Influence path of work-family conflict on primary care physicians’ resignation intention: Data from a Chinese cross-sectional survey

Abstract

BACKGROUND:

Primary care physicians and their teams are the leading force in constructing primary medical services, undertaking the critical responsibility of residents’ essential health, and also related to realizing the national health goal. However, primary care physicians generally have a high turnover rate due to problems such as high work pressure, low salary levels, and limited career development. Therefore, exploring primary care physicians’ resignation intentions plays a vital role in promoting the construction of primary care physicians’ health service system.

OBJECTIVE:

This study explores the factors influencing the resignation intentions of primary care physicians, specifically examining the roles of work-family conflict, job satisfaction, professional identity, and emotional exhaustion. By understanding these dynamics, the research aims to inform strategies that can enhance the stability and effectiveness of primary care services, ultimately contributing to the improvement of public health infrastructure and achieving national health goals. This investigation will utilize structural equation modeling to analyze the interrelationships among the identified variables, thereby providing a comprehensive framework for addressing the high turnover rates among primary care physicians.

METHODS:

This study uses the work-family conflict, job satisfaction, professional identity, and emotional exhaustion scales. The data comes from a cross-sectional survey in Zhejiang Province, China, in 2022. Using SPSS 27 and Mplus8.3 software to analyze 1205 primary care physicians and their team members, the selected cases all answered the relevant questions of resignation intention. The potential relationship among work-family conflict, job satisfaction, professional identity, emotional exhaustion, and family doctor resignation intention was explored by constructing structural equations.

RESULTS:

Work-family conflict can directly and positively affect primary care physicians’ resignation intention (β = –0.546, p < 0.001). The results of the mediation model found that job satisfaction, professional identity, and emotional exhaustion were significantly related to work-family conflict, and primary care physicians’ resignation intention has a significant mediating effect. It mainly includes six intermediary approaches: one is through the independent intermediary effect of job satisfaction; the second is through the independent intermediary effect of professional identity; the third is through the chain intermediary effect between Job satisfaction and professional identity; the fourth is through the intermediary effect of Job satisfaction and emotional exhaustion chain intermediary; fifth is through the chain intermediary of professional identity and emotional exhaustion; sixth is through the complex chain intermediary of job satisfaction, professional identity, and emotional exhaustion.

CONCLUSION:

Primary care physicians have a high score in resignation intention, which deserves continuous attention. Relevant department can help primary care physicians balance work and family roles, provide them with appropriate resources and rewards, as well as a good working environment and career development opportunities, to improve their job satisfaction and professional identity and reduce emotional exhaustion, thereby reducing the risk of resignation intention.

Keywords

Job satisfaction professional identity emotional exhaustion chain intermediary structural equation modeling turnover rates health policy healthcare management

1 Introduction

Primary care physicians and their teams are the leading force in the construction of primary medical services, undertaking essential responsibilities for the basic health of residents, and are also related to the realization of the goal of national health [1]. However, primary care physicians are challenging to recruit and retain due to problems such as high work pressure, low salary levels, and limited career development. Resignation intention and turnover rate are generally high [2]. According to a survey in China, the number of primary care physicians is declining yearly, with an average decrease of 36,000 people per year [3], dramatically harming the construction of primary care physicians in China. How to reduce the number of primary care physicians resignation intention has become essential to improving the public health service system at the grassroots level. Resignation intention refers to the possibility that employees have the idea of resignation within a certain period, and it is also used as a predictor of resignation behavior [4, 5]. The resignation intention of primary care physicians shows younger, higher education, and higher professional titles. High turnover rates will not only exacerbate the shortage of primary health resources but also increase the workload of medical staff and reduce the quality of medical services [6, 7].

Scholars at home and abroad have extensively discussed the influencing factors of primary care physicians’ resignation intention. Most studies begin by examining individual characteristics and environmental factors, positing that demographic traits and work-related stress are the primary factors influencing the intention of primary care physicians to resign. For example, primary care physicians who experience greater work pressure are more likely to consider leaving their positions [8]. And some studies have found that career development [9] and salary level [10] are essential factors affecting primary care physicians. Few studies have looked for the mechanism that affects primary care physicians’ resignation intention from the perspective of the nature of their work and emotional regulation and according to the connection between primary care physicians’ work requirements and work content and their psychological resources. As a part of psychological resources, emotional regulation is vital in guiding individual behavior. Effective emotional regulation can often deal with external affairs more rationally, while complex or improper emotional regulation will lead to emotional exhaustion, inevitably leading to destructive behavior [11, 12]. Empirical research is still needed on how the nature of the work of primary care physicians and emotional regulation work together to affect resignation intention.

