Changes in the Job Satisfaction of Village Clinic Doctors Since the New Health Care System Reform: A Comparison Based on Three Surveys in Shandong, China

Abstract Background: In 2009, the Chinese government launched a new health care system reform. One of the important aims of the reform was to improve the capacity of primary health institutions. Village clinic doctors are part of the health service force rooted in rural China and the basis of the three-tiered health service system. The job satisfaction of village clinic doctors has an important impact on the stability and sustainable development of the three-tiered health service system. This study aimed to analyse the changes in village clinic doctors' job satisfaction after the implementation of the new health care system reform.Methods:All the data came from three surveys of village clinic doctors in Shandong Province conducted in 2012, 2015 and 2018. In 2012, an originally designed questionnaire was used to conduct a baseline survey of 405 village clinic doctors from 27 townships in 9 counties (the response rate was 92.9%). In 2015 and 2018, 519 and 223 village clinic doctors in the same counties were surveyed with the same questionnaire (the response rates were 94.3% and 92.9%, respectively). Descriptive analysis, χ2 test and ANOVA were used to analyse the level of and changes in village clinic doctors' job satisfaction.Results: The mean scores of village clinic doctors' total job satisfaction were 2.664 ± 1.069, 3.121 ± 0.931 and 2.676 ± 1.044 in 2012, 2015 and 2018, respectively, with a significant difference (F = 28.732, P < 0.001). The mean scores of the medical practice environment and the job itself showed a continuous downward trend. The change trends of the mean scores for job reward, internal work environment and organizational management were consistent with the trend for total job satisfaction.Conclusion: After the implementation of the NHCSR, the job satisfaction of village clinic doctors showed a trend of first rising and then falling. To improve primary health care service capacity, the Chinese government has implemented a series of new reform policies. With their ongoing implementation, village clinic doctors' job satisfaction should be the subject of more systematic and detailed research.