healy et al. ¹⁹ and Ozyurt et al. ²⁰ revealed that job satisfaction is inversely correlated with burnout. Jackson et al. ²¹ showed that women and young doctors may have a higher risk of dissatisfaction at work. In a study among Australian nurses’ job satisfaction on retention by Cowin and Leanne ²² also confirmed that experienced nurses had relatively stable job satisfaction and salary became a significant area of young nurses’ job satisfaction. Tao et al. ²³demonstrated that job satisfaction was strong predicator of turnover intention among pediatricians in China

According to Mobley ²⁴, TI is considered to be the best and intuitive predictor of actual turnover behavior, and it refers to the probability that an employee will voluntarily leave his or her job in the period ahead ²⁵. As recognition has increased regarding the importance of the association between TI and the actual level of organization management ²⁶, a large number of studies have focused on TI in occupational populations. A study among Jordanian nurses in psychiatric units by Alsaraireh et al ²⁷. found a significant negative correlation between job satisfaction and turnover intention. Zhang et al. ¹⁵ demonstrated that professional identity, job satisfaction and work engagement were strong predicator of turnover intention among township health inspectors in China.

However, few investigations have been conducted to the status of occupational identity (OI), job satisfaction and TI among pediatrician. We administered a survey to registered pediatricians in China to identify the key factors that influence how pediatricians perceived toward their work, explore the relations between OI, job satisfaction and TI and develop new and better ways to address the shortage of pediatrician. Related to this issue is the benign professional attitude construction of pediatricians. In a stressful practice environment, pediatricians are subject to higher workloads and work pressure and relatively low salaries, which may place pediatrician at risk for emotional exhaustion and increased turnover intention (TI) ²⁸.

Participants

This study is a part of a research project by the Humanities and Social Sciences of the Ministry of Education of China, Exploration on Reasons and Countermeasures for the Shortage of Pediatricians in China. According to the national statistics, by the end of 2016, the number of pediatricians in China was 114,010 so the minimum sample size is 1,141(1%). For the purpose of data reliability and validity, the estimated sample size for this survey is 4,500. The study included a multi-stage hierarchical sample based on collaboration with the Pediatric Society of the Chinese Medical Doctor Association (PS-CMDA) and the Neonatal Society of the Chinese Medical Doctor Association (NS-CMDA). From August 2018 to December 2018, this study employed a multi-stage stratified random sampling method to conduct a questionnaire survey, which first divides the country into 7 regions of South China, Central China, North China, East China, Northwest China, Southwest China, Northeast China, and randomly selects 8 cities in each region. According to the proportion and grades of local medical institutions, and each medical institution randomly selects 10 to 20 pediatricians (including attending physicians and residents). A total of 4,906 questionnaires were distributed and 4,198 questionnaires were actually collected. The questionnaire recovery rate was 85.6%.

Study Measures

The study questionnaire, comprising 46 items, was based on world-widely accepted scale and translated into Chinese. The predicted time to finish questionnaire was 10–15 min.

Part 1 included basic socio-demographic and work-related characteristics, including age, gender, education, marital status, type and grade of practice setting, professional title, years in practice, number of hospital beds administered, rest day in a week and monthly salary.
In part 2, OI was measured using a 10-item Chinese version of the occupational identity scale (CPIS) developed by Cai (2003) and based on the original Occupational Identity Scale (Tyler & McCallum, 1998) ^29,30. Items included “My present job makes me feel very proud” and 9 other items. The CPIS has a 5-point response format, ranging from 1= “strongly disagree” to 5= “strongly agree”. Total scores can range from 10 to 50 and higher scores indicate higher levels of OI. Cronbach’s α for CPIS was 0.919.
In part 3, job satisfaction was measured using the Chinese version of the Minnesota Satisfaction Questionnaire-Short Version (MSQ-short version) developed by Wu and based on MSQ-short version developed by Weiss ³¹, a well-known and stable instrument used for measuring job satisfaction. The MSQ-short version includes 20 items. It includes two subscales: Intrinsic Job Satisfaction (IJS) (consisting of 12 items, including activity, independence, variety, social status, moral value, security, social service, authority, ability utilization, responsibility, creativity, achievement) and Extrinsic Job Satisfaction (EJS) (consisting of 6 items including supervision-human relation, supervision-technical, company policies and practices, salary, recognition). Two additional items explore satisfaction with working conditions and co-worker relationships. Results are reported as General Job Satisfaction (GJS), which is a total score for all 20 items and subscale scores for IJS and EJS ^32,33. The 20 items in the MSQ-short version are rated on a 5-point Likert scale (ranging from 1= “very dissatisfied with this aspect of my job” to 5= “very satisfied with this aspect of my job”). Item responses are summed or averaged to create a total score range from 20 to 100– the lower the score is, the lower the level of job satisfaction ³³. Cronbach’s α for MSQ was 0.919.
Part 4 consisted of a 4-item instrument measuring TI developed by Farh that is considered to have high internal uniformity and retest reliability ^34,35. The responses are based on a 5-point Likert scale (ranging from 1= “strongly disagree” to 5= “strongly agree”). Total scores can range from 4 to 20 and higher scores indicate higher levels of TI. Cronbach’s α for TI was 0.764.

