OCCUPATIONAL PREFERENCES AND TURNOVER DECISIONS:

INDIVIDUAL ORGANIZATIONAL AND LABOR MARKET EFFECTS

Rita Mano-Negrin
Department of Human Services
University of Haifa
Haifa 31905 Israel
rsso155@haifa.uvm.ac.il

and

Alan Kirschenbaum
Faculty of Industrial Engineering and Management
Technion-Israel Institute of Technology
Haifa 32000, Israel
avik@ tx.technion.ac.il

OCCUPATIONAL PREFERENCES AND TURNOVER DECISIONS:

INDIVIDUAL ORGANIZATIONAL AND LABOR MARKET EFFECTS

Abstract
Occupational preferences and subsequent turnover behavior are part of a
complex relationship between employees and their occupational and
organizational labor markets. Both contribute to matching skills and jobs.
Differences in individual, occupational and organizational attributes can predict
the direction and intensity of preferences for organizational, occupations and job
locations. Occupational preferences, which reflect the attractiveness of
alternative positions within and outside the employing organization, are
examined as central antecedents of occupation-specific turnover behavior. Over
700 medical employees and a follow-up sample of 81 "quitters" were analyzed
from a cross-sectional data set drawn from a representative medical
organizational sample,. The results suggest that occupational preferences, and
their impact on actual turnover behavior, are primarily influenced by the impact
of organizational and occupational employment opportunities. The implications of
such potential job shifting within and between work organizations are of a direct
relevancy for human resource managers.
OCCUPATIONAL PREFERENCES AND TURNOVER DECISIONS:
INDIVIDUAL ORGANIZATIONAL AND LABOR MARKET EFFECTS

INTRODUCTION
Staying in or leaving an organization is an integral part of the behavioral decision
set of its employees. The decision sequence is affected by individual perceptions
of the work place and the market and has an impact on social and demographic
processes within the organization (Dalton, 1997). Part of this turnover process
involves selecting a destination option. An employee simply does not leave a
position into an amorphous labor market. He or she takes into account
alternative positions, be they within or outside their present work site. We will
argue occupational preferences reflected in desired positions may be an
important clue to understanding employees' internal organizational transfers and
outright turnover. We will borrow a basic idea from traditional migration studies
that sees labor shifting as dependent on the availability and access ability of
alternative job locations (Dalton 1997; Breeden 1990). Individuals do not just
leave their jobs; rather they make a change from their present occupational
position in favor of an alternative specific occupational destination. Job shifting,
within this framework, comes to reflect a matching process between skills and
job opportunities (Granrose & Portwood, 1987) and involves moving from one
task-position to another, one organizational job-site to another, one type of
occupational group to another or totally withdrawing from the labor market. Such
types of turnover in the guise of employee relocation (Magnus & Dodd, 1981;
Fisher & Shaw, 1994), corporate transfers and career mobility (Kirschenbaum,
1991) became the primary pathways entailing occupational preferences. In this
sense, turnover behavior conceptually incorporates both a "job origin" and "job
destination" within its framework. Yet, the relevance of occupational preferences
on turnover decisions and the role individuals and organizational settings play in
defining them is overlooked in the majority of turnover models (Campion, 1991).

To enrich our understanding of turnover as a central component of

organizational behavior, we propose to examine (a) the antecedents of
occupational preferences and (b) how these antecedents along with occupational
preferences induce a turnover decision. We will do so by exploring how labor
market (macro-aggregate), individual (micro) and organizational attributes linked
to occupational preferences affect turnover.
 Turning to the first aim we suggest that occupational preferences tap the
rationalized outcome of the individual decision making process and may differ
along two basic dimensions the "physical" distance and the "social" distance
involved in the prospective change (Long, Tucker & Urton 1988). Occupational
preferences vary across individual characteristics including demographic
variables and employment conditions along with occupational organizational and
labor market opportunities. As a result the length of distance involved in an
occupational preference reflects the relative impact of these individual
organizational and labor market factors. These objective conditions though, can
be further mediated by subjective aspects i.e., perceived opportunities and
work attitudes.
Thus, following the logic of the above-cited argument, we will test the
direct effect of occupational preferences on turnover We suggest that one key to
understanding antecedents of occupational preferences and their effect on
turnover decisions depends on the tie between subjective / objective
opportunities - occupational destinations- turnover. Opportunities provide
employees with alternative destinations from which choices are shaped.
Objective conditions capture the range of occupational alternatives that
employees are "able" to attain within their organizational, occupational or local
labor-market (Mueller & Price, 1990). Similarly, subjective perceived
opportunities shape the relative "attractiveness" of future job sites (Noe, Steffy &
Barber, 1990; Turbon & Keon, 1993; Herriot & Pemberton, 1996 ) and therefore
affect the degree and direction of change that employees may be willing to
undertake (Fisher & Shaw, 1994; Kirschenbaum, 1991). In this sense, both
objective and perceived opportunities generate differences in occupational
preferences for employees (Kirschenbaum & Mano-Negrin, 1997).
While the relationship between objective and perceived opportunities
remains unclear, (Krischenbaum & Mano-Negrin 1998), the organizational and
market milieu itself from which the present, as well as the "foreseen"
opportunities are located, have been shown to have an impact on the final
outcome of staying or quitting (Hui, 1988; Gerhart, 1990). These opportunities
have been also detected as good predicators of directional choices and should
therefore improve predictability of decisions to change jobs (Kirschenbaum
1991). This suggests that there is a solid ground for a theoretical linkage
between objective/subjective opportunities - occupational preferences turnover
behavior (Figure 1).

In accordance three basic questions will be examined. First, to what

extent do individual, organizational and occupational attributes affect
occupational preferences? Second, how are occupational preferences related to
objective and subjective opportunities? Third, do occupational preferences
directly affect actual turnover behavior, controlling for occupational group
differences? To evaluate these questions, let us first examine the link between
occupational preferences and turnover from both an individual and organizational
/ sociological perspective.
THE INDIVIDUAL LEVEL APPROACH
From the viewpoint of the individual, occupational preferences provide a "proxy"
what links alternative job options to specific attributes of the individual. Vroom
(1964) highlighted this point by focusing on how such occupational preferences
were affected by an occupation's attractiveness and employees' willingness to
join/stay in that organization. The combined effect of "attractiveness" and
"willingness" is the basis that generates occupational and organizational
preferences. Such preferences can depend on the age, gender, education and
occupation of the employee (Boudreau & Berger 1985) as well as on career-
related attributes such as career incentives, career stages, career orientations
(Caldwell & O'Reilly 1990; Glass 1987), and professional expectations (Herriot &
Pemberton, 1996).

