Abstract: Sufficient and qualified general practitioners（GPs）are essential in establishing the "Gatekeeper health care system"，in which the patient's first consultation must be made by the GP.At present，the quantity of general practitioners in China is inadequate and cannot meet the actual demand within a short period of time.Meanwhile，the training and practice of general practitioners are disconnected，thus producing another problem in China.All of these directly affect the establishment of the "Gatekeeper system".This study took the "5+2+1 joint medical education model for general practitioners" at Guangzhou Medical University as an example and investigated the cause as to why students enrolled in this program from 2012 to 2016 were reluctant to practice as general practitioners.Through semi-structured interviews，the researchers try to find out the actual cause comparing training models at home and abroad and researching relevant data.The results showed that，on the surface，the causes included low income，poor working conditions，low social status，and poor career development prospects.But the root causes involved the medical system，the education system，the social security mechanism and the incentive mechanisms.Therefore，it is suggested that at the national level，the "Gatekeeper system" should be subject to legal restraint；establish a qualified recruitment and targeted training system for general practice；improve the working environment；develop a revised promotion system for general practitioners and strengthen the adjustment mechanism of medical insurance.Last but not least，the living conditions of general practitioners should be guaranteed to a certain extent by the government.

Key words: General practitioners；Education, medical；Health manpower

摘要： 具备数量充足的合格的全科医生是实现首诊在全科的关键所在，也是建立分级诊疗制度的核心。目前我国全科医生数量不足且短时间内难以解决，同时全科医生的培养与使用存在相脱节的问题，这直接影响了全科医生制度的建立。本研究以广州医科大学开展的“5+2+1”全科医学专业硕士生培养项目为例，通过半结构化访谈调查该项目2012—2016年招收学生不愿意到基层医疗卫生机构执业的原因，并以此为基础，通过国内外培养模式对比及相关数据研究，深入分析我国全科医生培养与使用相脱节的原因。结果显示，从表面上看，全科医生不愿到基层医疗卫生机构执业的原因包括收入较低、工作条件差、社会地位不高、职业发展前景堪忧等；但其深层次的原因涉及医疗体制、教育体制、社会保障机制与激励机制等方面。因此，建议在国家层面对首诊在全科进行法律约束，建立有人额限定的全科医学专业招生制度和有针对性的培养体系，改善基层全科医生的执业环境和职称评审途径，强化医疗保险的调节机制，同时从制度角度对全科医生的生活条件提供一定保障。

关键词: 全科医生；教育, 医学；卫生人力