Rural targeted general practitioners (referred to as "5+3" targeted general practitioners) who have completed 5-year college education and 3-year residency training are an important source of high-level health talents in rural areas. The post attractiveness of primary care general practitioners in China still needs to be improved, and it is necessary to analyze the relevant progress in the use and incentive of "5+3" targeted general practitioners.

To understand the policy and practice of use and incentive of "5+3" targeted general practitioners in targeted rural primary medical care institutions (referred to as "targeted institutions" ) .

August 2024, we reviewed policies and typical practices in various places on use and incentive of "5+3" targeted general practitioners issued by Chinese government since 2010. A series of questionnaire surveys and semi-structured interviews were conducted among "5+3" targeted general practitioners, presidents of targeted institutions and managers ofhealth administrativedepartments in 9 counties (cities) of 8 provinces in the midwest regions through the convergent-parallel mixed methods research.

From the perspective of policy progress, the ues and incentive policy of "5+3" targeted general practitioners in China before 2018 was mainly guidance document. After 2018, relevant policy requirements were more specific, mainly focusing on improving salary levels, hiring and staffing, career development and performance management. Survey data shows: From 2010 to 2015, 9 counties (cities) trained a total of 209 "5+3" targeted general practitioners, with the compliance rate of 90.0% (188/209), of which the compliance rate for the 2010-2012 level was 84.0% (63/75), and the compliance rate for the 2013-2015 level was 93.3% (125/134) ; The pre-work compliance rate was 91.4% (191/209), and the post-work compliance rate was 98.4% (188/191) ; 63 people had completed their service period, and 61.9% (39/63) had renewed their contracts after the service period expired. The annual per capita after-tax wage income of 142 on-the-job "5+3" targeted general practitioners was 54 000 CNY during the training period, and the annual per capita after-tax wage income after entering the targeted institutions was 57 000 CNY. 14.1% (20/142) of them are willing to renew their contracts after the expiration of their service period.

The compliance rate of "5+3" targeted general practitioners continues to increase, and the trend of renewal rate is positive but the willingness to renew is low. There is a gap between the training of "5+3" targeted general practitioners and the actual needs of primary medical care institutions, and the working conditions and career development of "5+3" targeted general practitioners in the targeted institutions are restricted. It is suggested that the government and relevant departments proceed from the actual needs of the grassroots, coordinate and arrange "5+3" targeted general practitioners training, fully implement the incentive policies such as salary and professional title promotion, and formulate the renewal plan after the expiration of service