关键词: 医学毕业生, 全科医生, 保留, 职业发展, 订单定向

Abstract: Background　The training of rural order-oriented medical students is an important initiative to address the shortage of medical human resources in rural areas. As of October 2023, three batches of order-oriented medical graduates have completed their prescribed service obligations. However, there is still a lack of systematic research and definitive conclusions regarding their career development and whether they will continue to serve in rural areas after fulfilling their service commitments. Objective　Based on eight years of panel data from a cohort of rural order-directed medical students, this study aims to analyze their early career development characteristics and identify key factors influencing their retention in primary healthcare institutions. The findings are intended to provide policy recommendations for the training and management of order-directed medical graduates in China. Methods　Since 2010, a dynamic follow-up cohort has been established, involving order-directed medical graduates from Qinghai University, Guangxi Medical University, Jiujiang University, and Gannan Medical University. This study utilized data from 2,041 graduates from the 2015–2019 cohorts, collected through annual online surveys conducted over eight years. The surveys tracked their career development, including professional title promotion, administrative role acquisition, average monthly income, and the proportion of performance-based pay. Descriptive analysis was used to summarize career development patterns, while logistic regression models were employed to explore factors influencing retention in primary healthcare institutions after the contractual period. Results　By the eighth year after graduation, 92% of graduates had obtained the title of attending physician, and 24% held administrative positions. The average monthly income was 5,573.4 yuan, with performance-based pay accounting for 45.7% of the total. The retention rate in primary healthcare institutions was 37.5%. Among those who left, 35.2% moved to hospitals above the county level, 27.7% joined county hospitals, 7.5% pursued graduate studies, and 23.8% were unemployed. Multivariate analysis revealed that being assigned to a work location in one’s hometown （OR=2.6） and holding an administrative position （OR=2.0） significantly increased the likelihood of remaining in primary healthcare institutions after completing the contract. Conversely, passing the medical licensing exam within two years of graduation （OR=0.4） significantly reduced the likelihood of retention （P<0.05）. Conclusion　Order-directed medical graduates show rapid career progression, with over half choosing to remain in county-level or lower primary healthcare institutions after fulfilling their contracts. This contributes to strengthening the primary healthcare workforce and improving healthcare service delivery at the grassroots level.

Key words: Medical graduates, General practitioners, Retention, Career development, Order-Directed