Workplace Violence and Turnover Intention Among Rural General Practitioners in China’s National Compulsory Services Program: The Mediating Role of Psychosocial Factors

Background: Workplace violence (WPV) against general practitioners (GPs) is a global issue, especially in rural regions. The National Compulsory Services Program (NCSP) was launched to address the primary care shortage in China. This study examines WPV prevalence and associated factors among NCSP GPs, its impact on turnover intention, and the mediating role of psychosocial factors. Methods: 3,615 GPs from township health centers (THCs) across nine provinces were recruited between 2021 and 2022. Logistic regression identified socio-demographic and occupational characteristics associated with WPV. Mediation analysis tested pathways between WPV and turnover intention. Findings: Among participants, 60.8% reported WPV in the past 12 months, with 60.3% experiencing verbal and 17.5% physical violence. WPV was associated with age ( OR = 0.95, 95% CI [0.91, 0.99]), higher professional rank ( OR = 1.26 [1.06, 1.50]), 2 years in practice ( OR = 1.42 [1.18, 1.71]), monthly income > CNY 4,000 ( OR = 1.25 [1.08, 1.45]), practicing in hometown ( OR = 1.20 [1.05, 1.38]), serving in general practice ( OR = 1.31 [1.14, 1.51]), and ≥ 55 weekly working hours ( OR = 1.58 [1.34, 1.88]). WPV influenced turnover intention directly and indirectly through four psychosocial mediators: job satisfaction (indirect effect = 0.023, p < .001, 45.1% of the total effect), loneliness (0.019, p < .001, 37.3%), well-being (0.015, p < .001, 28.8%), and career choice regret (0.009, p < .001, 17.6%). Conclusion: High WPV prevalence among rural Chinese GPs poses a threat to occupational safety and is associated with lower job and life satisfaction, greater loneliness and career choice regret, potentially threatening retention in THCs. Applications to Practice: Rural primary care systems should provide psychological counseling, group supervision, and career coaching as targeted psychosocial interventions to address these mediating pathways and strengthen rural GP retention.