Based on the work requirement-resource theory and the emotion regulation process theory, this study takes the grassroots primary care physicians’ team as the research subject. It constructs a multi-chain mediation model with emotional exhaustion as the mediator variable. Among them, the job requirements-resources theory holds that the characteristics and nature of jobs can include two parts: job requirements and job resources. Job requirements are mainly the energy and physical energy consumed by individuals in work, which is a negative factor. In contrast, job resources can promote individual growth, positive factors that convey work motivation, and job requirements—the core assumption of resource theory is that job characteristics have two paths of damage and enhancement to employees. The damage path refers to the fact that excessive job requirements and low job resources will reduce employee work enthusiasm and professional identity, resulting in job burnout. The enhancement path refers to sufficient work resources reducing job burnout and improving work efficiency, thus producing a positive impact [13 –15]. Primary care physicians, as front-line workers in the medical system, generally have objective factors such as heavy workload, high workload, and heavy work pressure [16]. When primary care physicians play the dual roles of family and work, role conflict inevitably arises, that is, work-family conflict. Some studies have found that work-family conflict can easily lead to job burnout, inhibit work engagement, and produce resignation intention [17]. Therefore, this study uses work-family conflict to measure the work requirements of primary care physicians and explores the impact of work-family conflict on primary care physicians’ resignation intention. Hypothesis of this study:

Work-family conflict and primary care physicians’ resignation intention will be positively correlated;

Professional identity and job satisfaction are positive indicators. When the external working environment is comfortable and the internal work resources are abundant, individuals will inevitably have a higher professional identity and job satisfaction. Related studies have also found that an excellent professional identity and job satisfaction can help primary care physicians relieve frustration and fatigue at work, relieve job burnout, and even reduce the turnover rate of doctors [18, 19]. This study also uses professional identity and job satisfaction as indicators to measure job resources. Moreover, the study explores the effects of professional identity, job satisfaction on primary care physicians’ resignation intention, and the mediation effect of professional identity and job satisfaction in work-family conflict and primary care physicians’ resignation intention. Relevant theoretical assumptions are as follows:

Job satisfaction is between work-family conflict and primary care physicians’ resignation intention There is an independent mediation effect;

Professional identity has an independent mediation effect between work-family conflict and primary care physicians’ resignation intention;

Job satisfaction and professional identity have a chain between work-family conflict and primary care physicians’ resignation intention mediating effect;

The theory of the emotional regulation process points out that individuals will adopt specific emotional regulations to promote their physical and mental health in the face of a stressful external environment and the process of vigorous activities. People with high emotional regulation ability will examine moderation, make the most favorable choice, and avoid being disturbed by emotions. In contrast, those with low emotional regulation ability will produce emotional exhaustion, leading to negative emotions, continuous consumption of psychological resources, and choosing pessimistic treatment schemes [20, 21]. Related studies have found that emotional exhaustion generally occurs after individuals consume excessive resources, and excessive work pressure and work requirements will increase the level of individual emotional exhaustion. In contrast, higher work resources can reduce emotional exhaustion [22]. Primary care physicians face high work pressure, high workload, complex work content, and emotional pressure. They must constantly deal with the patient’s disease problems and needs and provide emotional care to the patient and their family members, which is more prone to Emotional exhaustion. Then there is a turnover tendency [23]. Therefore, this study will also explore the mediating role of emotional exhaustion between primary care physicians’ work characteristics and resignation intention. Relevant theoretical assumptions are as follows:

Job satisfaction and emotional exhaustion have a chain mediating effect between work-family conflict and primary care physicians’ resignation intention;

Professional identity and emotional exhaustion exist between work-family conflict and primary care physicians’ resignation intention chain mediation effect;

Job satisfaction, professional identity, and emotional exhaustion have multiple chain mediation effects between work-family conflict and primary care physicians’ resignation intention.

What is the relationship between primary care physicians’ work-family conflict, job satisfaction, professional identity, emotional exhaustion, and resignation intention? Is there a mediation effect between job satisfaction, professional identity, and emotional exhaustion between primary care physicians, work-family conflict, and resignation intention? Based on the existing theoretical basis and literature, the research hypothesis is shown in Fig. 1.

Fig. 1

Hypothesized model of the research framework. Note: WFC: work-family conflict; JS: job satisfaction; PI: professional identity; EE: emotional exhaustion; RI: resignation intention.

2 Materials and methods

2.1 Participants

To enhance sampling efficiency and feasibility, particularly in large-scale and geographically dispersed population studies, a stepwise reduction of sample scope is employed to reduce costs and time investment while enhancing sample representativeness. This study adopts a survey methodology similar to Jiang et al. [24], conducted from July to October 2022, utilizing a stratified multi-stage random sampling approach. This method effectively addresses the complexity of geographic distribution and population structure, mitigates sample bias, and ensures that the final sample accurately reflects population characteristics. Taking the classification of administrative regions in Zhejiang Province as the basis for stratification, eight cities, Hangzhou, Ningbo, Wenzhou, Jinhua, Huzhou, Zhoushan, Taizhou, and Lishui were selected according to the degree of economic development. According to the development status of primary health centers, 15–20 health centers were selected from each city, and a total of 158 health centers were selected. All survey team members receive online training to clarify the meaning of survey content and how to fill it out, thereby reducing bias and errors caused by investigators. The investigator guided the questionnaire, and the respondents filled it out independently.. Inclusion criteria: (1) Participate in primary care physicians’ contract service workers; (2) Informed consent and willingness to participate in this research. Exclusion criteria: (1) Contracted service workers who did not participate in primary care physicians; (2) Unwilling to participate in this research; (3) Recently participated in similar research. Firstly, inform the participants about the purpose of the study, and then obtain their informed consent. 1469 questionnaires were recovered, 1205 valid questionnaires were recovered, and the effective recovery rate was 82.03%. This survey was approved by the Ethics Committee of Kangda College of Nanjing Medical University (2022-01), and written consent was obtained from the surveyed students and their parents. The study follows the Declaration of Helsinki.

