General Practitioner Education Reform in China: Most Undergraduate Medical Students do not Choose General Practitioner as a Career Under the 5+3 Model

Factors influencing residents' decision to sign with family doctors under the new health care reform in China

“…Its strict “first contact care” system ensures that general practitioners are fully equipped to play the role of “gatekeeper” fully. Compared with Britain, at this stage, China has a large deficit in the number of family doctors, and the standard of general practitioner training is lagging behind . As the posts of general practitioners are mainly held by the original community doctors, with short‐term training, competence and skill are limited.…”

“…(c) Thoroughly implement the hierarchical medical system, and define the service scope and allocation of functions in both large general hospitals CHCs. (d) Improve the development of skills, broaden the scope of training methods, and promote the standardization, specialization, and systematization of general practitioner training, strengthen the development of general medical disciplines and improve the quantity and quality of general practitioners . (e) Establish effective performance appraisal criteria, raise income levels, perfect incentive provision, and stimulate family doctors' work enthusiasm .…”

“…However, due to the delayed implementation of the community health service in China, most of the community doctors are not well‐educated; their education, training, and professional development are still in their initial stages. Their service mode and professional title assessment are still based on the clinical specialist model, which differs from the actual needs of the residents . In addition, because China does not implement a strict primary health care system and the professional level of CHCs is the lowest in the urban tertiary health care network, large general hospitals, which are at the top of the network, are overcrowded whereas there are few people in the CHCs …”

“…For example, Lou et al indicated that, under normal circumstances, the community health service is not the first choice for residents when they fall ill, and Tang et al found that the passion of doctors in grassroots medical institutions is poor. Additionally, the 2017 Chinese flu epidemic demonstrated the following limitations of community health services: (a) the distribution of high‐quality medical resources is uneven, and the resources of CHCs are poor and the hardware facilities are inadequate; (b) the general practitioner training model is imperfect, the quantity of general practitioners is insufficient, top‐ranking talent is scarce, and medical skills and service quality are deficient; and (c) the enthusiasm of general practitioners cannot be fully engendered due to the lack of effective, scientific performance appraisal criteria, and incentive mechanisms. This is also an important reason for the significant problems in CHCs, such as that “excellent talents cannot be attracted or retained.” (d) In developed countries, such as Britain and the United States, family doctors are required to be educated and trained to ensure their competence.…”

“…(c) Thoroughly implement the hierarchical medical system, and define the service scope and allocation of functions in both large general hospitals CHCs. (d) Improve the development of skills, broaden the scope of training methods, and promote the standardization, specialization, and systematization of general practitioner training,12 strengthen the development of…”