Medical Disputes Push Doctors and Technicians Toward the Exit, Chinese Study Finds

When a clinician decides to leave the profession, the decision rarely arrives out of nowhere. It accumulates through exhausting shifts, strained encounters with patients, and a quiet sense that the organization no longer values the work. A new cross-sectional study from Xuzhou, China, published in BMC Health Services Research, offers one of the clearest quantitative portraits yet of how those forces combine, and it identifies a factor that has often been overlooked in workforce research: the experience of a medical dispute. Among 1,570 physicians and medical technicians surveyed in public hospitals, nearly one in four reported an intention to leave their job, and those who had been through a dispute were roughly 68 percent more likely to want out than colleagues who had not, even after the analysis carefully balanced the two groups against each other.

The finding matters because turnover intention is not a trivial attitude. In health services research, it is treated as a strong behavioral predictor, the cognitive step that precedes actual resignation, and it tends to cluster in ways that destabilize entire departments. When experienced clinicians and laboratory technicians begin scanning job boards, the institutional knowledge they carry, from infection control protocols to the subtle judgment calls of clinical practice, walks toward the door with them. The Xuzhou study, led by researchers affiliated with Jiangsu University and Xuzhou Medical University, frames this as a growing threat to workforce stability in a country where doctor-patient tensions have become a recognized occupational hazard.

What makes the study technically interesting is its methodological discipline. Cross-sectional surveys are notoriously vulnerable to confounding: clinicians who experience disputes may differ systematically from those who do not, in age, seniority, department, workload, or personality, and a naive comparison would attribute to the dispute whatever differences actually stem from those baseline traits. To counter this, the team used propensity score matching, a statistical technique that estimates each participant’s probability of having experienced a dispute based on their observed characteristics, then pairs participants with and without dispute experience who share similar propensities. The idea is to manufacture, from observational data, something resembling the balance of a randomized experiment, so that the dispute itself, rather than the kind of person likely to encounter one, becomes the isolated variable.

Once the groups were balanced, the researchers applied hierarchical logistic regression, a modeling approach that enters predictors in blocks, allowing the team to see how much explanatory power each layer of factors adds. The outcome was binary: whether a participant reported turnover intention or not. The results paint a layered picture. Experiencing a medical dispute carried an odds ratio of 1.682, with a 95 percent confidence interval of 1.165 to 2.430, meaning the true effect almost certainly lies well above the threshold of no association. Burnout, measured with the Oldenburg Burnout Inventory, which captures both exhaustion and disengagement, added its own independent push: each unit increase in burnout score raised the odds of turnover intention by about 10 percent, with an odds ratio of 1.096.

Just as revealing are the factors that pull in the opposite direction. Participants who perceived higher healthcare service quality showed modestly lower odds of wanting to leave, with an odds ratio of 0.973 per unit increase. Those who described their income as neutral rather than unfavorable had odds roughly 40 percent lower, at 0.604. And the strongest protective signal in the entire model came from performance appraisal: participants who viewed their evaluations as neutral had odds 53 percent lower, at 0.470, while those who considered them reasonable had odds 69 percent lower, at 0.310. In other words, the study suggests that how clinicians are judged, paid, and treated by their institutions is not background noise but a central lever in whether they stay.

The dispute effect deserves particular scrutiny because it survived all of that statistical balancing. Medical disputes in China range from formal complaints and mediation proceedings to confrontations that can turn confrontational or violent, and they are increasingly recognized in the occupational health literature as a distinct stressor, separate from ordinary workload or interpersonal friction. The mechanism linking disputes to exit is plausibly twofold. Disputes inflict direct psychological harm, eroding the sense of safety and professional identity that keeps clinicians committed. They also signal something about the environment, a perception that the institution will not shield its staff when conflict arises, which converts a single bad experience into a durable judgment about the job’s future.

Burnout’s role in the model reinforces how entangled these forces are. The Oldenburg inventory distinguishes exhaustion, the depletion of physical and emotional reserves, from disengagement, the cognitive withdrawal from work and its meaning. Prior research has consistently tied both dimensions to turnover, and the Xuzhou data fit that pattern, with burnout operating as an independent predictor even after disputes, income, appraisal, and service quality were accounted for. This suggests a cascade: a dispute raises stress, stress feeds burnout, burnout erodes commitment, and commitment’s erosion surfaces as the intention to leave. Intervening at any point in that chain, whether through dispute resolution systems, psychological support, or workload redesign, could interrupt the progression before it reaches the exit.

The study’s conclusions are framed cautiously, as they should be. A cross-sectional design captures a single moment, so it cannot prove that disputes cause turnover intention; it is possible that clinicians already leaning toward the exit perceive or report disputes differently. The survey was also confined to public hospitals in one Chinese city, which limits how far the numbers generalize. Still, the use of propensity score matching addresses one of the most common objections to observational workforce studies, and the consistency of the dispute effect with prior qualitative accounts lends it credibility. The authors argue that turnover intention is shaped by a combination of professional experiences, organizational conditions, and personal health factors, and that addressing these interconnected elements is essential for retention.

For health systems everywhere, the implications extend beyond China. Clinician shortages are a global problem, and the Xuzhou findings translate into a straightforward proposition: retention is not only about salary. Fair and transparent performance evaluation, credible dispute handling, and burnout prevention may each carry more weight than a pay adjustment alone, because they target the experiences that convert dissatisfaction into departure. The study, funded by China’s Ministry of Education and the Jiangsu Hospital Association, was approved by the Ethics Committee of Xuzhou Medical University and conducted under the Declaration of Helsinki, with written informed consent from all participants. Its most durable contribution may be the insistence that a medical dispute is not an isolated incident to be managed by a legal department, but a workforce event with measurable consequences, one that ripples through burnout scores and, ultimately, through the roster of clinicians still willing to show up.

Subject of Research: Health Services Research

Article Title: Medical disputes and turnover intention among physicians and medical technicians: evidence from a cross-sectional study in Xuzhou, China

Article References: Qi, Z., Liu, Z., Shen, L., Li, J., Wu, S., & Chen, X. (2026). Medical disputes and turnover intention among physicians and medical technicians: evidence from a cross-sectional study in Xuzhou, China. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15679-5

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15679-5

Keywords: Medical, disputes, turnover, intention, physicians, technicians, evidence, cross-sectional, Xuzhou, China, scientific research