Long Hours and Night Shifts Drive Chinese Physicians Toward the Exit, Major Survey Finds

China’s physicians are running on empty, and the toll is showing up in the numbers. A new cross-sectional study of 1,324 doctors working in primary healthcare centers, hospitals, and Centers for Disease Control and Prevention across four provincial-level regions of China has quantified just how heavily the country’s clinical workforce is burdened and what that burden costs in well-being and retention. The research, led by Huixian Zheng and colleagues at Peking University and published in BMC Health Services Research, is among the first to break physician workload into its component parts, measuring not just total hours worked but the specific grind of outpatient visits, inpatient caseloads, surgical time, and night shifts.

The headline finding is stark. Physicians working more than 57 hours per week scored, on average, 12.64 points lower on a standard self-rated measure of physical health compared with colleagues working 45 hours or less, a difference the authors report with a 95 percent confidence interval stretching from -15.56 to -9.72. That gap came from the EQ-VAS, a visual analogue scale on which respondents rate their overall health from 0 to 100. In this sample, the mean score was 70.2 with a standard deviation of 16.7, meaning that the heaviest-worked physicians were falling well below an already modest average.

The psychological picture was equally concerning. In total, 42.3 percent of the physicians surveyed were classified as having poor psychological well-being, while only 27.6 percent met the criteria for good work-related well-being. Statistical modeling revealed that those working more than 57 hours weekly had 62 percent lower odds of good psychological well-being compared with the reference group working up to 45 hours, and fully 83 percent lower odds of good work-related well-being. In other words, the longest-working doctors were not merely tired; they were substantially more likely to be struggling emotionally and to feel drained by, or disconnected from, the job itself.

What sets this study apart methodologically is its decision to disaggregate workload. Most earlier research has collapsed clinical burden into a single figure, usually total weekly hours, which conceals the fact that a physician’s week can be composed of very different stresses. Zheng’s team therefore measured four distinct clinical workload metrics among clinical physicians: weekly outpatient visit volume, monthly inpatient management load, weekly surgical hours, and weekly night-shift frequency. This allowed the researchers to ask whether, say, a relentless stream of clinic patients affects well-being differently from a heavy roster of overnight calls.

The answer, intriguingly, is yes. Night shifts emerged as a particularly corrosive element: more frequent night shifts were associated with poorer physiological and work-related well-being in both primary healthcare centers and hospitals, and with poorer psychological well-being specifically in hospital physicians. The disruption of circadian rhythm is a well-documented mechanism behind such effects, and the pattern here is consistent with the idea that shift work degrades physical health and job-related functioning broadly, while its psychological impact concentrates in the higher-acuity hospital environment.

Outpatient volume told a more nuanced story. A higher weekly outpatient caseload was associated with lower odds of good psychological well-being in both primary care settings and hospitals, with odds ratios of 0.80 and 0.78 respectively, both statistically significant. Notably, the same metric did not show a corresponding association with physiological well-being, suggesting that the strain of high-volume patient encounters operates primarily on the mind rather than the body. Surgeons’ weekly operative hours and monthly inpatient loads showed their own dimension-specific patterns across the three well-being domains, reinforcing the study’s central argument that workload is not a monolith.

The downstream consequence of this erosion of well-being is turnover intention, the self-reported likelihood of leaving one’s job, which is one of the strongest predictors of actual attrition in workforce research. Here the findings converge sharply. Physicians with good psychological well-being had 64 percent lower odds of intending to leave, and those with good work-related well-being had 65 percent lower odds, with confidence intervals that exclude the null in both cases. Higher physiological well-being was also independently associated with reduced turnover intention. Every dimension of well-being the study measured pointed in the same direction: healthier, happier doctors are far less likely to walk away.

Placed in context, these results carry considerable weight for health policy. China’s healthcare system is grappling with a well-documented shortage and maldistribution of physicians, particularly in primary care, and any factor that accelerates departure from the profession compounds the problem. The study’s finding that overall work duration was the most consistent correlate of well-being across all three dimensions suggests that caps on total working hours would deliver the broadest benefit, while the dimension-specific effects of night shifts and outpatient volume imply that targeted scheduling reforms, such as limiting consecutive night duty or managing clinic throughput, could address particular vulnerabilities in particular settings.

The research draws its data from the eighth Chinese Physicians’ Practice Status Survey, and the authors used multivariable linear regression for continuous well-being outcomes and logistic regression for binary classifications, adjusting for covariates to isolate the contribution of workload. Ethics approval came from Peking University Health Science Center’s Institutional Review Board, and all participants provided electronic informed consent. The work was supported by the Chinese Medical Doctor Association, and the corresponding author is Xiaoyun Liu of the China Center for Health Development Studies at Peking University, whose affiliations include a National Health Commission key laboratory and a WHO Collaborating Centre for Universal Health Coverage.

Like all cross-sectional studies, this one captures a snapshot rather than a trajectory, and the authors acknowledge that reverse causation remains possible, since doctors in poorer health may work differently. Still, the consistency of the associations, the large and geographically diverse sample, and the fine-grained treatment of workload make a compelling case. As the authors conclude, balanced workforce management must address both how work is organized and how physicians actually feel, because the path from an overloaded clinic to an empty staff room runs directly through the well-being of the doctors in between. For a health system of China’s scale, that message could hardly be more urgent.

Subject of Research: Associations between clinical workload dimensions, physician well-being, and turnover intention in Chinese primary healthcare centers and hospitals

Article Title: Clinical workload dimensions, multidimensional physician well-being, and turnover intention across primary healthcare centers and hospitals in China: a cross-sectional study

Article References: Zheng, H., Li, M., Tang, H., Zhou, Y., & Liu, X. (2026). Clinical workload dimensions, multidimensional physician well-being, and turnover intention across primary healthcare centers and hospitals in China: a cross-sectional study. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15861-9

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15861-9

Keywords: physician well-being, workload, turnover intention, night shifts, China, primary healthcare, hospitals, cross-sectional study, health workforce, burnout, health services research, Clinical