Statistical Analysis

We analysed the collected data with SPSS 23.0 with the following objectives: 1) descriptive analyses including number (N) and percentage (%) for socio-demographic and work-related characteristics; 2) a controlling for effects of an unmeasured latent methods factor employed to common method bias: construct three models with four items of occupational identity(10 items),internal job satisfaction(12 items),external job satisfaction(6 items),turnover intention(4 items) and compare model differences in AMOS 24.0; 3) one-way analysis of variance to compare group differences on the measurements of the socio-demographic variables; 4) pearson correlation analysis of OI, job satisfaction and TI; and 5) bootstrap method used to mediating effect analysis: set internal job satisfaction and external job satisfaction as mediator variable to test mediating variable between occupational identity and turnover intention in SPSSMARO.

Descriptive Analysis of the Socio-demographic and Worked-related Characteristics

A total of 4906 paediatricians were invited to participate in the study, and valid data were collected from 4198 of the paediatricians (85.6%). Table 1 provides the descriptive statistics for the individual variables analysed in this study. The age of the respondents varied between 20 and 74 years old, and approximately 85% of the respondents were younger than age 50 years of age. A majority of the participants were female (70.1%), and the majority of paediatricians in China are female. In terms of education, most of the respondents had a university degree or above (94.7%), and most held a bachelor’s degree. A majority of the participants were married at the time of the study (88.7%).

With respect to practice setting, a majority of the participants worked in a government general hospital (71%), and smaller percentages worked in a children’s hospital (8.1%) or other settings (1.7%). A considerable majority of the respondents worked in a secondary (40.5%) or tertiary (55.8%) practice setting. Of the respondents, 29.3% were junior doctors, 30.6% were middle doctors, and 40.0% were senior doctors. Over half of the participants reported working for over 10 years (54.2%). Most of the respondents reported being responsible for 5–15 hospital beds (68.5%) and they were most likely to have 1 day of rest each week(42.6%). Monthly salary < 10000 yuan was reported by 82.5% of the respondents.

Common method bias analysis of Occupational Identity, Job Satisfaction and Turnover Intention

We used controlling for effects of an unmeasured latent methods factor to verify whether there was a common method bias. The single factor model has a poor fit, and the four-factor model has a good fit(Table 2). After adding the common method factor to the four-factor model, the fitting index of model was not improved a high degree. The RMSEA and SRMR reduction values was not more than 0.05(Table 2), and the CFI and TLI increased values was not more than 0.1(Table 2), which indicates the fitting date of model with the method factor no significant improvement was made, indicating that although common method bias may exist, it has less impact on the study ³⁶.

The Status Quo of Occupational Identity, Job Satisfaction and Turnover Intention among Paediatricians

The mean score for OI was 28.52 and ranged from 10 to 50 (SD = 8.516) (Table 3). The ANOVA revealed that with the exception of marital status, all the socio-demographic and work-related characteristics were tested to be significantly associated with OI (Table 3 & Table 4).

In the terms of job satisfaction, the distribution of the pediatricians’ responses to the 20 5-point indicators within the 4 dimensions is shown in Table 3 and Table 4. The mean total score for GJS was 61.15 ranging from 20 to 100 (SD = 12.252) (Table 3). In addition, the mean score for IJS was 38.39 (ranged from 12 to 60), while the mean score for EJS was 16.34 (ranged from 6 to 30).The results of the ANOVAs revealed that age, gender, region, grade of practice setting, professional title, years in practice, workload, rest day, monthly income were significantly associated with GJS (Table 3 & Table 4).