Thus, individual level characteristics can be of importto Moreover, job

satisfaction, broadly defined as the individual's affective response to the "work
investment- rewards" relationship, is often associated with organizational factors
(wages and career pathways), work environment factors (supervision, autonomy)
and individual level variables (age, gender and occupation). These factors may
operate differently across occupational groups: thus nurses are more sensitive to
stress (Fang & Baba 1993) whereas physicians are more sensitive to type of
work unit positions (Shye 1991; Uhleberg & Cooney 1990).
Following this individual level approach traditional models of work attachment
suggest that the individuals investment in the work and his/her satisfaction
with the outcome of an investment-cost relationship in work conditions produces
variations in the degree of attachment to the work situation (Farrell & Rusbult,
1981).

Organizational studies have attempted to bridge the gap between individual and
organizational attributes stressing how individual level decisions concerning
turnover - and the direction it takes - tend to be related to how opportunities are
viewed. The linkage is based on the assumption that employees have a range of
alternative job opportunities including new jobs at similar or different firms,
occupational sectors or job-site locations. An early study by Spitze and Waite
(1980) suggested that preferences for types of work are the outcome of past
work experiences and present jobs. Similarly Griffeth and Hom (1988) found that
(salesmen's) turnover behavior depended on organizational and occupational
group differences in work-related attitudes, but that turnover itself was finely
tuned to their choice of a destination. Finally, Tolbert and Moen (1996)
suggested that gender differences in work attainments reflect men and women's
choices of certain occupations rather than structural effects. However, the
interplay between individual preferences and organizational, or structural, effects
may also generate work experiences (Herriot & Pemeberton 1996).
These work experiences can be further evaluated under various opportunity
structures at the organizational occupational and local labor market.
THE ORGANIZATIONAL PERSPECTIVE
Organizational theory suggests the existence of two basic mechanisms of
advancement and consequently an occupational preference (Althauser &
Kalleberg, 1981). First, an organizational pathway, which generates variations in
internal opportunities which then "shape" diverse career lines and finally affect
work related outcomes and employee attachment (Caldwell & O'Reily 1990).
Second, an occupational pathway, which provides incumbents of the
occupational group with a "protected" area for advancement based on
occupational group criteria that may span local employment markets. These
mechanisms point employees toward different occupational options. This is done
in several ways: for example, well developed internal organizational and
occupational labor markets are considered effective means of controlling
outward turnover and minimize voluntary, career-related departures (Petersen &
Spilerman, 1990).

The same can be said of the way that employee retaining policies affect
employee attachment. Such policies have both a direct -through higher salaries-
(Idson & Feaster, 1990) and an indirect -through organizational experience-
effect on turnover decisions (Beehr & Juntunen, 1990; Diprete & Krecker, 1991).
Internal organizational labor markets, usually located in large firms (Idson & Feaster
1990) are reported as generating lower voluntary career-related departures (Benson,
Dickinson & Neidt, 1987). By contrast, in external labor markets it is the constant flux
in supply and demand for labor affecting unemployment rates at the occupational,
industrial and regional levels that affects alternative opportunities for employment
(Zagorski 1990) and enhances / impedes turnover rates.

Thus, internal and external labor markets generating alternative types of opportunities
provide two different mechanisms for advancement, which are likely to affect the
actualization of a turnover decision. Consequently, an occupational preference for
an intra-organizational job shift and its "sheltered" conditions reflects employees'
interest in a internal career advancement.

Connecting individual and organizational attributes with occupational preferences

(Kinicki 1989) may be crucial in differentiating between stayers and quitters
(Caldwell & O'Reilly, 1985). Indeed, if turnover-related decisions are rational and
individuals are assumed to be able to successfully cope with an economic
maximum-profit process that involves constant evaluations of individual and
organizational attributes (Osborn, 1990), then occupational and organizational
occupational preferences should be an accurate reflection of turnover
tendencies (Beach 1990). Indeed, a more structural view of organizational
attributes that take into account the dynamic, internal-labor market, processes
associated with the employees' opportunity choices and their subjective
perceptions of these opportunities which may further affect their occupational
preferences and turnover behavior is still lacking.
An absence of these inhibiting factors that strengthens organizational
attachment, would likely induce employees to investigate occupational
preferences outside their present work site. Without a developed organizational
internal labor market, perceived opportunities and expected advantages at
alternative work organization, occupation and/or geographic sites can become
extremely attractive (Boylan 1991). The implication of this option is that it may
play a key role in turnover decisions (March & Simon, 1958; Osborn, 1990).
Indeed, as suggested by Boudreau and Berger (1985), the distinction between
internal (within organization) and external (between organizations) in turnover-
related occupational preferences reflects the dynamic interplay between
organizational processes, individual attributes and the individual behavior of its
members.

Taken together, these studies suggest that an organization's internal

advancement pathway or the external occupational options, provide employees
with a mechanism for changing jobs and can take the shape of moves within or
between work sites, through the shaping of occupational preferences towards
alternative directions.

OCCUPATIONAL PREFERENCES
One possible way of examining the interplay between individual characteristics
and opportunities is by testing occupational preferences. Provided that
employees initiate turnover on the ground of alternative positions, be they within
or outside their present work site (Dalton 1997; Breeden 1990), individuals leave
their current jobs towards alternative occupational destination. The choice of an
occupational destination may well depend upon the tradeoff between macro-
market, organizational and particularly occupational attributes of the individual.
This tradeoff can be affected by the occupational groups stnegth in the external
labor market as suggested by the market viability argument. This claims that
the higher the market viability, usually reflecting the degree of control over
professional knowledge, the greater the mobility of the occupational group. The
market viability hypothesis, originally presented as an analytical, macro-level
framework to explore mobility patterns, has not been linked, however, to
individual or occupational level turnover differences (Bridges, 1995).

