The global prevalence of turnover intention among general practitioners: a systematic review and meta-analysis

Background General practitioners (GPs) are the foundation of any primary healthcare system. Their quality and quantity are directly associated with the effectiveness and quality of the health services of a nation. GPs' shortage and turnover have become an important issue in developed and developing countries. An accurate estimate of turnover intention prevalence among GPs would have important health policy implications, but the overall prevalence is unknown. We aimed to summarize the global prevalence of turnover intention and associated factors among GPs. Methods We systematically reviewed the PubMed, Embase, Web of Science and China National Knowledge Infrastructure (CNKI) databases from their inception up to May 2020, as well as the reference lists of all included studies. We included observational studies that reported data on turnover intention or their prevalence rate among GPs could be calculated based on the information provided. The prevalence rate of the turnover intentions was estimated using a random-effects meta-analysis. The heterogeneity was evaluated using I-2 statistic. Differences by study level characteristics were estimated via subgroup analysis and meta-regression. Results A total of 25 cross-sectional studies were included (a total of 27,285 participants). The prevalence of turnover intention was 0.47 (95% CI: 0.39-0.55). Those having a lower level of salary (OR = 1.38, 95% CI: 1.13-1.63) and job satisfaction (OR = 1.35, 95% CI: 1.12-1.70) or having lower level of morale (OR = 2.68, 95% CI: 1.56-3.80) had a higher intention. In contrast, GPs with a lower level of professional title had a lower turnover intention (OR = 0.81, 95% CI: 0.65-0.98). Conclusions In this systematic review, approximately half of the GPs had the intention to leave their current posts worldwide. The factors associated with turnover intention were higher professional title, lower income level, lower job satisfaction and lower morale.