The mean total score for TI was 11.35 ranging from 4 to 20 (SD = 3.289) (Table 3). The research results also indicated that there were significant differences among the respondents in terms of TI based on age, education, marital status, region, type and grade of practice setting, professional title, years in practise, workload, rest days, and monthly income (Table 3 & Table 4).

Pearson Correlation Analysis of Occupational Identity, Job Satisfaction and Turnover Intention

Correlation analysis was conducted on the OI, job satisfaction and TI among Chinese pediatricians (Table 5). The study validated that the level of OI was positively correlated with the respondents’ scores on GJS as well as IJS and EJS (r₁ = 0.702, p < 0.01; r₂ = 0.704, p < 0.01; r₃ = 0.564, p < 0.01). OI was negatively associated with TI (r=-0.601, p < 0.01). The level of GJS was negatively corelated with participants’ scores on TI (r=-0.605, p < 0.01).

Mediating effect analysis of Occupational Identity, Job Satisfaction and Turnover Intention

We used bootstrap method to analysis mediating effect, which showed that IJS and EJS will mediate relationships between OI and TI. The direct effect of OI on TI is -0.133 (-0.120,-0.145 ) (Fig. 1). When IJS is mediating effect, the indirect effect of OI on TI is -0.028 (-0.017༌-0.039), the total effect is -0.161, the ratio of mediating effect is 17.38% (Table 6). When EJS is mediating effect the indirect effect of OI on TI is -0.015 (-0.011༌-0.019), the total effect is -0.148, the ratio of mediating effect is 10.14% (Table 6). The indirect effect is -0.047 (-0.053, -0.0400), the total effect is -0.180, the ratio of mediating effect is 26.11%, when IJS and EJS is mediating effect (Table 6).

The study has explored the effects of occupational identity, job satisfaction and turnover intention among pediatrician in China. Our findings demonstrate that occupational identity and job satisfaction, occupational identity and job satisfaction, job satisfaction and turnover intention are prevalent among Chinese pediatricians. Furthermore, we show that pediatricians with increased job satisfaction and occupational identity were significantly less likely to get strong turnover intention.

Of the 12 IJS items, workload received the lowest score. According to data provided by the PS-CMDA, in Beijing Childrend’s Hospital, each pediatrician should offer 80 to 100 visits each day and sometimes up to 150 visits per day. Similar conditions have also been observed in other pediatric medical centres ³⁷.Also,number of hospital beds and rest day are two of the major factors affecting pediatricians’ turnover intention. On the whole, compared to the participants administering ≦ 10 hospital beds, pediatricians administering > 10 hospital beds attached to lower occupational, job satisfaction and higher turnover intention. According to Wang (2010), the standard of the number of hospital beds peditricians in tertiary general hospitals administer is 9.11 ³⁸. In our study, 52.0% of the pediatricians administered > 10 hospital beds and over half of participants administered more hospital beds than related reference criteria. In addition, when we pay more attention to the rest day, 80.0% of the participants taken 0 or only 1 rest day a week(Table 1). On the one hand, with the implementation of the two-child policy, the reach of a new baby boom has put a demand on the children's health services and requested more talents to contribute on paediatrics. On the other hand, pediatrics are exposed to the phenomenon of turnover among pediatricians. The leave of pediatricians with rich experience, especially young pediatricians, bothers medical institutions. According to the China Pediatric Resources White Paper, from 2011–2014, the loss rate of under 35-year-age group was 14.6%, the loss rate of under 35-to-45-year-age group was 11%, and the loss rate of 45-to-60-year-age group was 6.8% ⁸. Therefore, the heavy workload is the product of the contradiction between the shortage of talent supply and the increasing demand for services.

With a limited pediatric workforce and increasing demand for child health care, pediatrician are facing unprecedented challenges. Of the 6 EJS items, salary received the lowest score. At the same time, salary is one of and the direct and indirect significant predictors of turnover intention.