In that sense when the individual seeks an alternative positions he/she

acting in a rationalized process where present skills, work conditions and
constraints are tested against prospective job charactersitics (Granrose &
Portwood, 1987). Taken these rational considerations under account the
employees pursue different occupational preferences. These preferences reflect
the degree of change that individuals are willing and/or capable of making.
There are two ways to tap the nature of occupational preferences (a) the
"physical" distance and the (b) the "social" distance relative to the present one.
Short "physical" distances included a shift between within the same organization
while long "physical" distances included shifts between geographic locations.
Minimal ''social" distances involved moves between medical-related positions
within the same organization while substantial ''social impact" distances involved
an occupational sector change (Long, Tucker & Urton 1988).

Our aim here is to discern the relevance of individual and organizational

factors through the mediating role of opportunities and work attitudes to predict
the distance involved in occupational preferences and their subsequent effect on
turnover decisions (Figure 1).

HYPOTHESES

On the basis of the reported model the following hypotheses were formulated:

Assuming that longer the distances involved in a prospective change reflect a

higher need for a matching between skills and opportunities ( Noe et. Al. 1990;

Kirschenbaum & Golberg 1976), H1: The longer the distance in a prospective

change the higher the effect of the individual skills (demographic and

occupational) and opportunities will be whereas shorter distances involved in a

prospective change will necessitate only a small effect of individual skills

(demographic and occupational) and opportunities. As a result and accordingly,

H2. Longer distances of occupational preferences, in contrast to smaller

distances will have a lower effect on turnover decisions (Kirschenbaum 1991).

METHODOLOGY
To document the linkage between individual or organizational attributes and
occupational preferences, we chose to examine Israel's public-sector medical
organizations.

Organizational Sample

The sample database was drawn from a cross sectional analysis of eight medical

organizational settings and five medical occupational sectors. Organizational selection

was based on a Ministry of Health master list of hospitals (Israel Ministry of Health,
1991). From this list only general service hospitals were selected (25% of all hospitals).

Based on this organizational group, a representative sample of eight organizations was

selected on the basis of organizational size (number of beds and employees), affiliation

(National Health, Government, etc.), and location (periphery / central).

Differences in organizational context and environment features were tapped by

identifying the size, location, and affiliation of the organizational labor markets

(see also Variables).Organizations ranged in size from small (<350 employees; n=1),

moderate (351-2500 employees; n=5), large (2500+ employees; n=2). These were located

in isolated peripheral (n=2), semi-urbanized (n=3) or metropolitan areas (n=3) and were

affiliated to four medical sector groups (Government n=2, National Health Insurance n=3,

Private n=1; Municipal n=2). Basic turnover-related determinants, such as pay level

(based on collective bargaining), type of organizational structures or types of services

were similar among all the organizations (Shuval, 1992).

The similarity of goals, organizational structure and occupational distribution in

the eight general-care medical-institutions allowed a cross-sectional analysis of
four medical sectors by key organizational and market variables. This was
followed by a longitudinal study (1993-1994) that tracked employees who left
their positions.

THE SAMPLE
On the basis of this organizational-level sample a closed-end questionnaire was
sent to a random sample of 15% of the overall organizational population drawn
from each organization's master pay-roll, not including sub-contracted service
workers. Four occupational sectors (physicians, nurses, paramedical/laboratory
and clerical / administrative employees) were identified. The respondents'
sample (N=707, a 30% average return rate) was representative of the Israeli
national medical-sector, labor-force (Israel Central Bureau of Statistics 1991).

All employees --including physicians-- were salaried workers (a total of 2500 employees).
707 hospital employees (a response average rate of 30%) returned the questionnaires.
This included nurses (n=357) physicians (n=128), paramedical employees (n=42)
laboratory employees (n=82) and clerical employees (n=112). Occupational sample
sizes compared with their equivalent national distributions were as follows:
nurses (46%:36%); physicians (19%:12%); paramedical/laboratory (18%:19%)
and clerical-administrative employees (17%) for which no information was
available in the national data source). All employees -including physicians- were
salaried workers with salary level and work conditions based on collective
bargaining agreements. The proximity of these distributions can be viewed as
compensating for the relatively low rate of return, which can be attributed to the
limitations of the mail-return based research method. The "quitters"
demographic-profile was mainly female (65%), dominated by nurses (43%),
followed by physicians (28.4%), Israeli-born (63.5%), aged 31-40 (36.8%) and
41-50 (29.4%) years old, married (79%), having 1-3 children (64.2%), with an
academic education (50.7%) and with a 3-10 years length of organizational
experience (51.8%). Women's turnover rate was twice as high as that of their
male counterparts (7/100 vs. 3.5/100). The turnover rate of the two occupational
groups (nurses and physicians) was nevertheless similar (0.04). Differences by
employment status show that the proportion of permanent employees in the
"quitters" group (70.3%) was lower than within the "stayers" group (85.5%), but
surprisingly most of these "quitters" were from tenured positions (70.3%).
Metropolitan-located and large-size organizations were characterized by similar
turnover rates (0.056 and 0.060 respectively). Quitters were differentiated also
by occupational preferences (for a detailed description see Appendix 4).
Information on turnover rates in the medical sector was not available in the
national data source.
VARIABLES
Objective Opportunities: (a) Organizational Location (a proxy for local labor
market opportunities) was measured in terms of organizational location in three
types of urban areas: metropolitan, semi-periphery (located within a short
distance of a major metropolitan area) and periphery areas. (b) Organizational
affiliation: a dummy variable for four major affiliation groups (type of ownership):
government, municipal-local authorities, health-insurance and private ownership.
(c) Organizational size ranged from small (up to 350 employees) to large (4500+
employees). Organizational size, location and affiliation were used as proxies for
organizational and occupational opportunities (see Method) Perceived
Organizational Opportunities: Perceived internal-organizational and perceived
external-occupational labor-market opportunities were measured by single Likert
type items (ranging from 1 -lowest perception- through 4 higher perception).
They included measures of (a) Perceived existence of departmental
opportunities, (b) Perceived existence of organizational opportunities and (c)
Perceived attainability of organizational positions (internal recruitment).
Perceived Opportunities were measured by (a) Perceived existence of national-
level labor market opportunities (b) Perceived existence of local labor market
opportunities and (c) Perceived attainability of occupation specific positions.
Actual Turnover was measured in terms of the respondents voluntary (quit)
separation from the work place during the first year following the administration
of the cross-sectional field study questionnaire. Non-voluntary separations were
not included and represented only a very small proportion of those who left their
positions. The "stayed/quit" code was determined from organizational reports
that indicated which employees on the original pay-roll were absent at the end of
one year. Occupational Preferences: Occupational preferences was
operationalized in two ways to tap (a) the "physical" distance and the (b) the
"social" distance relative to the present one. Short "phys" distances included a
shift between departments within the same organization while long "physical"
distances included shifts between geographic locations. Minimal ''social"
distances involved moves between medical-related positions within the same
organization while substantial ''social impact" distances involved an occupational
sector change (Long, Tucker & Urton 1988).
Respondents were required to choose one or more occupational preferences
(number of responses differs from original occupational sub samples sizes) and
evaluate them on a four-point Likert type single-item scale (ranging from 1=low to
4=high) answering to the following statement: "I wish I could change my present
job for a ..................".. Responses were later collapsed into four basic distance
categories by type of degree of distance involved in the prospective change:
Physical Distance including: 1. Intra-Organizational Choices: the same type of
job but in another department; 2. Inter-Organizational Choices: (a) the same type
of job but in another hospital, (b) the same type of job but in a bigger hospital (c)
the same type of job but in a private hospital, or (d) the same type of job but not
in a hospital; 3. Inter-Location Choices: the same type of job but in another city
Social distance including 1. Inter-Occupational Choices: another kind of job.
Work attitudes: originally measured as single items, were later combined into
constructs using scale reliability measures (Alpha Cronbach). Attitudes (level of
importance or satisfaction) were measured by Likert-type scales ranging from
1=low to 4=high. Three constructs were used: WORK ENVIRONMENT-
satisfaction with work arrangements, work load, physical accommodations,
schedule flexibility, work condition (Alpha Cronbach = ); RETURNS-
importance given to salary, pension funds, non-monetary benefits and career
prospects (Alpha Cronbach = ); and CAREER PROSPECTS, evaluation of
organizational career opportunities, departmental opportunities, internal labor
markets (Alpha Cronbach = ). (Mano-Negrin 1998).

