AUTHOR=Hu Ning , Ma Jing , Wei Wei , Jiang Xiaoying , Zhu Aiping , Zhang Chunyu 

TITLE=The combined effect of perception of pay fairness and institutional transparency on physicians’ work enthusiasm: a mixed method study from China

JOURNAL=Frontiers in Public Health

VOLUME=Volume 13 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1555684

DOI=10.3389/fpubh.2025.1555684

ISSN=2296-2565

ABSTRACT=IntroductionPhysician salary structures in Chinese public hospitals are crucial for motivating healthcare providers. Based on Expectancy Theory, this study aims to provide an evidence-based foundation for hospital managers in salary system design through investigating the combined effect of perceptions of pay fairness and institutional transparency on Chinese physicians’ work enthusiasm, with a focus on the moderating effect of institutional transparency.MethodsA qualitative study was conducted from December 2023 to February 2024 to initially explore the relationships of perception of pay fairness, institutional transparency, and work enthusiasm. Subsequently, a quantitative study was conducted between April and May 2024 to examine the combined interaction of these factors. Physicians from Beijing, Haikou, Linyi, Nanjing, and Yinchuan were recruited to participate in the study.ResultsThe qualitative analyses showed that most physicians knew the determinants of salary but were not familiar with the details. The monthly salary gaps acceptable by most physicians featured time allocation ranging from 0.5 to 1.0, or less than ¥10,000 ($1,378). The structural results of the equation modeling showed that the perception of pay fairness had a significant and positive impact on work enthusiasm (β = 0.454, p < 0.001), and institutional transparency promoted the association between the perception of pay fairness and work enthusiasm (β = 0.229, p = 0.003).ConclusionReasonable salary gaps and awareness of the scheme are required to improve physicians’ enthusiasm for their work.