Salary is identified as the contributing factor on high level of turnover intention ³⁹⁻⁴¹.A survey performed by the PS-CMDA, which found that approximately 96% of pediatricians were not satisfied with their salaries in 2011 ⁴². When compared to other industry, according to national data, in 2017, the average salary of urban employees in the financial industry reached 122,851 CNY and that of urban employees in the computer services and software industry was 133,150 CNY, the salary of pediatricians was behind that of the two other industry ⁴³. On the one hand, the low salary of physician is controlled strictly by the government to keep health care affordable ⁴⁴. According to a survey conducted by the PS-CMDA, in 2015, the workload of pediatricians in general hospitals was 1.68 times that of non-pediatricians, while the income earned by pediatricians represented 46% of the income earned by non-pediatricians ⁴⁵. Compared to other physicians, because of limited revenue pediatric department generate, there exist the income gap which makes pediatricians more likely to get fatigue and frustration.

Through Pearson correlation analysis, we observed that there were active correlations between OI, IJS and EJS. Thus they have negative correlations with TI. These findings are consistent with those found a negative correlation between OI and TI among Chinese nurses ^46,47, and a study directed towards job satisfaction and TI among pediatricians illustrated the negative impact of age and job satisfaction on TI ⁴⁷. Moreover, the mediating effect analysis found that OI generates TI through four paths: First, OI directly affects TI. Second, OI indirectly affects TI through IJS. Third, OI indirectly affects TI through EJS. Forth, OI indirectly affects TI through IJS and EJS. Among the four paths, the direct effect of path one is the highest. For each unit of OI improvement, the turnover tendency decreases by 0.133 units. Path four has the highest indirect effect, with a relative mediating effect of 26.09%(Table 6). It shows that in addition to directly affecting TI, OI will also affect internal job satisfaction, and then external job satisfaction, and ultimately affect turnover intentions.

To our knowledge, this is the first time to investigate occupational identity, job satisfaction and turnover intention at a national level and study the relationships between occupational identity, job satisfaction and turnover intention among pediatricians in China. We spend a lot of time and energy investigating many pediatricians and try to achieve a representative sample by planning a reasonable method for sample selection in China.

This is only a cross-sectional study, no causal inferences can be made. In addition,because the questionnaire involves personal privacy, some respondents maybe conceal their real situation and report bias occur in the study. Third, the study was focused only on the relationships between OI, job satisfaction and TI among pediatricians. The study was conducted is from a unilateral view, and some factors may have been ignored. Therefore, we should expand the field of investigation and identify additional problems in future research.

Pediatricians play a vital role in driving the child health system in China. Based on the results, we suggest that the healthcare managers improve the vacation polices, increase financial investments in pediatric, fund pediatric infrastructure, scientific research, education and other projects: provide grant allowances to pediatricians and, most importantly, reform salary mechanism for pediatricians. In addition, the government should pay attention to the rights of young pediatricians, as they present a large percentage of Chinese pediatricians but get high level of turnover intention.

OI:occupational identity; JS:job satisfaction; TI:turnover intention; GJS:general job satisfaction; IJS:intrinsic job satisfaction; EJS:extrinsic job satisfaction; PS-CMDA:the Pediatric Society of the Chinese Medical Doctor Association; NS-CMDA:the Neonatal Society of the Chinese Medical Doctor Association.

Ethics approval and consent to participate

Ethical clearance was obtained from the ethics committee of Zhujiang Hospital of the Southern Medical University. (2018-JWC-001)Signed informedconsent was obtained from each participant. Confidentiality and anonymity were assured and confirmed. Participants were informed of their rights to withdraw from the study. All data have been secured safely with limited access to the authors only.

Consent to publish

Not applicable.

Availability of data and materials

All authors confirm that the data of this study will be made available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing financial interests.

Funding

The project was funded by the Humanities and Social Sciences of the Ministry of Education of China (17YJAZH093).

Authors' Contributions

Wanjun Deng, Zhichun Feng, Oudong Xia and Bin Wang carried out the investigation work and the data collection and interpretation. Wanjun Deng, Zhichun Feng, Oudong Xia, Tingting Yang and Lan Lin participated in the design and coordination of investigation work, and acquisition of data. Wanjun Deng, Xinying Yao, Jun Jiang and Wenhao Zhong participated in the study design, data collection, analysis of data and preparation of the manuscript. Xinying Yao, Lan Lin and Oudong Xia carried out the study design, the analysis and interpretation of data and drafted the manuscript. All authors read and approved the final manuscript.

