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

Physician well-being is important for maintaining a stable health workforce and the continuity of healthcare delivery. However, existing research often focuses on a single dimension of well-being or represents workload using total working hours, potentially overlooking differences among specific clinical workload components. This study examined the associations of total weekly working hours and disaggregated clinical workload metrics with physiological, psychological, and work-related well-being, and assessed how these well-being dimensions were associated with turnover intention among physicians in China. A cross-sectional survey was conducted among 1,324 physicians from primary healthcare centers(PHCs), hospitals, and Centers for Disease Control and Prevention (CDCs) across four provincial-level regions in China. Workload was assessed using total weekly working hours and, among clinical physicians, four disaggregated clinical workload metrics: weekly outpatient visits, monthly inpatient management, weekly surgical hours, and weekly night-shift frequency. Multivariable linear and logistic regression models were used to examine associations between workload measures and three dimensions of physician well-being, and between well-being and turnover intention. The mean EQ-VAS score was 70.2 (SD 16.7). Overall, 42.3% of physicians were classified as having poor psychological well-being, and 27.6% met the criteria for good work-related well-being. Compared with physicians working no more than 45 h per week, those working more than 57 h had a 12.64-point lower physiological well-being score ( β =-12.64, 95% CI -15.56 to -9.72), lower odds of good psychological well-being ( OR = 0.38, 95% CI 0.27–0.54), and lower odds of good work-related well-being ( OR = 0.17, 95% CI 0.11–0.27). More frequent night shifts were associated with poorer physiological and work-related well-being in both PHCs and hospitals, and with poorer psychological well-being in hospitals. Higher weekly outpatient volume was associated with lower odds of good psychological well-being in PHCs ( OR = 0.80, 95% CI 0.67–0.97) and hospitals ( OR = 0.78, 95% CI 0.63–0.97). Good psychological and work-related well-being were associated with lower odds of turnover intention ( OR = 0.36, 95% CI 0.25–0.50 and OR = 0.35, 95% CI 0.22–0.57, respectively), and higher physiological well-being was also associated with lower odds of turnover intention. Physician workload is closely linked to multidimensional well-being, which in turn is strongly associated with turnover intention. Overall work duration emerged as the most consistent correlate of well-being, whereas specific clinical workload components exhibited dimension-specific patterns. These findings advocate for balanced workforce management strategies that address both workload organization and multidimensional physician well-being.