Motivational Factors for Physicians and Nurses Retention in Public Healthcare System: A Case Study of Tertiary Care Hospital General Hospitals and Community Hospitals under Nakhon Si Thammarat Provincial Health Office

Abstract

Medical personnel shortage is a critical challenge in Thailand's public health system, with Nakhon Si Thammarat province experiencing a 6.7% annual turnover rate exceeding the national average. This study examined intrinsic motivation, extrinsic motivation, organizational commitment, and retention intention levels among physicians and nurses; compared these factors across demographics; and analyzed factors influencing retention intention. A cross-sectional study was conducted with 164 participants from tertiary care, general, and community hospitals under Nakhon Si Thammarat Provincial Health Office. Data were collected using reliable questionnaires and analyzed using descriptive statistics, non-parametric tests, and multiple regression. Results showed high intrinsic motivation ( = 4.10) with sense of value and pride highest ( = 4.54) but autonomy and participation lowest ( = 3.81). Extrinsic motivation was moderate-to-high ( = 3.48) with relationships and teamwork highest ( = 3.94) but salary and benefits lowest ( = 3.06). Organizational commitment was moderate – to - high ( = 3.70) while retention intention was moderate ( = 3.43). Age significantly affected intrinsic motivation with ages 31 - 35 lowest. Work experience significantly influenced intrinsic motivation and commitment with 5 - 10 years lowest and 16 - 20 years highest. Marital status significantly affected intrinsic motivation and commitmentwith divorced/separated individuals lowest. Multiple regression revealed extrinsic motivation had strongest influence (β = 0.513) followed by intrinsic motivation (β = 0.280), explaining 54.9% of variance. This study concludes that enhancing extrinsic motivating factors is crucial for personnel retention, with special attention needed for at-risk groups.