关键词: 全科医生；农村订单定向医学生；教育, 医学；工作现状；职业满意

Abstract: Background　So far，the rural-oriented tuition-free medical education（RTME） program initiated in 2010 by the National Development and Reform Commission and other four departments have trained nearly 57 000 targeted admission medical graduates to become healthcare workers in township health centers in central and western of China，achieving the objective of "full coverage" in terms of the number of general practitioners，namely，training one general practitioner with a five-year undergraduate medical degree for each township health center in central and western of China. The status of work and life of the targeted admission medical graduates，and the assessment for them by the primary hospitals deserve attention. Objective　To investigate the work and life situation of the first（2010 admitted） targeted admission medical graduates in primary care in Chongqing，offering suggestions for the culture and employment of these graduates. Methods　From August to December 2019，a survey was conducted among the first targeted admission medical graduates（n=160） who were admitted in 2010，and started to fulfill the obliged health services in primary care in Chongqing in 2018 after completing a five-year undergraduate medical degree program and a three-year national standardized residency training program using a questionnaire developed by our research group for collecting information regarding their contracted hospital，salary，career planning after fulfilling the contractual obligations，living conditions and difficulties，as well as job satisfaction. Besides，for collecting the assessment for them by their contracted side，factors associated with their retention in primary care as well as recommendations on fostering targeted admission medical graduates，focus group discussions were carried out with managers from the local health commissions of Yongchuan District，Nanan District，Liangping District，and Qianjiang District，administrators and middle-level managers from the contracted township health centers. Results　The survey achieved a response rate of 75.6%（121/160）. In terms of work status，the contracted township health centers of 35.5%（43/121） of the respondents had set up a general practice department/general practice clinic；13.2%（16/121） of the respondents worked as a general practitioner in their contracted hospital；81.0%（98/121） had a monthly income lower than 6 000 yuan；80.2%（97/121） had passed the intermediate professional title examination，but 92.8%（90/97） of them had not been employed as an attending physician；66.9%（81/121） had not participated in a continuing medical education training/academic conference in the last year. For career planning after the expiration of the contractual obligation services，54.6%（66/121） said they were unclear，but 4.1%（5/121） planned to continue to work in primary care. In terms of life condition，17.4%（21/121） of the respondents said that they were provided with a free room for temporary residence by the contracted hospital；76.9%（93/121） said that their contracted hospital could not help them to address some of the practical difficulties relating to living. In terms of satisfaction with job：71.1%（86/121） of the respondents were dissatisfied with their income；47.1%（57/121） were dissatisfied with their jobs and tasks；19.9%（24/121） were dissatisfied with their work performance；and 18.2%（22/121） were dissatisfied with being undervalued by leaders of their contracted hospital. Focus group discussions revealed that targeted admission medical graduates were evaluated with strong learning ability，and high overall personal qualities，but may be relatively underpaid. Moreover，due to many factors，their levels of intention to work in primary care for a long period of time were not high. And the fostering suggestions were as follows：Universities and organizations（implementing the national standardized residency training program） should strengthen the ideological guidance of working in primary care in targeted admission medical graduates；the contracted hospitals should strengthen communications with targeted admission medical graduates. Conclusion　The first targeted admission medical graduates working in primary care in Chongqing showed low level of job satisfaction，and may be undervalued by the contracted hospitals，indicating that the training mode for these graduates and requirements of the contracted hospitals may be not well matched. In view of this，it is suggested that universities and organizations implementing the national standardized residency training program should improve the training mode for targeted admission medical graduates，and relevant government departments should improve the treatment for these graduates，such as salary and professional title promotion，so that these graduates are willing to work and retain in primary care，and have chances to put into practice the things they learn.

Key words: General practitioners；Target admission medical graduates；Education, medicine；Job status；Job satisfaction