Acknowledgements

We would like to thank the Pediatric Society of the Chinese Medical Doctor Association, the Neonatal Society of the Chinese Medical Doctor Association and all the participants for their cooperation.

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Table 1 Descriptive data for the socio-demographic and worked-related characteristics of the pediatricians

Characteristic	Total sample		Characteristic	Total sample
Characteristic	N	%	Characteristic	N	%
Age (years)			Grade of practice setting
20-29	594	14.1	Primary	100	2.4
30-39	1635	38.9	Secondary	1700	40.5
40-49	1337	31.8	Tertiary	2342	55.8
50-59	610	14.5	Not rated	56	1.3
>=60	22	0.05	Professional title
Gender			Junior	1231	29.3
Male	1256	29.9	Middle	1286	30.6
Female	2942	70.1	Senior	1681	40.0
Education			Years in practice
College graduate	223	5.3	<1 year	156	3.7
Bachelor’s degree	3035	72.3	1-5 years	894	21.3
Master’s degree	817	19.5	6-10 years	868	20.7
Doctorate degree	123	2.9	11-15 years	606	14.4
Marital			16-20 year	459	10.9
Not married (single and others)	475	11.3	>20 years	1215	28.9
Married	3723	88.7	Number of hospital beds
Region			<5	379	9
Northeast China	534	12.7	5-10	1634	38.9
North China	537	12.8	11-15	1243	29.6
East China	632	15.1	16-20	409	9.7
South China	659	15.7	>20	533	12.7
Central China	597	14.2	Rest day / week
Northwest China	635	15.1	0 day	1568	37.4
Southwest China	604	14.4	1 day	1790	42.6
Type of practice setting			2 days	821	19.6
General hospital	2980	71.0	3 days	19	0.5
Children’s hospital	342	8.1	Monthly income (CNY)
Maternal and child care service centre	806	19.2	<10000	3462	82.5
Other	70	1.7	10001-20000	637	15.2
			20001-30000	73	1.7
			>30000	26	0.6

Table 2 Common method bias

Model	c2	df	RMSEA	SRMR	TLI	CFI
Single factor model	19055.63	464	0.098	0.071	0.708	0.727
Four-factor model	11181.44	458	0.075	0.057	0.829	0.842
Four-factor model + Common method factor	8802.427	429	0.068	0.051	0.858	0.877

Table 3 Descriptive data and ANOVA results for the socio-demographic characteristics of the pediatricians

Characteristic	Occupational identity		General job satisfaction		Intrinsic job satisfaction		Extrinsic job satisfaction		Turnover intention
	Mean (SD)	P	Mean (SD)	P	Mean (SD)	P	Mean (SD)	P	Mean (SD)	P
Age (years)		**		**		**		**		**
20-29	28.02 (8.51)		61.64 (13.25)		38.14 (8.10)		17.03 (4.61)		11.94 (3.51)
30-39	26.81 (8.13)		59.93 (12.31)		37.42 (7.69)		16.13 (4.46)		11.82 (3.21)
40-49	29.21 (8.51)		61.14 (11.60)		38.80 (7.21)		15.98 (4.38)		11.06 (3.11)
50-59	31.82 (8.31)		63.85 (12.14)		40.23 (7.640)		16.97 (4.52)		10.20 (3.30)
>=60	35.23 (8.11)		64.91 (8.18)		41.36 (4.44)		17.00 (3.51)		9.91 (2.00)
Gender		**		**		**		**		-
Male	27.61 (8.82)		59.64 (13.03)		37.31 (8.25)		15.96 (4.60)		11.48 (3.27)
Female	28.90 (8.36)		61.80 (11.85)		38.85 (7.27)		16.50 (4.42)		11.30 (3.30)
Education		**		-		-		**		*
College graduate	29.46 (9.39)		61.89 (12.13)		39.34 (7.51)		16.08 (4.54)		11.19 (3.24)
Bachelor’s degree	28.15 (8.48)		60.91 (12.22)		38.28 (7.60)		16.21 (4.47)		11.44 (3.31)
Master’s degree	29.20 (8.14)		61.59 (12.11)		38.41 (7.49)		16.74 (4.38)		11.15 (3.22)
Doctorate degree	31.41 (9.37)		62.94 (14.09)		39.29 (8.67)		17.10 (5.14)		10.71 (3.33)
Marital		-		-		-		**		**
Not married (single and other)	28.28 (8.30)		61.85 (12.79)		38.14 (7.86)		17.23 (4.40)		11.83 (3.47)
Married	28.55 (8.54)		61.06 (12.18)		38.42 (7.58)		16.22 (4.48)		11.29 (3.26)
Total	28.52 (8.52)		61.15 (12.25)		38.39 (7.61)		16.34 (4.48)		11.35 (3.29)

