关键词: 家庭医生团队, 家庭医生, 护士, 公共卫生人员, 激励因素, 偏好

Abstract: Background　To improve the subjective initiatives of family physician team members，it is necessary to establish an effective incentive mechanism. Different incentive factors may have different effects on these team members. Objective　To compare the level of satisfaction with and preference of incentives in family physician team members in different positions，providing a basis for further improving and refining the incentive mechanism for the team. Methods　Using a questionnaire designed by research group，a survey on demographics，basic characteristics of the working environment，the incentive mechanism，and the preference for incentive factors was conducted in all 676 incumbent family physician team members（consisting of family physicians，nurses and public health workers） from 27 community health centers in Xiamen，Hangzhou，Shanghai，and Beijing from July to September 2019，Chi-square test or analysis of variance was used for comparing the demographics and preferred incentives among the members in different positions. Results　A total of 676（96.6%） cases who handed in responsive questionnaires were finally included. There were significant differences in the proportion of family doctor special fund and contracted service fee in the monthly income and total income of family doctor team members in different positions（P<0.001），and the proportion of clinical medical workers was higher than that of nursing and public health workers（P<0.016 7）. There were significant differences in the evaluation of the matching degree between income and work value of family doctors among different positions of family doctors（P<0.05）；the proportion of public health workers who thought that the matching degree of income and work value was higher than that of nursing workers（P<0.016 7）. There was no significant difference in the satisfaction of family doctor team members in different positions（P=0.204）. There were significant differences in the participation of family doctor team members in different positions（P<0.05）；the proportion of clinical medical workers participating in staged refresher training was higher than that of nursing and public health workers（P<0.016 7）. The proportion of clinical medical workers participating in relevant professional courses training was higher than that of nursing workers（P<0.016 7）. There was no significant difference between the promotion of family doctor team members and the promotion of professional title among different positions（P>0.05）.  The majority of family physician team members believed that personal income and welfare were the most important motivators，including 95.6%（387/405） of family physicians，95.7%（180/188） of nurses and 98.8%（82/83） of public health workers. Training opportunities，social recognition and respect，title promotion opportunities ranked the second，third and fourth，respectively. The fifth incentive factor was unit management for family physicians，workload for nurses，and working conditions for public health workers. Conclusion　The incentive mechanism varies for family physician team members in different positions. Members engaged in clinical medicine have higher levels of income，welfare and training than those engaged in nursing and public health. Moreover，different family physician team members have different preferences for incentive factors. We should continue to optimize the salary structure of family physician team members，increase family physicians' income and contract service fee，and improve financial incentives；strengthen training，and improve the service capacity at primary health care institutions；protect the rights and interests of medical personnel，and raise their social recognition.

Key words: Family physician team, Family physician, Nurse, Public health worker, Incentive factors, Preference