ANALYSIS AND RESULTS

An initial analysis showed that the four occupational groups were significantly
different in terms of their demographic and employment characteristics, such as
age and length of organizational service. Likewise, occupational groups differed
significantly across types of perceived opportunities (for a detailed description
see Appendix 1). These individual differences also related to the degree of
attractiveness of occupational preferences (for a detailed description see
Appendix 2). Thus, age, tenured positions and income differences were
significantly related to differences in employees' occupational preference. In
contrast, length of organizational service, extent of employment, job level,
number of previous organizational positions and occupational group were only
partly associated with differences in occupational preferences. Nevertheless, the
intensity for a physical locational change towards the more demanding inter-
location and inter-occupation preferences did differ on the basis of income,
extent of employment, job level, and occupational groups. Similarly, inter-
organizational preferences are affected as well by occupational group
characteristics. Furthermore, testing the relationship between occupational
preferences and work attitudes, the evidence suggests (Appendix 3) that nurses
and physicians (and not paramedical and clerical employees) are most sensitive
to work conditions: thus, nurses' tendency to prefer any occupational alternative
was mostly affected by the work conditions whereas physicians were more
attracted by career prospects. For the former, satisfaction with work conditions
and salary was negatively related to occupational preferences, whereas for the
latter, career prospects increased their tendency toward alternative occupational
preferences. No effects were found for paramedical and clerical employees.
Finally, differences in proportions of quitters in the four occupational sectors
across occupational preferences (Appendix 4). Thus, among all groups and for
all occupational preferences, the proportion of "quitters" was higher for the
nurses in every preference category. Clerical employees showed no interest for
any occupational preference, and physicians and paramedical employees had
similar preferences Among the "quitters" the strongest preference was for
another job (N=30) or for a private hospital (N=35).

These findings emphasize occupational prerogatives in occupational

preferences. Yet, there also appears to be ample room to interpret these results
in terms of objective and perceived opportunities. Thus, organizational size and
location, reflecting competition levels, generated by organizational and
residential opportunities for alternative employment, also affect the majority of
occupational preferences. Their impact is similar to the effect of perceived
internal opportunities for the same occupational preferences. These results
suggest that occupational preferences reflect the availability of occupational
alternatives and differentiate between employees' perceptions of the availability
of internal opportunities. This basic tendency apparently was unrelated to
previous experiences gained through organizational advancement and
organizational tenure. However, job level, as an indication of skill-related
experience in bureaucratic organizations, did significantly affect an occupational
preference by directing employees toward larger work organizations and inter-
location destinations. This same pattern appears was evident when perceived
external opportunities affected the choice of 'longer' distance inter-location and
inter-occupational preferences.

These initial results from the bivariate analysis suggest that occupational
preferences accurately reflect differences in individual and organizational
attributes. To further explore these findings, we test how each set of the
predicting variables demographic, organizational determinants, occupational
group, objective and subjective opportunities and work attitudes affect
occupational preferences. The impact of these variables on occupational
preferences was examined using seven logistic regression equations, one for
each occupational preference.

Table 1 About Here

Predicting Occupational Preferences

The findings from Table 1 suggest that demographic attributes, a central set of variables in
work-related analysis have a significant effect on all occupational preferences with the strongest effect
revealed in regard to the largest social distance i.e. the change towards an occupational change. This
suggests that largest distances as expected would be more constrained by effects of age and family
responsibilities which provide a set of constraining effect in work-related decisions (Shaw 1987). Similarly,
organizational determinants had the largest effect in regard to the larger distances such as inter-
organizational and inter-location preferences, also suggesting that once organizational returns have been
assured the willingness to move is affected by the extent to which the occupational preferences will further
ensure at the very least the previously achieved returns. This is further revealed by the effect of objective
opportunities on type of occupational preferences. In the case of organizational size, larger
organizations affected occupational preferences in two opposing ways: first,
reluctance to move outside a department suggests the existence of opportunities
at the departmental level. At the same time, organizational size enhanced
occupational preferences toward other hospitals, suggesting less willingness to
be employed in large medical centers. In addition, as expected, organizational
location in larger metropolitan areas negatively affected both inter-organizational
and inter-location occupational preferences suggesting that competing
opportunities in the same local labor market do not necessarily affect the need to
seek opportunities elsewhere.

