Attitudes towards primary care career in community health centers among medical students in China
Zhang et al. BMC Family Practice
Attitudes towards primary care career in community health centers among medical students in China
Lingling Zhang 1
Thomas Bossert 0
Ajay Mahal 2
Guoqing Hu 5
Qing Guo 4
Yuanli Liu 0 3
0 Department of Global Health and Population, Harvard T.H. Chan School of Public Health , 665 Huntington Avenue, Boston, MA 02115 , USA
1 Department of Public Health Sciences, Clemson University , 515 Edwards Hall, Clemson, SC 29634 , USA
2 Monash University School of Public Health and Preventive Medicine , Welling Road, Clayton, Victoria 3800 , Australia
3 Peking Union Medical College School of Public Health , Beijing 100730 , China
4 Zhejiang Chinese Medical University; Intelligent Health Management Institute, Hangzhou Normal University , 16 Xuelin St, Jianggan, Hangzhou 310036 , China
5 Xiangya School of Public Health, Central South University , 110 Xiangya Road, Changsha 410078 , China
Background: Very few of the primary care doctors currently working in China's community health centers have a college degree (issued by 5-year medical schools). How to attract college graduates to community services in the future, therefore, has major policy relevance in the government's ongoing efforts to reform community health care and fill in the long-absent role of general physicians in China. This paper examined medical school students' attitudes towards working in communities and the factors that may affect their career choices in primary care to inform policy on this subject. Methods: A cross-sectional survey was designed upon the issuance of community health reform policy in 2006 by the Chinese government. The survey was conducted among 2714 medical students from three medical schools in representative regions in China. Binomial and multinomial regression analyses were carried out using a collection of plausible predictors such as place of rearing, income, etc. to assess their willingness to work in communities. Results: Of the 2402 valid responses, besides 5.7 % objection to working in communities, 19.1 % expressed definite willingness. However, the majority (41.5 %) of students only consider community job as a temporary transition, in addition to 33.7 % using it as their backup option. The survey analyses found that medical students who are more likely to be willing to work in communities tend to come from rural backgrounds, have more exposure to community health reform, and possess certain personally held value and fit. Conclusion: To attract more graduates from 5-year medical schools to work in communities, a targeted recruiting approach or admission policy stands a better chance of success. The findings on the influencing factors of medical students' career choice can help inform policymakers, medical educators, and community health managers to improve the willingness of swing students to enter primary care to strengthen basic health services.
Career choice; Primary health care; General Physicians; Medical student; Community health center; China
Background
Effective primary care have been shown to be associated
with improved access to health care services and
population health, cost effectiveness, and enhanced
equity [
1–4
]. A key element of China’s recent health
system reform efforts is building of a primary care
safety net at the level of the local community with
the hope that community doctors in China will
eventually become the “gate-keepers” of the health of the
population with a role similar to the General Physicians
(GPs) in more developed countries. Community health
centers (CHC), thus has become the foundation of
providing primary health care services in China. In 2006, the
State Council promulgated “Guidelines on the
Development of Urban Community Health Services” [No.10 (2006)
of the State Council] and “Guidelines on Strengthening the
Role of Urban Community Health Personnel” [No. 69
(2006) of the Ministry of Human Resources and Social
Security]. In 2011, the State Council further announced
the goal of achieving 2–3 qualified GPs for every 10,000
residents in both urban and rural China by 2020. [No. 23
(2011) of the State Council] But less than 13 % of health
care providers held a bachelor’s degree in medicine or
higher in community health centers in China [5]. The
government has attempted to upgrade these health care
providers to be a fully GP with a bachelor degree and
promote community health services. However, China is
facing a paradox where urban oversupply and rural
scarcity in health professionals coexist [
6
], which has
been seen in developed countries as well [
7, 8
]. Despite
the governments’ efforts at tackling this issues, many
medical graduates with a bachelor’s degree in medicine
or higher still chose a career of becoming a specialist
[8], which leads a severe shortage of health providers
with desired academic training in both urban and rural
community health services.
Unlike countries such as the US, Canada, and Australia
where medical education is a grad (...truncated)