Barriers to Primary Care Provision and Relevant Solutions: an Analysis from the Perspective of Targeted Admission Medical Graduates

Abstract

Background The continuous development of the rural-oriented tuition-free medical education program has greatly contributed to the increasingly expanding of team of general practitioners in primary care. And the service status of targeted admission medical graduates has become a focus of current concern. Objective To explore the barriers faced by targeted admission medical graduates during the contracted period of providing primary care, and to propose corresponding countermeasures and suggestions. Methods From January to March 2021, 73 targeted admission medical graduates (admitted in 2010 & 2011) who were working in primary hospitals in Guizhou were selected to attend a semi-structured interview with an outline involving brief introduction of the development of their hospitals, job duties, job progression, main problems existing in work, capability areas for improvement, current situation of continuing education, current living conditions, level of targeted admission medical graduates valued by hospitals, future work plan, and so on. The interview results were analyzed in accordance with the procedures of grounded theory. Results One hundred and twenty-seven concepts, 21 categories, 7 main categories (work environment, policy guarantee, family factors, future planning, psychology and perception, person-job fit and career development needs) were identified by an analysis, forming four axes: working practice (primary medical conditions, environment, management and other factors restrict the development of targeted admission medical graduates, and they hope to get more organizational support and suitable job arrangements) , family factors (part of targeted admission medical graduates affected by factors such as family distance and economic pressure during the service period, it is difficult to take into account the responsibility of family care) , internal demand (targeted admission medical graduates are prone to psychological and cognitive gaps, think that their personal abilities and development are limited, and hope for better career development prospects) , policy driving (policy factors run through all aspects of primary care for targeted admission medical graduates, and the implementation and promotion of some policies are insufficient and need to be further strengthened) . Conclusion The targeted admission medical graduates in Guizhou mainly faced difficulties in career development, ability improvement, caring for families, economic treatment and other aspects during the contracted period of providing primary care. To improve the situation, retain them in primary care as well as promote their career development, it is suggested to establish a mechanism for receiving their feedback, providing long-term trainings and guidance for them, allocate targeted admission medical graduates from other places, speed up the construction of regional medical consortiums, set up special subsidy funds, and clarify the arrangements after the expiration.

Keywords

• general practitioners|target admission medical graduates|education, medicine|job status|qualitative study