These effects however can only be effective if occupational group effects have been accounted for. The
findings from Table 1 suggest that occupational preferences were affected by
type of occupational group. First, nurses were reluctant to work in larger
organizational settings (as indicated by the negative sign). Paramedical
employees, however, look forward to working in a non-hospital setting, whereas
physicians are constrained to working in a hospital. Physicians are more inclined
toward an inter-location change whereas paramedical employees seemed to
avoid such "long" physical-distance changes. Both groups, however, in contrast
to nurses and clerical employees, resisted inter-occupational change, probably
because of high occupational group investments.

As suggested by our second question, the two final steps examine

whether perceived opportunities and work attitudes representing the subjective
aspect of work, are effective as well in the prediction of occupational preferences
The results suggest that such choices are related to perceived opportunities but
not work attitudes. The differences in perceived opportunities, in addition to
differences in and demographic attributes organizational determinants and
objective opportunities had an overall significant (model improvement) effect on
three types of alternative destination sites: intra-organizational, non-hospital
(inter-organizational) and inter-occupational preferences. However, the direction
of the specific effect of internal and external opportunities is ambiguous: On the
one hand, perceptions of external opportunities should enhance long, rather than
short, physical occupational preferences. On the other hand, perceptions of
internal opportunities, reflecting the existence of internal organizational
opportunities, should constrain all "outgoing" occupational preferences.
Both these assumptions are challenged by the findings: perceived
external opportunities do not necessarily promote inter-organizational
occupational preferences (except when maximum physical and non-hospital and
inter-occupational changes are considered). Moreover, while perceived internal
organizational opportunities do enhance intra-organizational at the same time
they do also promote inter-organizational choices, suggesting a possible mixture
between of internal and external opportunities as mentioned above.

Overall, the findings from Table 1 suggest that hypothesis H1 has

been supported partially. It is mainly perceived opportunities and
only in the prediction of large social distances that the proposed
relationship between individual and organizational determinants
count. This suggests that (a) occupational changes reflect
feelings rather than objective conditions of occupational
alternatives and (b) It is only for the large physical change (inter-
location that objective conditions in the labot market -such as the
degree of competition in the area -i.e. metropolitan vs. periphery
location- have a direct and the strongest effect. For smaller
distances the significant effects are those of demographic variables
and opportunities and in general these effects are much smaller
than those involved in large distances.

These findings confirm previous theoretical arguments regarding

the significance of opportunities to prospective work behavior. Yet, they
refute our basic assumptions regarding the substantiation of occupational
preferences in terms of a general distinction between perceived internal
and external opportunities. In other words, perceptions of opportunities,
while generally favoring occupational preferences in their expected
theoretical direction, their empirical contribution stand up to closer
inspection when occupational features are controlled for. The findings
also suggest that occupational preferences do not necessarily reflect
general employment opportunity differences. In fact each occupational
preference seems to be affected by a different combination of
determinants. Thus, for example demographic characteristics affect all
occupational preferences emphasizing the role of individual
characteristics in work-related decisions. Work attitudes are shown to be
insignificant for occupational preferences emphasizing the rationality
rather than the subjectivity of work-related decisions. This is also revealed
by the impact of organizational determinants specially when longer
 distances (larger organizations and inter-location and inter-occupational
preferences) are considered. In all cases occupational group distinctions
are shown to be important here.

In regard to the variations of distances involved in turnover decisions the

findings suggests that turnover decisions included not only rational based
decisions and that there is at least some distance between foreseen destinations
and turnover decisions. Smaller distances are more affected by objective
opportunities, whereas larger distance are affected by perceived opportunities,
suggesting that the longer the distance the less objective conditions are the
basis of our rational decisions. The findings are less clear regarding middle
range distances. On one hand, the more the destination differs from the present
one (private hospitals and not - hospitals) the more the importance of perceived
opportunities. On the other hand, the more the destination is similar (another
department) or amorphous (another / larger hospitals) the higher the effect of
organizational determinants suggesting that such moves involve an immediate
improvement of the working conditions.

Taking the analysis one step further, to test out third question we
compared actual turnover behavior differences among the occupational sectors.
in light of employees' occupational preferences.

Occupational Preferences and Turnover Behavior

In the final stage of the analysis, we test whether occupational preferences
directly affect actual turnover behavior. Demographic, organizational
determinants, objective and perceived opportunities and work attitudes were
inserted in a similar stepwise method for each occupational group to predict
turnover behavior. To controlling for the effects of these sets of determinants
occupational preferences were inserted last. The results are presented in Table
2.

Table 2 About Here

The results provided a partial confirmation of the propositions H2 predicting that

actual turnover is affected by occupational preferences.

Overall Model Estimation

Observing the _2LL estimates and the model improvement estimates it can be
generally seen that (a) models including demographic attributes only describes
significantly turnover behavior only for paramedical employees whereas
organizational determinants affect only the physicians turnover behavior. No
single model, whatsoever, was identified as capable of significantly determining
either nurses of clerical (both female occupations) employees turnover. This
suggests that turnover behavior in these cases is a more complicated process
involving a mixture of different work and non-work related aspects. This indeed
seems to fit the traditional studies of womens turnover behavior suggesting that
womens work behavior reflects their roles as secondary bread -winners and
basically responsible for family duties (Tolbert & Moen 1998) .

Individual Characteristics and Turnover

Observing The differences

Opportunities and Turnover

When the overall impact of opportunities is tested it can be seen that a model
containing objective opportunities does not provide a good model for the
prediction of turnover except in the case of paramedical employees. This implies
that objective opportunities for this occupational group are not directly affected
by organizational size and labor market characteristics i.e. labor market forces.
Yet, once opportunities are perceived to exist, then they enhance turnover
behavior. In fact this seems to apply to most occupational groups.

The findings in Table 2 also reveal that internal perceived opportunities do not
affect turnover behavior. Yet, external perceived opportunities significantly
enhance physicians (1.8367), paramedics (3.89), and clerical employees (
3.323) turnover behavior. This tendency, contrasts the negative effect of the
number of previous positions in the employing organization on turnover for
physicians (-1.3896), and that of length of service for clerical employees (-.0316)
or the effect of a tenured position for nurses (-1.2364). It seems then that internal
opportunities are effective through the objective organizational characteristics
rather than perceived effects. This provides an overall (though partial)
assessment of the second hypothesis, suggesting that turnover behavior is
affected by opportunities through individual, organizational and occupation
variations.