2.2 Measures

2.2.1 Work-family conflict

Work-family conflict, using the scale for measuring work-family conflict compiled by Netemeyer [25], mainly includes work-family conflict and family-work conflict to evaluate the mutual influence between work and family. Each dimension has five questions, including the influence of family relationships, entertainment activities, emotional control, work performance, family responsibilities, The specific items include: “The demands of my work interfere with my home and family life. The amount of time my job takes up makes it difficult to fulfill family responsibilities. Things I want to do at home do not get done because of the demands my job puts on me. My job produces strain that makes it difficult to fulfill family duties. Due to work-related duties, I have to make changes to my plans for family activities. The demands of my family or spouse/partner interfere with work-related activities. I have to put off doing things at work because of demands on my time at home. Things I want to do at work don’t get done because of the demands of my family or spouse/partner. My home life interferes with my responsibilities at work such as getting to work on time, accomplishing daily tasks, and working overtime. Family-related strain interferes with my ability to perform job-related duties.” Responses are scored using a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). The scale comprises solely positively worded items with no reverse scoring. The score ranges from 10 to 50, and the higher the score, the greater the individual’s work-family conflict. The original scale’s Cronbach’s α coefficient is 0.880. The Cronbach alpha coefficient of work-family conflict in this study is 0.887, KMO is 0.902.

2.2.2 Job satisfaction

The job satisfaction scale refers to the job satisfaction scale studied by Hadadi [26]. The Job satisfaction scale [27] studied by Spector, combined with the occupational characteristics of primary care physicians from the promotion system (3 items), salary and benefits (3 items)), the external environment (3 items), leadership and management (3 items), work content (4 items), a total of 5 dimensions and 16 items. Each item is rated on a 5-point Likert scale, ranging from 1 (very dissatisfied) to 5 (very satisfied), with no reverse-scored items. Scores are not reversed, and the total score ranges from 16 to 80 points, where higher scores indicate greater levels of job satisfaction. Cronbach alpha coefficient of job satisfaction in this study is 0.814, KMO is 0.843.

2.2.3 Professional identity

This study refers to the professional identity-related scale [28, 29] and improves it according to the characteristics of primary care physicians. The scale contains five dimensions and 26 items, including career expectations (4 items) and occupational affiliation (5 items), professional values (5 items), professional cognition (6 items), and professional behavior (6 items). Moreover, it use s1-7 grades for scoring, from low to high, respectively (1–7 points), it with no reverse-scored items. The higher the score, the stronger the professional identity. Score range is 26∼182 points. The Cronbach alpha coefficient of professional identity in this study is 0.907, KMO is 0.892.

2.2.4 Emotional exhaustion

The scale was measured using the scale developed by Maslach and Jackson (1981) [30], with a total of 5 items, including “Work makes me feel physically and mentally exhausted,” “I feel exhausted when I get off work,” “I have to wake up in the morning When facing a day’s work, I feel exhausted,” “Working all day is stressful for me,” “Work makes me feel like I am about to collapse.” Answers to each question consisted of 7 options (never = 1, several times a year or less = 2, once a month on average = 3, several times a month = 4, once a week on average = 5, each Several times a week = 6, every day = 7), Score ranges from 5 to 35 points, The Cronbach alpha coefficient of emotional exhaustion in this study is 0.949, KMO is 0.921.

2.2.5 Resignation intention

Resignation intention adopts a scale with 1 item, and the item is: In the past year, have you ever had the idea of resigning? The questionnaire uses a 5-point scoring method (never = 1 point, always = 5 points). The higher the score, the higher the idea of leaving the job, and the scale has good reliability in previous studies [31].

2.3 Research methods

This study employs Structural Equation Modeling (SEM), a multivariate statistical technique that integrates factor analysis, path analysis, and regression analysis to quantify and analyze complex causal and structural relationships. SEM is capable of simultaneously handling latent variables (variables that cannot be directly measured) and observed variables (variables that can be directly measured). It utilizes measurement models and structural models to describe the relationships between latent and observed variables, as well as among latent variables themselves. Researchers typically use path diagrams to visually represent the relationships between variables and evaluate the model fit to the data through various fit indices. The construction of the model involves five steps: specification, identification, estimation, evaluation, and modification, making it suitable for fields such as social sciences, psychology, and education. The strengths of SEM lie in its ability to handle complex models, analyze latent variables, and provide model validation tools. However, Structural Equation Modeling (SEM) analysis requires fulfillment of multiple conditions for effective implementation. Firstly, it is essential to ensure that the research question can be addressed within the SEM framework, involving complex causal and structural relationships between latent (unobservable) and manifest (observable) variables. Secondly, SEM necessitates a sufficiently large sample size to ensure accurate estimation of model parameters, typically requiring several dozen observed indicators per latent variable. Data distribution should approximate a normal distribution; otherwise, appropriate transformation methods or non-parametric approaches may be necessary. Furthermore, model construction and parameter estimation rely on prior theoretical or empirical research support to ensure the validity and explanatory power of the model setup. Lastly, evaluation of model fit is imperative, employing various statistical indices such as chi-square test, fit indices, and residual analysis to assess the consistency between the model and data, thereby validating the model’s appropriateness and applicability [32]. Overall, SEM is a powerful tool that offers a systematic approach to understanding complex phenomena.

