关键词: 家庭医生签约服务, 全科医生, 社区卫生服务, 专业能力, 职业满意

Abstract: Background　As the "gatekeepers" of residents' health and control of medical expenses，general practitioners（GPs） play an important role in the delivery of essential medical services.GPs' service capabilities，incentives for GPs and GP workforce stability are of great significance in the promotion of contracted family doctor services（CFDSs） and in the development of hierarchical medical system.Objective　To obtain a deep understanding of the job competencies and satisfaction in grassroots GPs.Methods　In July 2016，by use of stratified cluster sampling，440 GPs（including TCM GPs） were recruited from 15 community health centers（CHCs） in urban and suburban areas and urban-rural fringe in Shanghai's Pudong New Area，and were surveyed with a questionnaire composed mainly of implementation of CFDSs，job competencies and satisfaction.Results　The survey obtained a response rate of 100.0%.Among the respondents，95.2%（419/440） reported that they could fully/basically deliver first contact services，81.0%（350/432） considered that they were fully/ basically competent for their job in terms of medical knowledge and skills，and 70.2%（302/430） reported that they worked under very/relatively high pressure.GPs' assessments for the level of working pressure and the role of a regional medical consortium in the development of hierarchical medical system differed significantly by the location area of CHCs（P<0.05）．GPs' assessments for the abilities in the management of difficult basic medical problems，challenging chronic conditions，and working pressure，and for the fulfillment of potential as a GP varied obviously by the type of CHCs（P<0.05）．The mean satisfaction scores evaluated by the GPs for the value of a GP，and payment for GP，as well as for collaborative diagnosis and treatment were all less than 3.0 points，but those for working environment，job supports provided by community（residential） committees and teams were greater than 3.0 points.Conclusion　 GPs in Pudong New Area showed high level of competencies for being a GP，which is conducive to attracting residents to community healthcare facilities to receive first contact services，and to chronic disease prevention and treatment and health management.However，in order to promote the development of family doctor system，GPs self-perceived value as being a GP，and payment for GPs should be improved，and regional differences in these two aspects should be narrowed.

Key words: Contracted family doctor services, General practitioners, Community health services, Professional competence, Job satisfaction