Occupational Preferences and Turnover

Next, the differential effect of occupational preferences on each occupational
sector's turnover behavior is tested. Three major tendencies emerged. First,
inter-departmental occupational preferences did not promote turnover at all,
suggesting that moving from one department to another is a rare case for all
occupational groups. Second, nurses' turnover behavior was affected by inter-
organizational occupational preferences. The positive sign for preferences for
another (.9745), or the negative sign for a larger hospital (-1.6133) suggest that
nurses avoid large establishments despite their interest for another job site.
This tendency holds true for clerical employees as well, suggesting that there is
more similarity between the female than between the medicine-related
occupational groups. Among all the occupational groups, physicians were most
affected by occupational preferences in their turnover decisions (Model
Improvement 16:55). First, a metropolitan job location (in contrast to all other
occupational groups) is relevant to them only when a turnover decision is
considered apparently because of the abundance of local opportunities. ,
Turnover was also promoted when non-hospital positions are preferred because
the nature of the profession enables the combination of hospital and private
clinic employment. Larger organizations, however, or private hospitals obstruct
their turnover decisions, similarly to all groups (except paramedics).

But are these differences occupationally based? To complete the analysis the
above parameters where inserted in a single model containing occupational
groups as dummy variables and the interaction terms between parameters
revealed as significant in the specific occupational group analysis.

Occupational Group Effects.

The analysis of the Sample suggests that

Overall the findings showed that (a) the turnover decisions depend on the
combination individual organizational and labor market determinants (b) the type
of occupational preference involved in a turnover decision depends on the
marketability of occupational group and its gendered needs (c) the effect of
occupational preferences on turnover decisions is a fairly accurate determinant
of turnover provided that individual, organizational and occupational
characteristics are controlled for. This provides an overall (though partial)
assessment of the second hypothesis, suggesting that turnover behavior is
affected by opportunities through individual, organizational and occupation
variations.

CONCLUSIONS AND DISCUSSION

In the present paper, occupational preferences were examined as a means to
better understand turnover decisions and their consequent impact on matching
labor with job opportunities.
Turnover decision variations among four medical sector occupational groups
were examined, concentrating on the linkage between occupational preferences
and the organizational and market milieu from which present, and "foreseen"
opportunities are generated.
Despite scattered evidence of the importance that occupational preference plays
in job changes, it has remained relatively unexplored in turnover studies. In our
analysis, we explored three basic propositions that would, in their cumulative
effect, support the notion that occupational preferences form an integral part of
the turnover process.
Testing the relative impact of the "foreseen" opportunities, in terms of
occupational preferences, along with the present ones it was confirmed that
occupational preferences differentially reflect individual, employment and
organizational attributes that eventually generate occupation group differences in
turnover decisions among medical sector employees.

Occupational preferences were influenced by perceived, and to a lesser extent

objective opportunities. This was evident in how the perception of internal
organizational opportunities affected intra-organizational occupational
preferences. This was also true for external market opportunities and their
impact on inter-location occupational preferences. However, the diffuse impact of
opportunities on occupational preferences implied that such choices were linked
to opportunities enmeshed (although not exclusively) in organization,
occupational and labor market opportunities. These variations were themselves
occupation specific, further binding the link between occupations and
opportunities as catalysts in affecting occupational preferences.

The impact of occupational preferences on actual turnover demonstrated that,

except for clerical employees, knowing an employee's occupational preference
beforehand can improve prediction of actual turnover behavior. It is possible to
speculate that in addition to opportunities, the gender, age or skill composition
of each occupational group may have influenced its occupational preference. For
example, more "male-dominated" groups, such as physicians, may be inclined
toward inter-location job changes whereas more "feminine" groups would be
more locally oriented and focus on organizational level occupational preferences.
As a result, occupational preferences, due to the particular character of the
occupational group, may produce different effects on each group's turnover
behavior. Taking these findings a step further, it is reasonable to infer that
although both perceived opportunities and occupational preferences act
separately in predicting turnover behavior, they reflect basic occupational based
conditions found in the respondent's organization, occupation and labor market.
If this is the case, then fundamental occupational group differences generate
different "opportunities - occupational preference - turnover" linkages which
make turnover decisions occupation-specific. In short, it is the attractiveness of
alternative employment positions, involving different job change "distances", that
produces occupational group variations in ac turnover behavior.
This same hypothesis can provide a meaningful theoretical and empirical
springboard toward understanding important organizational issues, such as the
determinants of the degree of fit" between organizational and individual career
prospects and the degree to which such a "fit" reflects group (occupational, work
unit) level "shared-feelings". The constant flow of manpower that is endemic
within and between medical organizations is a byproduct of these same
decisions made by individuals under the influence of their occupational and work
place.

LIMITATIONS
The present study focuses on medical sector employees' occupational
preferences and turnover decisions. Our own limited exploratory study has
shown that occupational preferences, regulated by opportunities and constrained
by occupational skills, are an effective way to predict turnover. While the
dynamics of these changes are clear in the present methodological context,
future studies should use larger and more occupationally diverse samples. The
specificity of our sample in terms of occupational composition and their public
sector affiliation limits the generalizability of the results, stressing nevertheless
that occupational preferences can be helpful in understanding additional
complexities of work outcomes and processes. Moreover, longitudinal studies
should be pursued. These studies could control for time-related effects such as
unemployment rates, organizational decline following increased competition or
privatization processes and national-level health policy that generate major side-
effects on work and employment choices.
Table 1: Logistic Regression Estimates of Demographic, Organizational, Occupational, Perceived and Objective Opportunities on Occupational Preferences
Involving a Change In Organizational Job Site, Geographic Location and Occupational Sector. + ++

Intra-Organizational Inter-Organizational Change Inter-Location Inter-Occupational