2.4 Data analysis

Excel software was used for real-time statistical input of data, and SPSS27 and Mplus8.3 software were used for statistical analysis. SPSS was used to analyze the correlation between variables, Cronbach alpha coefficient was used to evaluate the scale’s internal consistency, and Mplus was used to build a chain structure equation. SEM analysis with full information likelihood estimation was used to test the hypothesized mediation models. Testing for the direct, indirect, and total effects was based on 1,000 bootstrapped samples; effect estimates and bias-corrected 95% confidence intervals (CI) were derived. Indices of good model fit included root mean square error of approximation (RMSEA) <0.08 and comparative fit index (CFI) and Tucker Lewis Index (TLI) >0.90 [32].

3 Results

3.1 Descriptive data

Table 1 shows the main demographic characteristics of the respondents. Among the 1,205 primary care physicians, there were significantly more women than men, a total of 720 (59.75%), with an average age of 38.41±11.26 years old, and most of them had undergraduate education, a total of 689 (57.18%), only 114 (9.46%) with a graduate degree or above, a total of 408 general practitioners (33.86%), 124 specialists (10.29%), and 379 nursing positions (31.45%), 55 in pharmacy (4.56%), and 239 in administrative positions (19.83%). Most professional years are 1–5 years and 6–10 years, with 643 people (53.37%). Among the professional titles, the number of junior professional titles is 558 (46.31%), and only seven have senior professional titles (0.58%). A total of 402 people (33.36%) had an income of less than 3,000 yuan, a total of 580 people (48.13%) had an income of 3,000 to 5,000 yuan, a total of 5,001 to 7,000 yuan (16.93%), and 19 people (1.58%) had an income of more than 7,000 yuan.

Table 1
Demographics characteristics of the sample (N = 1205)

Variables Group Frequency Percent

Regions Hangzhou 168 13.94%

Ningbo 157 13.03%

Wenzhou 144 11.95%

Jinhua 146 12.12%

Huzhou 141 11.70%

Zhousha 152 12.61%

Taizhou 139 11.54%

Lishui 158 13.11%

Gender male 485 40.25%

female 720 59.75%

Age <25 191 15.85%

26∼35 388 32.20%

36∼45 317 26.31%

46∼55 269 22.32%

>55 40 3.32%

The average age was 38.41±11.26 years

Marriage have a partner 890 73.86%

no partner 315 26.14%

Educational Junior college and below 402 33.36%

bachelor degree 689 57.18%

master degree or above 114 9.46%

Vocational post general practitioner 408 33.86%

specialist 124 10.29%

nurse 379 31.45%

apothecary 55 4.56%

administrative personnel 239 19.83%

Career years (year) <1 189 15.68%

1∼5 407 33.78%

6∼10 236 19.59%

11∼15 145 12.03%

16∼20 143 11.87%

>20 85 7.05%

Professional title no title 251 20.83%

junior professional title 558 46.31%

intermediate title 301 24.98%

associate senior title 88 7.30%

senior professional title 7 0.58%

Monthly income (RMB) <3000 402 33.36%

3000∼5000 580 48.13%

5001∼7000 204 16.93%

>7000 19 1.58%

Variables	Group	Frequency	Percent
Regions	Hangzhou	168	13.94%
	Ningbo	157	13.03%
	Wenzhou	144	11.95%
	Jinhua	146	12.12%
	Huzhou	141	11.70%
	Zhousha	152	12.61%
	Taizhou	139	11.54%
	Lishui	158	13.11%
Gender	male	485	40.25%
	female	720	59.75%
Age	<25	191	15.85%
	26∼35	388	32.20%
	36∼45	317	26.31%
	46∼55	269	22.32%
	>55	40	3.32%
The average age was 38.41±11.26 years
Marriage	have a partner	890	73.86%
	no partner	315	26.14%
Educational	Junior college and below	402	33.36%
	bachelor degree	689	57.18%
	master degree or above	114	9.46%
Vocational post	general practitioner	408	33.86%
	specialist	124	10.29%
	nurse	379	31.45%
	apothecary	55	4.56%
	administrative personnel	239	19.83%
Career years (year)	<1	189	15.68%
	1∼5	407	33.78%
	6∼10	236	19.59%
	11∼15	145	12.03%
	16∼20	143	11.87%
	>20	85	7.05%
Professional title	no title	251	20.83%
	junior professional title	558	46.31%
	intermediate title	301	24.98%
	associate senior title	88	7.30%
	senior professional title	7	0.58%
Monthly income (RMB)	<3000	402	33.36%
	3000∼5000	580	48.13%
	5001∼7000	204	16.93%
	>7000	19	1.58%

3.2 Correlation analysis

The results of the correlation analysis found that work-family conflict was negatively correlated with job satisfaction and professional identity and positively correlated with emotional exhaustion and resignation intention, with a correlation coefficient between 0.061 and 0.559. Job satisfaction and professional identity were negatively correlated with emotional exhaustion and resignation intention, and the correlation coefficients were between 0.035 and 0.462. Moreover, emotional exhaustion was positively correlated with resignation intention (all p < 0.05). The scores of each index are work-family conflict 27.079±8.296, job satisfaction 58.882±10.983, professional identity 127.722±41.812, emotional exhaustion 16.670±7.585, resignation intention 3.396±1.166 (Table 2).

