With the growing public awareness of health, residents' demand for medical and health services has increased dramatically, which in turn raises higher requirements for the service capacity of primary healthcare institutions. Strengthening the deployment of general practice talents in primary health facilities serves as an effective way to meet the basic health needs of residents.

Based on the iceberg model, this study analyzes the current status and interrelationship between the explicit and implicit competencies of primary care doctors in China, and identifies existing problems.

In August 2020, a multistage stratified cluster sampling method combined with typical sampling was adopted. First, the country was divided into eastern, central, and western regions according to the gradient distribution of socioeconomic development levels. Sample provinces and prefecture-level cities were selected from each region, and one district and one county (or county-level city) were chosen from each sample city as urban and rural survey sites. An online questionnaire survey was conducted among 8 537 primary care doctors. Differences in explicit and implicit competency levels between urban and rural areas, as well as across the eastern, central, and western regions, were compared. A negative binomial regression model was used to analyze the association between implicit and explicit competency levels.

A total of 8 469 valid questionnaires were collected, yielding an effective response rate of 99.2%. Among the respondents, 2 863 (33.8%) were urban primary care doctors, and 5 606 (66.2%) were rural ones. In terms of regional distribution, 2 953 (34.9%) were from the eastern region, 3 200 (37.8%) from the central region, and 2 316 (27.3%) from the western region. Regarding explicit competencies, five areas with the lowest proficiency levels among primary care doctors include use of simple medical devices (4 589/8 469, 54.2%), medical coordination (4 800/8 469, 56.7%), community rehabilitation guidance (5 166/8 469, 61.0%), traditional Chinese medicine service capacity (5 613/8 469, 66.3%), and diagnosis and treatment of common diseases (6 497/8 469, 76.7%). In terms of implicit competencies, 8 167 out of 8 469 physicians (96.4%) possessed humanistic literacy, and 5 768 (68.1%) possessed learning ability. Rural primary care doctors showed higher proficiency rates in most health service competencies than their urban counterparts (P<0.05). The overall competency level of physicians in the western region was relatively low. Furthermore, implicit competencies (humanistic literacy and learning ability) were significantly and positively associated with the comprehensive level of explicit competencies (P<0.001).

The overall level of health service competencies among primary care doctors in China is not high and exhibits regional disparities. Notable weaknesses exist in medical services and learning capacity. Implicit competency is found to be a potential key factor in enhancing the comprehensive level of explicit competency. Therefore, it is recommended that the government strengthen the construction of the primary care workforce in the western region, promote the sharing and flow of medical resources in rural areas, accumulate practical experience, provide targeted skills training, and simultaneously focus on cultivating the intrinsic qualities of primary care doctors, thus improving the overall service capacity.