The statistical test was 2-tailed, and P<0.05 was considered significant.

*p<0.05; **p<0.01

Table 4 Descriptive data and ANOVA results for the work-related characteristics of the pediatricians

Characteristic	Occupational identity		General job satisfaction		Intrinsic job satisfaction		Extrinsic job satisfaction		Turnover intention
Characteristic	Mean (SD)	P	Mean (SD)	P	Mean (SD)	P	Mean (SD)	P	Mean (SD)	P
Region		**		**		**		**		**
Northeast China	27.62 (7.68)		61.19 (11.72)		38.52 (7.35)		16.40 (4.34)		11.73 (3.11)
North China	29.97 (8.74)		62.12 (13.31)		38.93 (8.13)		16.68 (4.79)		10.95 (3.38)
East China	29.21 (8.26)		61.14 (12.39)		38.39 (7.57)		16.15 (4.49)		10.92 (3.17)
South China	28.33 (8.47)		61.77 (11.67)		38.49 (7.43)		16.79 (4.18)		11.36 (3.23)
Central China	27.95 (8.52)		60.60 (11.58)		38.08 (7.39)		16.07 (4.27)		11.58 (3.09)
Northwest China	27.60 (8.74)		59.03 (12.25)		37.46 (7.53)		15.35 (4.55)		11.64 (3.25)
Southwest China	29.03 (8.87)		62.39 (12.60)		38.96 (7.79)		16.98 (4.56)		11.29 (3.68)
Type of practice setting		**		-		-		**		**
General hospital	28.22 (8.50)		60.87 (12.15)		38.25 (7.56)		16.19 (4.42)		11.44 (3.30)
Children’s hospital	29.47 (8.60)		62.55 (12.39)		38.93 (7.46)		17.21 (4.66)		10.70 (3.34)
Maternal and child care service centre	29.00 (8.46)		61.50 (12.68)		38.56 (7.87)		16.47 (4.64)		11.28 (3.22)
Other	30.73 (8.62)		62.43 (10.49)		39.71 (7.11)		16.57 (3.62)		11.56 (3.21)
Grade of practice setting		**		**		**		**		**
Primary	28.31 (8.95)		59.46 (11.39)		37.54 (7.45)		15.77 (3.99)		11.49 (3.37)
Secondary	27.73 (8.49)		60.01 (12.26)		37.93 (7.73)		15.74 (4.47)		11.69 (3.25)
Tertiary	29.08 (8.45)		62.04 (12.14)		38.73 (7.46)		16.79 (4.45)		11.10 (3.29)
Not rated	29.39 (9.84)		61.89 (14.90)		39.36 (9.63)		16.23 (4.82)		11.41 (3.39)
Professional title		**		**		**		**		**
Junior	27.70 (8.62)		61.20 (13.04)		37.89 (8.00)		16.85 (4.60)		11.81 (3.44)
Middle	26.81 (8.11)		59.02 (11.70)		37.25 (7.37)		15.47 (4.32)		11.77 (3.12)
Senior	30.42 (8.38)		62.75 (11.83)		39.62 (7.32)		16.62 (4.42)		10.70 (3.20)
Years in practice		**		**		**		**		**
<1 year	31.13 (8.36)		64.91 (13.47)		39.58 (8.08)		18.43 (4.75)		10.92 (3.45)
1-5 years	27.88 (8.54)		61.12 (12.88)		37.91 (7.90)		16.83 (4.54)		11.68 (3.44)
6-10 years	26.69 (8.01)		59.93 (12.21)		37.57 (7.64)		15.95 (4.42)		12.00 (3.13)
11-15 years	27.20 (8.58)		60.25 (12.00)		37.90 (7.45)		15.99 (4.38)		11.61 (3.20)
16-20 year	28.23 (8.36)		59.92 (11.83)		37.86 (7.47)		15.66 (4.42)		11.24 (3.18)
>20 years	30.72 (8.37)		62.49 (11.71)		39.61 (7.28)		16.41 (4.41)		10.61 (3.21)
Number of hospital beds		**		**		**		**		**
<5	30.03 (8.51)		63.02 (13.08)		39.36 (7.90)		17.16 (4.77)		10.63 (3.36)
5-10	28.38 (8.15)		61.46 (11.87)		38.62 (7.30)		16.39 (4.38)		11.45 (3.16)
11-15	27.75 (8.42)		60.36 (11.78)		37.82 (7.37)		16.15 (4.38)		11.58 (3.28)
16-20	27.90 (8.70)		59.64 (12.74)		37.46 (8.13)		15.85 (4.44)		11.40 (3.35)
>20	30.14 (9.34)		61.89 (13.24)		39.04 (8.26)		16.39 (4.76)		11.00 (3.49)
Rest days / week		**		**		**		**		**
0 day	26.29 (8.43)		58.15 (12.29)		36.54 (7.74)		15.41 (4.41)		12.16 (3.22)
1 day	29.32 (8.38)		62.27 (12.02)		39.12 (7.43)		16.63 (4.45)		11.01 (3.20)
2 days	30.90 (7.98)		64.32 (11.43)		40.25 (6.98)		17.41 (4.35)		10.55 (3.28)
3 days	34.53 (6.35)		66.89 (12.17)		41.68 (7.08)		18.11 (4.78)		10.89 (3.41)
Monthly income (CNY)		**		**		**		**		**
<10000	27.86 (8.46)		60.42 (12.215)		37.96 (7.60)		16.08 (4.47)		11.61 (3.24)
10001-20000	31.19 (8.02)		63.95 (11.678)		40.01 (7.19)		17.31 (4.25)		10.21 (3.19)
20001-30000	33.03 (8.05)		68.34 (10.737)		42.42 (6.35)		19.07 (4.22)		9.19 (3.32)
>30000	37.46 (8.12)		70.77 (14.866)		44.42 (9.94)		19.19 (5.36)		10.54 (4.07)