Table 2
Descriptive statistics and correlation analysis results

Variable WFC JS PI EE RI

WFC 1

JS –0.559^*** 1

PI –0.061^* 0.057^* 1

EE 0.504^* –0.462^* –0.067^* 1

RI 0.495^* –0.435^* –0.035^* 0.457^*** 1

Mean 27.079 58.882 127.722 16.670 3.396

SD 8.296 10.983 41.812 7.585 1.166

Variable	WFC	JS	PI	EE	RI
WFC	1
JS	–0.559^***	1
PI	–0.061^*	0.057^*	1
EE	0.504^***	–0.462^***	–0.067^*	1
RI	0.495^***	–0.435^***	–0.035^*	0.457^***	1
Mean	27.079	58.882	127.722	16.670	3.396
SD	8.296	10.983	41.812	7.585	1.166

Note:^*p < 0.05, ^**p < 0.01, ^***p < 0.001.

3.3 Mediation analyses

The structural equation model was constructed by Mplus software, and the results showed that the model fit was good. χ²/df = 2.492, CFI = 0.923, TLI = 0.907, RMSEA = 0.069, SRMR = 0.066 (Table 3).

Table 3
Model fit index

Fit Key figures (recommended values) Model metrics Degree of compliance

ML χ² The smaller the better 316.444 –

DF The bigger the better 127 –

χ²/df(Normed Chi-sqr) 1 <χ²/df <3 2.492 Satisfy

CFI >0.90 0.923 Satisfy

TLI >0.90 0.907 Satisfy

RMSEA <0.08 0.069 Satisfy

SRMR <0.08 0.066 Satisfy

Fit	Key figures (recommended values)	Model metrics	Degree of compliance
ML χ²	The smaller the better	316.444	–
DF	The bigger the better	127	–
χ²/df(Normed Chi-sqr)	1 <χ²/df <3	2.492	Satisfy
CFI	>0.90	0.923	Satisfy
TLI	>0.90	0.907	Satisfy
RMSEA	<0.08	0.069	Satisfy
SRMR	<0.08	0.066	Satisfy

According to the research results, the total effect is 0.649 (95% CI = 0.516∼0.782), the total indirect effect is 0.279 (95% CI = 0.210∼0.348), the direct effect is 0.372 (95% CI = 0.256∼0.488), all p < 0.05, indicating that the mediation effect is significant. The model has a partial mediation effect. The mediation model also found that job satisfaction and professional identity directly mediate between work-family conflict and primary care physicians’ resignation intention. There are three chain mediation paths, namely Work-family conflict ⟶ Job satisfaction ⟶ Emotional exhaustion ⟶ Resignation Intention, Work-family conflict ⟶ Professional identity ⟶ Emotional exhaustion ⟶ Resignation intention, Work-family conflict ⟶ Job satisfaction ⟶ Professional identity ⟶ Emotional exhaustion ⟶ Resignation intention (Table 4).

Table 4

Analysis and comparison of specific indirect effects

	Point estimate	Product of coefficients			Bootstrap 1,000 times 95% CI
	Estimate	S.E.	Est./S.E.	p-Value	Percentile		Bias corrected
					Lower	Upper	Lower	Upper
JS	0.089	0.007	12.714	<0.001	0.075	0.103	0.074	0.104
PI	0.049	0.008	6.125	<0.001	0.033	0.065	0.033	0.068
JS⟶PI	0.036	0.012	3.000	<0.001	0.012	0.060	0.010	0.059
JS⟶EE	0.156	0.025	6.240	<0.001	0.107	0.205	0.105	0.206
PI⟶EE	0.011	0.004	2.750	<0.001	0.003	0.019	0.002	0.020
JS⟶PI⟶EE	0.007	0.003	2.333	<0.001	0.001	0.013	0.001	0.014
TIE	0.279	0.035	7.971	<0.001	0.210	0.348	0.210	0.348
DE	0.372	0.059	6.305	<0.001	0.256	0.488	0.255	0.487
TE	0.649	0.068	9.544	<0.001	0.516	0.782	0.513	0.784

Note: Estimate is an unstandardized coefficient, TIE: total indirect effect, TE: total effect, DE: direct effect.

Figure 2 shows the impact path between work-family conflict and primary care physicians’ resignation intention. The study found that work-family conflict significantly impacts doctor resignation intention. The standardized coefficient is –0.546 (p < 0.001), and hypothesis 1 (H1) got data support. Job satisfaction negatively affects resignation intention (β= –0.069, p < 0.05). Professional identity also has a direct impact on primary care physicians’ resignation intention (β= –0.103, p < 0.01), indicating that work-family conflict can pass job satisfaction, professional identity indirectly affects primary care physicians’ resignation intention, hypotheses 2 and 3 (H2, H3) are supported to a certain extent. In addition, job satisfaction and professional identity negatively affect emotional exhaustion (β₁ = –0.525, β₂ = –0.087, p < 0.01). In contrast, job satisfaction positively affects primary care physicians’ professional identity (β= 0.271, p < 0.01). emotional exhaustion also positively affects primary care physicians’ resignation intention (β= 0.229, p < 0.05), indicating that work-family conflict can increase emotional exhaustion by reducing job satisfaction, thereby increasing resignation intention, and can also increase emotional exhaustion by reducing professional identity, thereby promoting resignation intention, and at the same time reducing job satisfaction, thereby reducing professional identity, and finally affecting resignation intention. Finally, it can also reduce job satisfaction, weaken the professional identity, and increase emotional exhaustion, which further affects the resignation intention. Therefore, hypotheses 4, 5, 6, and 7 (H4, H5, H6, H7) were also somewhat confirmed.

