Page 73 - 中国全科医学2022-07

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【Abstract】 Background In view of the shortage of general practitioners（GPs） and limited community healthcare
resources，it is urgently necessary for community health institutions to find accurate and scientific incentive methods to retain
GPs and help them to realize their full potential，as well as promote the development of both community health institutions and
GPs，thereby benefiting the health promotion of community residents. Objective To develop an incentive model for GPs to test
the performance and effectiveness of current incentives for GPs，so as to put forward suggestions to improve the mechanisms of
employing and retaining GPs. Methods In August 2019，we recruited 204 GPs from 11 community health centers（CHCs）
in Shanghai's Fengxian District using stratified random sampling to attend an online survey using a questionnaire named General
Practitioners' Perception and Evaluation of Incentive Measures developed based on our previous research results and Herzberg's
motivation-hygiene theory. Then from August to September 2019，we invited directors responsible for medical care or public
health issues，and medical quality control department heads from the above-mentioned 11 CHCs to attend an online survey using
a questionnaire named Workload for General Practitioners in Community Health Centers of Fengxian District developed by usbased
on a literature review. Then under the guidance of Herzberg's motivation-hygiene theory，we constructed a structural equation
to develop an incentive model for GPs within Fengxian District with representative incentive policies，systems and initiatives
related to GPs selected from the survey results as latent independent variables to measure GPs'（responders'） perception and
assessment of incentives，and with willingness to work，service radius，and workload of GPs as dependent variables. Results
The average scores for the implementation of incentive measures，and its associated influence on GPs' work status assessed by
the 204 GPs were （0.77±0.14），and （0.73±0.19），respectively. The assessment score for implementation of incentive
measures for GPs differed significantly by personal health condition and administrative position in the respondents（P<0.05）.
The assessment score for the influence of implementing incentive measures on GPs' work status differed significantly by personal
health condition in the respondents（P<0.05）. Spearman correlation analysis showed that GPs' work status was associated with
the implementation of 25 incentive measures（one incentive measure at the subdistrict level was not included for analysis）
（P<0.05）. The top three most highly correlated incentive measures were performance distribution（r s =0.652），performance-
based salary calculation（r s =0.621），and wages and benefits（r s =0.614）. Partial correlation analysis indicated that，after
controlling for variables such as the regional policy environment，the street and town government，and the work unit，the
assessment score for implementation of either regional，or subdistrict or institutional incentive measures for GPs，was positively
correlated with the assessment score for the influence of implementation of incentive measures for GPs on GPs' work status（r=0.381，
0.387，0.528，P<0.001）. Theaverage assessment score for willingness to work by the respondents was （0.76±0.18） points.
Theassessment scores of willingness to work by the respondents differed significantly by work unit（P<0.05）. Structural equation
modeling revealed that the implementation of policy incentive measures influenced GPs' workload via GPs' willingness to work.
Specifically，the implementation of policy incentive measures increased GPs' willingness to work（w1=0.43），while GPs'
willingness to work decreased with the increase of weighted workload（w2=-0.156）. Conclusion The GPs in Fengxian District
showed higher level of willingness to work，namely，relatively high job stability，but they had not been incentivized by policy
incentives to be competitive in obtaining improved performance，indicating that although policy incentives have produced partial
effects on incentivizing GPs，the effects are still unsatisfactory. In the long run，it is necessary to consider whether there will be
changes in GPs' retention status due to the lack of work initiative. For GPs，besides a guarantee of stable income，incentives to
get more by doing more are also needed，which may be achieved by increasing the incentive authority and proportion of community
health institutions when the total amount of incentives is limited.
【Key words】 General practitioners；Herzberg's motivation-hygiene theory；Incentive model；Structural equation；
Weighted workload

在基层医疗卫生机构持续推进家庭医生制度落地和 到精准而科学的“激励”方式，“留住人、用足人”，
社区卫生服务综合改革过程中，全科医生群体作为落实 并促成组织与个人共同成长，进而利好社区居民？本研
改革的“主力军”，随着时间的推移，在配套资源到位 究以赫兹伯格的双因素激励理论 ［4-6］ 为理论指导，以上
速度不抵工作量升级速度情况下，其出现了一定的倦 海市奉贤区为研究范围，以上海市奉贤区全科医生为研
怠 ［1］ ，表现在疲于应对日常工作和临时负荷、无暇顾 究对象，使用结构方程，将各层面与激励相关的政策、
及科研与教学两大关乎学科发展的部分、无暇思考健康 制度和举措作为输入，将全科医生群体作为反应主体，
管理与健康教育两大关乎学科终极服务目标的部分 ［2］ 。 提取有代表性的潜变量测量该群体的激励认知和激励评
如何在全科人才紧缺、社区资源有限的背景下 ［3］ ，找 价，将全科医生群体的工作意愿（主观采集）、服务半