The statistical test was 2-tailed, and P<0.05 was considered significant.

*p<0.05; **p<0.01

Table 5 Pearson bivariate correlations

Item	Mean	SD	2	3	4
Occupational identity	28.52	8.516
General job satisfaction	61.15	12.252	NA
Intrinsic job satisfaction	38.39	7.607	.953**	NA
Extrinsic job satisfaction	16.34	4.481	.878**	.706**	NA
Turnover intention	11.35	3.289	-.605**	-.563**	-.557**

The statistical test was 2-tailed, and P<0.05 was considered significant.

*p<0.05; **p<0.01

Table 6 Mediating effects analysis of OI on TI

Mediation variable	Indirect effect	Boot SE	Boot CI		Total effect	Relative mediating effect/%
Mediation variable	Indirect effect	Boot SE	Lower bound	Upper bound	Total effect	Relative mediating effect/%
IJS	-.028	.006	-.017	-.039	-.161	17.39
EJS	-.015	.002	-.011	-.019	-.148	10.14
IJS EJS	-.047	.003	-.040	-.053	-.180	26.11

STROBEchecklistcrosssectional.doc

Occupational Identity, Job Satisfaction and Their Effects on Turnover Intention among Chinese Pediatricians: A Cross-sectional Study

Status:

Journal Publication

Version 1

Abstract

Figures

Background

Methods

Participants

Study Measures

Statistical Analysis

Results

Descriptive Analysis of the Socio-demographic and Worked-related Characteristics

Common method bias analysis of Occupational Identity, Job Satisfaction and Turnover Intention

The Status Quo of Occupational Identity, Job Satisfaction and Turnover Intention among Paediatricians

Pearson Correlation Analysis of Occupational Identity, Job Satisfaction and Turnover Intention

Mediating effect analysis of Occupational Identity, Job Satisfaction and Turnover Intention

Discussion

Strengths and limitations of this study

Conclusions

Abbreviations

Declarations

References

Tables

Supplementary Files

Status:

Journal Publication

Version 1