Change Change Change
Another Department Another Hospital Larger Hospital Private Hospital Not a Hospital Another City Another
Occupation
Demographic Characteristics
Age 1.5865 -0.0311** - 0.0096** -0.2483** -0.2171** - 0.2625* -0.0303**
Gender (1=Male) 0.0671 0.6180 1.1614 2.1146 -0.0567** -1. 9541 0.0458
-2LL 660.26(682) 696.21(681) 663.96(681) 873.26(681) 790.70(681) 579.03(681) 873.52(681)
Model Improvement 11.43* 10.94* 4.62 25.76** 22.01** 7.82* 50.09***
Organizational Determinants
Job Level -.8471 -.0235 -.0351 -.0469 -.0385 -.2265 -.0112
Length of Organizational Service - 0.0027** -0.0024** - 0.0053** - 0..0017*** -0.0018*** - 0.0037 0.0003
Extent Of Employment - 0.0104** 0.3292** - 0.1264 0.3185 0.1227 0.0898 0.3290**
Tenured Positions 0.1800 -0.2187 1.6151* 0.6359 -0.1527 0.9873** - 1.3318**
# Previous Organizational Positions 0.9926 1.2960 0.2887* 1.9269 0.1378 0.2248 0.5280
Income 1.5324 0.0004* 0.0061** 0.0908 0.0403 0.0006 1.2053
-2ll 650.62 676.94(675) 616.40(675) 863.98(675) 783.14(675) 541.19(675) 859.44(675)
Model Improvement 9.40 19.27** 47.54** 9.27 7.56 37.83** 14.08**
Occupational Characteristics**
Nurses 0.1649 -0.4734 -2.0915*** 0.0001 -0.6265 0.9087 -0.2627
Paramedical 0.2828 0.1347 1.7515 0.8200 0.7232** 1.3037 -0.6458*
Physicians (Clerical = omitted category) 1.7928 -0.3466 0.6520* 0.0677 -1.6737** 0.9873** - 1.3318**
-2ll 649.83 674.94(672) 609.84(672) 862.14(672) 768.47(672) 532.23(672) 841.87(672)
Model Improvement .747 1.97 6.56 1.84 14.69 8.96* 17.56**
Objective Opportunities
Organizational Size - 0.2625* 0.7266** 0.1967 1.7428 0.3437 0.3387 0.2319
Organizational Location - 0.0181 -1.2020** -0.6469** 1.1920 0.4598 -0.6349* - 0.3259
-2ll 644.75 664.70(670) 609.23(611) 858.229670) 764.76(670) 511.10(670) 840.43(670)
Model Improvement 4.34 10.64** .651 4.28 4.04 21.94** 2.33
Perceived Opportunities
Perceived Internal Opportunities 0.8789*** 1.0963 0.0040 0.6227 0.7322** 1.5624 0.9532**
PercExternal Opportunities 0.4332** 0.8630 0.0723 0.3539 0.3162* 1.4040 0.3583*
-2ll 630.19 662.78(668) 609.06(668) 848.21(668) 751.30(668) 508.51(668) 812.47(668)
Model Improvement 14.68 1.64 .126 9.64** 13.11** 7.82* 27.08**
Work Attitudes
Satisfied with work conditions -.0981 2.631 0.1810 1.2110 -.2168** 0.440 -.2527
Satisfied with salary .3024 1.089 0.0740 .7374 .3956 2.762 -.1806
Satisfied with career prospects .0142 3.642 0.5089 .2839 .6726 4.616 .2710
-2ll 629.78 658.12(664) 606.82(664) 843.39(664) 742.67(664) 505.74(664) 804.58(664)
Model Improvement .970 4.65 2.24 4.81 8.63* 2.76 7.83
Constant - 0.9904** -1.5073*** -2.5434*** -0.1540 - 0.9587* -0.9732 0.1722
+ N in parentheses ++ Dummy variables *p>.05 ** p>.01 ***p>.001
 Table 2: Logistic Regression Estimates of Demographic, Organizational Determinants, Objective and Perceived
Opportunities, Work Attitudes and Occupational Preferences On Actual Turnover Behavior +.
\
Demographic Characteristics Nurses Physicians Paramedical Clerical
Age -0.3772* -0.1418 -0.8449*** 0.6593
Gender -0.0043 -.7059 -0.3249 -1.901
-2ll 200.27(309) 118.75 (134) 76.36 (123) 65.61 (107)
Model Improvement 1.69 1.98 7.30 ** 1.408
Organizational Determinants
Job Level 0.0874 0.4229 -1.5183** 0.0854
Length of Service -0.091 -0.002 -2.1687 -.0118*
Extent of Employment -0.8592 -0.0956 -0.8777* 1.9537**
Tenured Position -0.9455** 1.3513 -2.1534** -0.3784
# Previous Organizational Positions 1.1563 -1.203*** -0.0518 -1.7415
Income -0.0451 -0.3963** -0.9091 -0.2061
-2ll 191.71 (303) 102.62(128) 67.85(117) 57.74(101)
Model Improvement 8.56 16.13** 8.59 7.87
Objective Opportunities
Organizational Size -0.3137 -1.1535** -0.1422 0.1959
Organizational Location 0.2399 1.0388* -0.1227 -0.1874
-2ll 189.10 (301) 100.03 (126) 67.17(115) 57.37(99)
Model Improvement 2.60 2.39 .667 .005
Perceived Opportunities:
Internal Opportunities -0.7277** 0.0095 3.1536 0.0341
External Opportunities 0.4629 1.1436** 1.6150** 1.9500**
-2ll 186.24 (299) 96.08 (124) 56.98(113) 56.30(97)
Model Improvement 2.85 3.94 10.18** 1.43
Work Attitudes
Satisfied with work conditions -0.8931 -0.2552 -0.4221 -0.3421**
Satisfied with salary 0.0107 -0.9599** -0.0257 -0.2457
Satisfied with career prospects 0.6591 0.6395 0.3756 0.3756
-2ll 182.30(296) 91.32(121) 53.70(110) 50.38(94)
Model Improvement 3.97 4.74 3.28 5.91
Occupational Preferences
I. Intra-Organizational preferences:
Another Department -.3577 .8019 .9549 2.343
II. Inter-Organizational preferences:
Another Hospital -0.5919*** 0.1393* 0.0066 0.6966
Larger Hospital -0.6269*** -2.1341** 0.8354 -1.1096*
Private Hospital 0.5631 0.3505* 0.0036 0.2456
Not A Hospital -0.4947 1.5722** 0.2965* 0.4565
III. Inter-Location preferences:
Another Town 0.0642 1.8451** 0.1110 0.7930
IIII. Inter-Occupational preferences:
Another Job 0.8645 -1.2203 0.0723 0.1784
-2ll 170.36(289) 74.77(114) 45.28(103) 38.34(87)
Model Improvement 11.93 16.55** 6.02 11.40*
Constant -.4480 1.9719 -3.5389 .1.628
+ N in parentheses.
*p>.05 ** p>.01 ***p>.001
Appendix 1: Means, Standard Deviations, Sample Size and Between-Groups Comparisons (Anova Fs) of Bio-
demographic Variables and Perceived Opportunities for Nurses, Physicians, Paramedical and Clerical Employees
*+
Nurses Physicians Para- Clerical F
medical
Age 40.47 44.82 44.31 41.45 8.38
(10.09) (9.28) (9.53) (10.54) [.0345]
N=306 N=136 N=125 N=112
Length of Organizational Service 117.26 92.1 98.73 96.07 3.45
(Months)
(93.16) (77.92) (94.79) (79.97) [.0134]
N=302 N=134 N=122 N=110
Job Status (1=Tenured Positions) 0.834 0.697 0.779 0.866 5.1
(0.371) (0.46) (0.416) (0.342) [.0017]
N=327 N=139 N=127 N=112
Extent of Employment 34.31 51.23 33.82 36.16 93.66
(Hours Per Week)
(9.22) (12.1) (10.47) (7.78) [.0002]
N=271 M=122 N=118 N=105
# Previous Organization Positions 1.64 1.83 1.54 1.51 3.19
(0.95) (1.01) (0.81) (0.8) [.0234]
N=312 N=137 N=126 N=110
Income 2316.51 3359.71 2560.71 2370.57 117.11
(375.21) (779.79) (673.79) (693.53) [.0002]
N=327 N=137 N=127 N=112
Perceived Internal Opportunities: 2.81 2.42 2.81 2.99 .567
(1.02) (1.04) (1.05) (0.95) [.0681]
N=309 N=133 N=122 N=105
Perceived External Opportunities: 2.63 2.47 2.26 2.38 5.5
(0.96) (0.90) (0.86) (0.82) [0013]
N=301 N=135 N=124 N=108
standard deviations in parentheses
+ significance levels in brackets
Appendix 2: Chi-square Estimates Of Occupational Preferences by Demographic Employment and Organizational Variables.

