关键词: 全科医生, 社区卫生服务, 人员开发, 制度建设, 影响因素分析

Abstract: As a valuable resource of medical institutions at all levels，health human resources not only fundamentally determine the overall professional level of medical institutions，but also are valuable wealth for the long-term development of medical institutions in the future，especially grass-roots medical institutions.There is a long-term shortage of health human resources at the grass-roots level in China.The causes of relevant systems determine the systematicness and complexity of solving this problem.Based on the contents of the Regulations on the Registration of Doctors implemented by the former National Health and Family Planning Commission in April 2017 and the spirit of the Opinions on Reforming and Improving the Training for General Practitioners and Use of the Incentive Mechanism issued by the General Office of the State Council in January 2018，and the current situation of the construction of the grass-roots health human resources system in Beijing，this paper applied a questionnaire survey.By means of in-depth interviews，the occupational status and expectations of general practitioners in Beijing were investigated and analyzed.Five factors that seriously affected the rational distribution of health human resources at the grass-roots level were summarized：（1）the limitation of the scope of practice in the registration of doctors；（2）the limitation of the promotion system of professional titles；（3）the limitation of "human-governing factors" in the old personnel system in public institutions；（4） subjective restrictions on the main body of managerial standard caused by the long-term shortage of health personnel at the grass-roots level；（5）unique household registration constraints in Beijing.Five countermeasures and suggestions were put forward：（1）standardizing training，improving salary and establishing good career expectations；（2）reforming personnel management system and establishing two-way position transfer mechanism；（3）perfecting relevant legal system and defining the boundary of personnel rights；（4）increasing the scope of practice in accordance with the law and opening the access of talents；（5）drawing lessons from the experience of tertiary medical institutions to construct the mechanism of talent flow.

Key words: General practitioners, Community health services, Staff development, Institutional improvement, Root cause analysis