Fig. 2

Structural equation model of the impact of work–family conflict on resignation intention of primary care physicians. Note:^*p < 0.05, ^**p < 0.01, ^***p < 0.001.

4 Discussion

The focus of this study is to explore the formation mechanism and impact path of primary care physicians’ resignation intention to provide a reference for reducing the turnover rate of primary care physicians and promoting the construction of primary care physicians’ health service system. Through the structural equation model, the study verified the influence of job characteristics on primary care physicians’ resignation intention. The results found that work-family conflict significantly impacts doctors’ resignation intentions. The mediation model found that job satisfaction and professional identity are in the relationship between work-family conflict and primary care physicians. There is a direct mediation effect between care physicians’ resignation intention. In addition, this study also found that there are three chain intermediary paths between work-family conflict and primary care physicians’ resignation intention, namely Work-family conflict ⟶ Job satisfaction ⟶ Emotional exhaustion ⟶ Resignation intention, Work-family conflict ⟶ Professional identity ⟶ Emotional exhaustion ⟶ Resignation intention, Work-family conflict ⟶ Job satisfaction ⟶ Professional identity ⟶ Emotional exhaustion ⟶ Resignation intention.

4.1 Primary care physicians’ resignation intention score is high but still needs further attention

The study found that the primary care physicians’ resignation intention score was 3.396±1.166 points, 3 points higher than the median value, indicating that the primary care physicians’ resignation intention was relatively high. The front line is not only faced with treating patients and saving lives but also needs to carry out the health management of residents. Under the heavy workload and complex working environment, they feel colossal work pressure during the period, which will affect their work enthusiasm and improve their resignation intention [33]. Secondly, the income of primary care physicians may also fluctuate to a certain extent. The service charges of primary care physicians are usually billed according to the number of services or cases, which may also lead to instability of their income [34, 35]. In addition, they also lack career development opportunities. Some primary care physicians may feel that their career prospects are not clear enough and lack development opportunities, which may cause them to feel frustrated and disappointed, resulting in resignation intention [36]. At the same time, the disharmonious doctor-patient relationship may also affect primary care physicians’ work mood and experience [37, 38]. Therefore, providing primary care physicians with better working conditions and support is necessary to reduce work pressure, such as strengthening teamwork, providing vocational training, and upgrading skills opportunities. It is also necessary to stabilize the income of primary care physicians,improve their social status and treatment, and provide more career development opportunities for primary care physicians. Finally, it is necessary to improve patients’ medical literacy and awareness of politeness, strengthen doctor-patient communication and understanding, and establish a harmonious doctor-patient relationship.

4.2 Work-family conflict is an essential factor affecting primary care physicians’ resignation intention

The research results show that work-family conflict can directly affect the resignation intention of primary care physicians. Work-family conflict refers to individuals’ incongruity in their work and family roles [39]. That will lead to job burnout and even resignation [40]. Primary care physicians are an essential part of the primary medical service system and will also be affected by this phenomenon. Specifically, when primary care physicians cannot balance work and family roles, they may feel physically and mentally exhausted, unable to concentrate, and lack work motivation, which will reduce work efficiency and affect the quality of medical services. In this case, primary care physicians may consider leaving or seeking other job opportunities. The work stress theory holds that work pressure may increase primary care physicians’ workload and work intensity, leading to conflicts between work and family in primary care physicians, thereby increasing their resignation intention [41]. Secondly, work-family conflict may also lead to tension between primary care physicians and family members. Long-term work pressure and lack of time may make primary care physicians unable to fully take care of the needs of family members, which in turn leads to dissatisfaction or complaints from family members, further aggravating the conflict between work and family. Social identity theory also suggests that primary care physicians may feel that their careers and family responsibilities are incompatible. That leads to a sense of division and imbalance between work and family, thereby increasing their resignation intention [42, 43]. The psychological contract theory also points out that primary care physicians may feel that job requirements are inconsistent with their psychological contract, causing them to feel exhausted and lost between work and family, thereby increasing their resignation intention [44]. Therefore, in order to avoid the impact of work-family conflict on primary care physicians’ resignation intention, relevant departments should take measures to help primary care physicians balance work and family roles, such as providing flexible working hours, reasonable salary and benefits, vocational training, etc., to alleviate primary care physicians work pressure, improve their job satisfaction and loyalty. At the same time, primary care physicians should also be aware of their own work-family conflict problems and actively take measures to solve them, such as adjusting work and family time allocation, seeking support from family members, to maintain physical and mental health and work stability.