Intra- Inter-Organizational Inter- Inter-

Organizat. Change Location Occupation.
Change Change Change
Another Another Larger Private Not a Another Another
Demographic Department Hospital Hospital Hospital Hospital City Occupation
Age 51.62** 38.67** 45.59** 44.75** 59.76** 55.34* 61.02**

Sex .752 .356 .589 .208 .305 .979** 612*

Education 5.92 3.21 8.44 6.97 4.22 5.12 2.15

Organizational Determinants
Income 32.77** 28.77* 42.59*** 30.32* 29.07* 40.23*** 32.64**

Length of Service (Months) 8.91* 3.21 8.44 6.56 5.21 7.12 9.16

Extent Of Employment (Hrs/Wk) 12.30 18.75 29.60** 13.46 16.01 35.00*** 28.21**

Tenured Position (1= Tenured) 5.90** 3.25* 2.44* 1.39* 3.89** 4.10 6.91*

# Previous Positions 9.45** 9.77 12.90 14.71** 1.30 1.28 11.80**

Occupational Sector 18.87 15.34** 39.31** 9.76 31.04*** 35.04*** 37.50**

Job Level 9.42 5.24 19.42** 3.76 10.75 34.95** 1.93**

Objective Opportunities
Organizational Size 8.93 10.64 24.13*** 2.37 5.62 29.65** 4.77

Organizational Location 14.31* 16.32** 31.73*** 5.16 4.23 33.76*** 4.43

Perceived Opportunities

Internal 35.26*** 27.19*** 23.48*** 33.01*** 35..84*** 21.67*** 40.56**

External 12.34** 4.92 4.01 6.00 8.85* 8.53* 9.91**

*p>.05**p>.01***p>.001
Appendix 3: Pearson Correlation of Occupational Preferences by Work Attitudes.

OCCUPATIONAL work salary career work salary career work salary career work salary career
PREFERENCES conditions prospect conditions prospect s conditions prospects conditions prospects
NURSES PHYSICIANS PARAMEDICAL CLERICAL
Another Department -.0112 .1116* .0121 .0736 .0586 .0688 -.1249 .0259 -.0768 -.0584 -.1101 -.1092
Another Hospital -.1135* -.0433 .0062 .0352 .0030 .0514 -.1177 -.0702 -.0250 .0866 .1825 .0223
Larger Hospital -.0942 .1238* .0922 .0618 .1121 .1134 .0230 .0666 .0062 .0084 -.0624 -.0765
Private Hospital -.1608** -.0764 -.0022 .0866 -.0043 .0372 -.2278* -.0972 -.0818 .1070 .0414 -.0302
Not a Hospital -.0906 .0297 -.0171 -.0682 -.0441 .0354 -.1819* -.1341 -.0105 .0788 .0590 -.0896
Another City -.0395 .1208* -.0088 .0803 .1065 .2160* -.0512 .0196 .0697 -.1036 .0923 -.0125
Another Occupation -.1484** -.0245 -.0920 .0196 .0316 .2084* .0854 .1069 -.0313 -.0897 .0751 -.1398

*p>.05**p>.01***p>.001

Appendix 4: Distribution of Quitters by Occupational Preferences and Occupational Group

OCCUPATIONAL NURSES PHYSICIANS PARAMED. CLERICAL TOTAL

PREFERENCES
Another Department 47.4 21.1 21.1 10.5 13.3 (N=19)

Another Hospital 27.8 38.9 27.8 5.6 12.0 (N=3)

Larger Hospital 48.1 37.0 3.7 11.1 18.9 (N=27)

Private Hospital 37.1 31.4 20.0 11.5 13.4 (N=35)

Not a Hospital 34.8 13.0 34.8 17.4 11.4 (N=23

Another City 60.0 33.3 6.7 6.7 12.7 (N=15)

Another Occupation 53.3 20.0 26. 10.0 10.3 (N=30)

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