全科医生职业吸引力评价研究

There are some problems such as shortages and staff retention difficulties among General Practitioners (GPs) faced by our nation. It has greatly affected the level and quality of primary healthcare services and brought enormous challenges for the implementation and promotion of grading healthcare system. Therefore, it is an urgent need to develop effective policies and management measures in this area; however, understanding the determinants and mechanism of occupational attractiveness among GPs is the key to formulate scientific and effective policies and management measurements. On the basis of defining the concept and the core elements of occupational attractiveness among GPs, we investigate the determinants, mechanism and structural models of GPs’ occupational attractiveness, and explore the policies and measurements of improving the occupational attractiveness of GPs through a series analysis procedure, including the literature review, policy analysis, field investigation, Delphi method, interviews, multi-level model, structural equation model, and systematical archetype feedback analysis methods. Our project could fill the theoretical gaps of current GPs' occupational attractiveness evaluation and help to identify the key factors and the mechanism across these key factors associated with the occupational attractiveness among GPs. The research findings can supply a new insight for the study on occupational attractiveness of GPs across our nation and provide the scientific evidence for formulating effective healthcare policies and measurements and enhancing the construction of GPs group.

我国全科医生队伍面临人才短缺、人员留用困难等问题，极大地影响着基层医疗卫生服务的水平和质量，也给分级诊疗制度的落实与推进带来巨大的挑战，迫切需要制定有效的政策和管理措施，而明确全科医生职业吸引力的关键因素和作用机制，是制定科学有效政策和管理措施的基础和关键。本课题在明确全科医生职业吸引力的概念和核心要素的基础上，通过文献研究、政策分析、现场调研、专家咨询、关键人物访谈以及多水平模型、结构方程模型、基模分析等方法，研究全科医生职业吸引力决定性因素、作用机制及其结构模型，探索提升全科医生职业吸引力的政策和管理措施。本课题在理论上能够弥补当前全科医生职业吸引力评价研究的不足，在实践中有助于明确影响全科医生职业吸引力的关键因素及其作用路径，预期可为我国全科医生职业吸引力研究提供新的视角，为制定有效的政策和措施，促进全科医生队伍建设提供科学依据。

全科医生作为基层医疗服务的提供者，其数量和质量直接决定着基层卫生服务体系的服务质量和水平，明确全科医生职业吸引力的研究进展和主要影响因素，对于稳定全科医生队伍建设，加强基层医疗卫生机构服务能力至关重要。本项目对国内外全科医生职业吸引力研究进展进行综述，提炼全科医生职业吸引力的关键要素，并根据关键要素开展实证研究，探索全科医生职业吸引力的主要影响因素，进而提出提升全科医生职业吸引力的建议策略，为指导全科医生人才队伍培养、使用及激励提供参考。.本项目首先采用文献研究、政策分析和Meta分析等方法综述了国内外全科医生职业吸引力研究进展，提炼了全科医生职业吸引力的关键要素，譬如，工作满意度、职业倦怠、离职意愿和职业认同等。在此基础上，于2017年10月—2018年2月采用多阶段分层随机抽样方法在中国东中西部地区12个省/市/自治区360个社区卫生服务机构抽取3244名全科医生进行微信问卷调查，共纳入3236名全科医生进行统计分析。全科医生工作满意度、职业倦怠和离职意愿平均得分分别为（34.12±6.56）分、[情绪耗竭（24.80±13.17）分、去人格化（5.76±6.36）分、个人成就感（34.44±10.05）分]和（15.07±4.33）分，1895名（58.56%）全科医生认为工作压力较高，表明我国全科医生工作满意度一般，职业倦怠、离职意愿和工作压力处于较高水平。多因素结果显示，不同地区全科医生的工作满意度、职业倦怠、离职意愿和工作压力有差异，其影响因素也不尽相同。结构方程模型结果显示，物质满意度、关系满意度和成长满意度均与职业吸引力呈正相关（路径系数分别为0.91、0.96、0.84），职业倦怠和离职意愿与职业吸引力之间为负相关关系（路径系数分别为-0.51、-0.55）。基于现场调查结果、SWOT分析、政策分析与专题研讨，总结了提升全科医生职业吸引力的策略，如加大财政对全科医生人才队伍建设的支持力度，保障全科医生薪酬水平，完善职称评审机制，明晰全科医生职业发展前景等。