4.3 Work resources as a positive factor can alleviate the impact of work-family conflict on resignation intention

The study found that job resources, as a positive factor, hurt primary care physicians’ resignation intentions. Among them, the lower the job satisfaction and the professional identity, the higher the resignation intention. Job satisfaction refers to the degree to which an individual is satisfied with his or her job. It is an individual’s evaluation of multiple factors, such as the working environment, work tasks, and work benefits [45]. If primary care physicians are less satisfied with their work and think they cannot obtain satisfaction and fulfillment in their current work, a resignation intention will arise. Secondly, when primary care physicians feel too much work pressure, too many work tasks, and fewer work benefits, it may cause physical and mental exhaustion and fatigue, leading to physical discomfort. Primary care physicians may leave the organization to relieve stress in such cases. The two-factor theory also holds that satisfaction and dissatisfaction factors determine job satisfaction. Satisfaction factors include job achievement, recognition, and working environment, while dissatisfaction factors include work pressure and poor working environment. If primary care physicians feel fewer satisfaction factors and more dissatisfaction factors at work, it may affect their Job satisfaction and resignation intention [46]. Professional identity refers to the individual’s sense of identity with the profession he is engaged in, and it is an experience in which a person obtains satisfaction in the profession [47]. Relevant studies have also found that when primary care physicians have a strong sense of identity with the profession they are engaged in, they can fully implement their professional skills and abilities in this profession. With a smaller tendency to leave, physicians will have the high sense of self-worth. Moreover, when primary care physicians have a higher sense of identity and believe that their occupation has particular social significance and value, their job satisfaction will be higher, and the risk of resignation intention will be reduced [48, 49]. Self-determination theory also believes that people must meet their basic needs, such as autonomy, ability, and interpersonal relationship, to obtain satisfactory work experience [50]. Suppose primary care physicians feel that the organization limits their autonomy or cannot meet their needs at work. In that case, it may reduce their job satisfaction and professional identity and increase resignation intention. In addition, job satisfaction and professional identity mediate between work-family conflict and resignation intention, which may be because primary care physicians may feel physically and mentally exhausted when it is challenging to balance work and family roles. It is not easy to maintain high levels of job performance and a lower sense of identity and self-worth itheir occupations. That may weaken the Job satisfaction and Professional identity of primary care physicians, increasing the risk of resignation intention [51, 52]. Therefore, relevant departments should pay attention to primary care physicians’ job satisfaction and professional identity, provide appropriate resources and rewards, protect their autonomy, and provide a good working environment and career development opportunities. At the same time, they should also pay attention to the professional value and professional identity of primary care physicians’ Social responsibility, enhance their job satisfaction and professional identity, and reduce their resignation intention.

4.4 Emotional exhaustion as a negative psychological resource can enhance the resignation intention of primary care physicians

The study’s results found that emotional exhaustion was significantly positively correlated with the resignation intention of primary care physicians and had a significant mediating effect between job characteristics and resignation intention. Emotional exhaustion is when individuals can no longer effectively regulate their emotions and produce emotional responses after facing adverse situations such as tension, fatigue, and stress for a long time [53]. Primary care physicians have been in medical work for a long time. They may face heavy workloads, occupational pressure, pressure from patients’ diseases, which may lead to emotional exhaustion. Emotional exhaustion can negatively impact the mental and physical health of primary care physicians and their job and career satisfaction. First, emotional exhaustion will affect primary care physicians’ cognition and concentration ability, leading to decreased work motivation, an inability to treat work actively, and even job burnout, affecting their enthusiasm and dedication to work [54]. Fatigue and fatigue theory also believes that emotional exhaustion may lead to physical and mental exhaustion of primary care physicians, loss of enthusiasm and motivation for work, work fatigue, and job burnout, thus affecting their resignation intention [55]. Second, emotional exhaustion may decrease job satisfaction among primary care physicians, resulting in negative emotions such as anger, anxiety, and depression, which in turn lead to job dissatisfaction and complaints, increasing the possibility of leaving the job [56]. At the same time, emotional exhaustion will have adverse effects on the physical and mental health of primary care physicians, such as decreased sleep quality, decreased physical strength, decreased immunity, which will increase the number of illnesses and vacations, affect work stability and efficiency, and affect resignation intention [57]. Coping and adaptation theory also confirms that emotional exhaustion may cause primary care physicians to lose confidence and courage in their work, resulting in frustration and powerlessness in coping with difficulties, affecting their adaptability and confidence in work and affecting their resignation intention [58]. In addition, emotional exhaustion has a significant mediating effect between work characteristics and resignation intention. First, work-family conflict may cause primary care physicians to find it challenging to balance work and family, resulting in stress, burden, and emotional exhaustion. For example, primary care physicians may need to choose between work and family, which may cause them to feel tired, restless, and powerless, reduce job satisfaction and professional identity, and aggravate emotional exhaustion [59]. Second, when primary care physicians feel a lack of fulfillment and satisfaction in their work, they may feel lost and depressed, intensifying emotional exhaustion [60]. Finally, professional identity can influence primary care physicians’ commitment and willingness to work. When primary care physicians doubt their professional value and ability, they may feel helpless and depressed, which can exacerbate emotional exhaustion [61]. Therefore, in order to reduce the impact of emotional exhaustion on work and life, primary care physicians need to pay attention to emotional regulation and the maintenance of physical and mental health and enhance the sense of balance and control between work and life, thereby reducing the possibility of leaving the job.

