Page 110 - 2022-25-中国全科医学

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incentives regarding the SGPRP. But there is a lack of such studies in non-targeted admission medical graduates completing the
SGPRP. Objective To understand the employment status of non-targeted admission medical graduates finishing the SGPRP
in Henan Province，and to identify the causes of choosing other careers instead of being a GP，providing a reference for the
improvement of SGPRP management and incentive mechanisms for human resource management. Methods In August 2021，
multistage random sampling was used to select non-targeted admission medical graduates（n=326） who had been admitted to the
SGPRP during 2014 to 2017 and had completed it in Henan Province. They were invited to complete a self-administered survey
questionnaire through the platform of wjx.cn for understanding their general information，and self-perceived status of training with
SGPRP，current job，and causes of being a GP or choosing other careers. Results The survey obtained a response rate of 83.1%
（271/326）. Among the respondents，77（28.4%） chose GP as a career，and other 194（71.6%） chose other careers after
completing the SGPRP. Multivariate Logistic regression analysis showed that age，education level，type of source and the location
of the general practice residency training base were associated with the career choice（P<0.05）. Compared with respondents with
a non-GP career choice, those with a GP career choice had higher prevalence of having general practice as the registered major
〔70.1%（54/77）vs 32.0%（62/194），P<0.05〕，and working at township health centers or community health centers〔49.4%
（38/77） vs 6.2%（12/194），P<0.05）〕. Among those with a non-GP career choice，the top three careers were internal
medicine practitioners〔40.2%（78/194）〕，emergency and critical care practitioners〔17.0%（33/194）〕，and surgical
care practitioners〔8.8%（17/194）〕. The three major causes of choosing a non-GP career were appointed by the employed
hospital〔34.5%（67/194）〕，lack of general practice department in the employed hospital〔29.9%（58/194）〕 and low
salary〔26.8%（52/194）〕. Conclusion In these non-targeted admission medical graduates finishing the SGPRP，the
prevalence of choosing a GP career was relatively low，which may be associated with age, education level，type of source，and
the location of the general practice residency training base. To increase the attractiveness of GP as a career，it is recommended to
expand the publicity of the concept of general medicine，accelerate the construction of the general practice department in general
hospitals，and improve the salary of GPs.
【Key words】 General practice；Standardized residency training program；Education，medical；Health workforce；
Employment；Career choice

全科医生既是基本医疗服务的提供者，也是医疗卫 已有注册全科医生 5 万余，但全科医生的数量缺口仍较
生服务系统的“守门人”，在国家和区域的医疗卫生服 大，高质量的全科医生和农村执业的全科医生则更为缺
务中发挥着重要作用 ［1］ 。加快培养合格的全科医生， 乏 ［4］ 。目前，针对非订单定向全科住院医师规范化培
对于加强基层医疗卫生服务体系建设、推进家庭医生签 训（简称全科住培）学员结业后是否选择继续从事全科
约服务、建立分级诊疗制度、维护和增进人民群众健康 医学专业工作，以及影响学员择业、保留及流失的因素
具有重要意义。全科医生的数量和区域分布是各国都需 尚缺乏报道。本研究调查了河南省非订单定向全科住培
要考虑的问题。美国、加拿大、澳大利亚等国家在现有 结业学员的就业状况，并分析影响其执业选择的原因，
丰富全科医生资源的基础上，通过开展农村医学教育和 从而为今后精准制定激励机制和方针政策提供依据，以
实习、专用资金支持等培养与激励机制，不同程度上改 确保更多全科医生“下得去、留得住、用得好”。
善了全科医生在农村和边远地区缺乏的局面 ［2］ 。与上 1 对象与方法
述国家相比，我国全科医生在数量、质量和区域分布上 1.1 研究对象 于 2021 年 8 月，根据全科住培基地的
都存在明显差距，《国务院关于建立全科医生制度的指 地域分布情况，将河南省划分为郑州市、豫东、豫南、
导意见》（国发〔2011〕23 号）和《国务院办公厅关 豫西、豫北 5 个区域，对每个区域的全科住培基地进行
于改革完善全科医生培养与使用激励机制的意见》（国 编号，然后在每个区域随机抽取 2 家基地，抽取的 10
办发〔2018〕3 号）发布后，我国全科医生缺乏的局面 家基地分别为河南省人民医院、郑州人民医院、新乡医
逐步得到改善。河南省是中国第三人口大省，其中农民 学院第一附属医院、濮阳市人民医院、河南科技大学第
近一半，经济欠发达，医疗条件薄弱。与城市相比，农 一附属医院、三门峡市中心医院、南阳市中心医院、
村地区居民的健康状况更差，吸烟、慢性病（冠心病、 信阳市中心医院、河南大学第一附属医院、商丘市第一
慢性阻塞性肺疾病、脑卒中及肥胖等）、精神疾病、妇 人民医院。采用整群抽样法，将该 10 家全科住培基地
科疾病的患病率更高，儿童和青少年的死亡率也更高， 2014—2017 年入培且已结业的非订单定向全科住培学
且有留守老年人和留守儿童，居民总体家庭经济收入水 员共 326 例纳入研究。本研究经河南省人民医院伦理委
平和受教育水平不高 ［3］ 。因此，无论是慢性病管理还 员会审核批准。
是健康促进，农村都更需要全科医学服务。尽管近年来 1.2 研究方法
河南省加大了全科医生培养工作力度，截至 2019 年底 1.2.1 调查工具 在查阅相关文献和咨询相关领域专家