背景:有效利用专职医疗人员可能有助于解决到2030年估计的1800万卫生工作者的预计短缺问题。有关专职卫生专业人员减员的知识,或者打算离开,和影响减员的因素可以帮助制定循证策略来缓解这一问题。审查旨在绘制自然减员率和自然减员率,及其对全球专职医疗专业的归因因素。
方法:遵守PRISMA-ScR指南,跨学术数据库进行了全面搜索(PsycINFO,MEDLINE,Embase,Emcare,CINAHL,Scopus,和科克伦图书馆数据库)和灰色文献(谷歌,谷歌学者,组织网站)。两名审阅者使用定制的数据提取表格独立地进行了两阶段的筛选过程以及数据提取。使用叙述性综合来综合数据。
结果:纳入了1990年至2024年间发表的32项研究。在所有相关卫生学科中,损耗率从0.5%到41%不等。药剂师表现出最低的流失率,而听力学家报告最高。放射技师报告说,离开的意愿最低,为7.6%。虽然职业治疗师表现出最高的离开意图,从10.7%到74.1%不等。分析揭示了导致减员的三个反复出现的主题:以职业为中心的因素(例如,职业发展,工作满意度,支持,和专业成长),以系统为中心的因素(例如,补偿,人员配备挑战,临床实践,病人护理,工作量),和以个人为中心的因素(例如,认可,需要改变,和倦怠)。
结论:专职医疗中的减损仍然是一个重大挑战。解决这个问题需要一个系统,细微差别,和基于证据的方法,鉴于复杂,相互关联,以及导致减员的多方面因素。年轻的劳动力,以改变代际价值观为特征,需要创新思维,部门间合作,以及与他人共同创造解决方案的潜力,for,以及专职医疗人员。
BACKGROUND: Efficient utilisation of allied health workforce may help address the predicted shortfall of 18 million health workers estimated by 2030. Knowledge about allied health professionals\' attrition, or intention to leave, and factors influencing attrition can assist in developing evidence-informed strategies to mitigate this issue. The review aimed to map attrition and attrition intention rates, and its attributing factors for allied health professions worldwide.
METHODS: Adhering to the PRISMA-ScR guidelines, a comprehensive search was conducted across academic databases (PsycINFO, MEDLINE, Embase, Emcare, CINAHL, Scopus, and the Cochrane Library database) and grey literature (Google, Google Scholar, organisational websites). Two reviewers independently undertook a two-stage screening process along with data extraction using customised data extraction forms. A narrative synthesis was used to synthesise the data.
RESULTS: Thirty-two studies published between 1990 and 2024 were included. Attrition rates ranged from 0.5% to 41% across allied health disciplines. Pharmacists demonstrated the lowest attrition rates, while audiologists reported the highest. Radiographers reported the lowest intent to leave at 7.6%, while occupational therapists showed highest intent to leave, ranging from 10.7% to 74.1%. The analysis revealed three recurring themes contributing to attrition: profession-centric factors (e.g., career progression, job satisfaction, support, and professional growth), systemic-centric factors (e.g., compensation, staffing challenges, clinical practices, patient care, workload), and individual-centric factors (e.g., recognition, the need for change, and burnout).
CONCLUSIONS: Attrition in allied health remains a significant challenge. Addressing this issue requires a systemic, nuanced, and evidence-based approach, given the complex, interlinked, and multifaceted factors contributing to attrition. The younger workforce, characterized by changing generational values, necessitates innovative thinking, intersectoral collaboration, and the potential for co-created solutions with, for, and by the allied health workforce.