In order to reduce the turnover intention of primary care physicians, a series of measures need to be taken to balance work and family, thereby alleviating work pressure and emotional exhaustion. Firstly, establishing clear boundaries between work and family is crucial. Primary care physicians need to focus on work during working hours and try to avoid bringing work home. They can set fixed working hours to ensure spending as much time as possible with family during family time, thus alleviating work-family conflicts and maintaining family harmony. Secondly, prioritizing self-care and mental health is an important way to reduce emotional exhaustion. Primary care physicians should learn to effectively manage stress and emotions, such as through exercise, leisure activities, and social interactions to relax themselves. They can participate in mental health training to learn techniques for coping with stress and emotion management, thereby enhancing their coping abilities. Additionally, establishing a good support system is key to reducing emotional exhaustion. Primary care physicians can share their feelings and experiences with colleagues, family, and friends to gain understanding and support. At the same time, healthcare institutions should provide mental health support services to offer professional psychological counseling and assistance for primary care physicians. Lastly, enhancing job satisfaction and professional identity is also an important way to reduce turnover intention. Primary care physicians can improve their professional competence and work skills through continuous professional development and learning, thus gaining a sense of achievement and satisfaction. Moreover, healthcare institutions should pay attention to the working environment and treatment of primary care physicians, providing favorable working conditions and development opportunities to enhance their professional identity and commitment to the profession.

4.5 Limitations

Some limitations to this study warrant consideration. First, the associations among work-family conflict, job satisfaction, professional identity, emotional exhaustion, and resignation intention are cross-sectional in the study. Mere correlation between the five cannot confirm causality. Therefore, this could be further validated using longitudinal data in the future. Second, since the information was gathered from the participants in the study, self-report/recall bias may have existed. Finally, our findings with acceptable goodness-of-fit indices deserve greater attention.

5. Conclusions

Primary care physicians have high resignation intentions and must be paid attention to. In addition, our study found that Work-family conflict can directly and positively affect primary care physicians’ resignation intention and indirectly affect primary care physicians’ resignation intention through the mediating effects of job satisfaction, professional identity, and emotional exhaustion. This intermediary includes six ways: one is through the independent intermediary effect of job satisfaction; the second is through the independent intermediary effect of professional identity; the third is through the intermediary chain effect of job satisfaction and professional identity; the fourth is through job satisfaction and emotional exhaustion. The fifth is through the intermediary chain effect of professional identity and emotional exhaustion; the sixth is through the complex chain intermediary effect of job satisfaction, professional identity, and emotional exhaustion. Therefore, we can help primary care physicians balance work and family roles, provide them with appropriate resources and rewards, as well as a good working environment and career development opportunities, improve their job satisfaction and professional identity, and reduce emotional exhaustion, thereby reducing resignation intention risks.

Based on these insights, practical recommendations for healthcare organizations and policymakers include prioritizing strategies that help primary care physicians balance their work and family responsibilities. This can be achieved through providing adequate resources, fair compensation, supportive working environments, and opportunities for career advancement. Enhancing job satisfaction and professional identity are crucial, as they directly influence physicians’ intentions to remain in their roles. Moreover, efforts to reduce emotional exhaustion among primary care physicians are essential, as it can exacerbate resignation intentions. By addressing these factors comprehensively, healthcare systems can effectively mitigate the risks of physician turnover and ensure sustainable workforce retention in primary care.

Ethical approval

All methods were carried out in accordance with relevant guidelines and regulations. Ethical approval was granted by the Ethics Committee of Kangda College of Nanjing Medical University (2022-01).

Informed consent

The study team obtained informed consent from all participants. The participants were made aware that they could withdraw at any time.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Footnotes

Acknowledgments

The authors thank all participants, assistants, and researchers for their contribution to this study.

Funding

This study was supported by the National Natural Science Foundation of China (no.72274023), Special Project on Philosophy and Social Sciences and Ideological and Political Work in Colleges and Universities of Jiangsu Province, China (2022SJSZ0945), and the Scientific Research Talent Training Program of Kangda College, Nanjing Medical University.

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Influence path of work-family conflict on primary care physicians’ resignation intention: Data from a Chinese cross-sectional survey

Abstract

BACKGROUND:

OBJECTIVE:

METHODS:

RESULTS:

CONCLUSION:

Keywords

1 Introduction

2.1 Participants

2.2 Measures

2.2.1 Work-family conflict

2.2.2 Job satisfaction

2.2.3 Professional identity

2.2.4 Emotional exhaustion

2.2.5 Resignation intention

2.3 Research methods

2.4 Data analysis

3 Results

3.1 Descriptive data

Table 2 Descriptive statistics and correlation analysis results Variable WFC JS PI EE RI WFC 1 JS –0.559*** 1 PI –0.061* 0.057* 1 EE 0.504*** –0.462*** –0.067* 1 RI 0.495*** –0.435*** –0.035* 0.457*** 1 Mean 27.079 58.882 127.722 16.670 3.396 SD 8.296 10.983 41.812 7.585 1.166

4.1 Primary care physicians’ resignation intention score is high but still needs further attention

4.2 Work-family conflict is an essential factor affecting primary care physicians’ resignation intention

4.3 Work resources as a positive factor can alleviate the impact of work-family conflict on resignation intention

4.4 Emotional exhaustion as a negative psychological resource can enhance the resignation intention of primary care physicians

4.5 Limitations

5. Conclusions

Ethical approval

Informed consent

Conflict of interest

Footnotes

Acknowledgments

Funding

References

Table 2
Descriptive statistics and correlation analysis results

Variable WFC JS PI EE RI

WFC 1

JS –0.559^*** 1

PI –0.061^* 0.057^* 1

EE 0.504^* –0.462^* –0.067^* 1

RI 0.495^* –0.435^* –0.035^* 0.457^*** 1

Mean 27.079 58.882 127.722 16.670 3.396

SD 8.296 10.983 41.812 7.585 1.166