Abstract: As a valuable resource of medical institutions at all levels，health human resources not only fundamentally determine the overall professional level of medical institutions，but also are valuable wealth for the long-term development of medical institutions in the future，especially grass-roots medical institutions.There is a long-term shortage of health human resources at the grass-roots level in China.The causes of relevant systems determine the systematicness and complexity of solving this problem.Based on the contents of the Regulations on the Registration of Doctors implemented by the former National Health and Family Planning Commission in April 2017 and the spirit of the Opinions on Reforming and Improving the Training for General Practitioners and Use of the Incentive Mechanism issued by the General Office of the State Council in January 2018，and the current situation of the construction of the grass-roots health human resources system in Beijing，this paper applied a questionnaire survey.By means of in-depth interviews，the occupational status and expectations of general practitioners in Beijing were investigated and analyzed.Five factors that seriously affected the rational distribution of health human resources at the grass-roots level were summarized：（1）the limitation of the scope of practice in the registration of doctors；（2）the limitation of the promotion system of professional titles；（3）the limitation of "human-governing factors" in the old personnel system in public institutions；（4） subjective restrictions on the main body of managerial standard caused by the long-term shortage of health personnel at the grass-roots level；（5）unique household registration constraints in Beijing.Five countermeasures and suggestions were put forward：（1）standardizing training，improving salary and establishing good career expectations；（2）reforming personnel management system and establishing two-way position transfer mechanism；（3）perfecting relevant legal system and defining the boundary of personnel rights；（4）increasing the scope of practice in accordance with the law and opening the access of talents；（5）drawing lessons from the experience of tertiary medical institutions to construct the mechanism of talent flow.

Key words: General practitioners, Community health services, Staff development, Institutional improvement, Root cause analysis

摘要： 卫生人力资源作为各级医疗机构的宝贵资源，不仅从根本上决定了医疗机构的总体业务水平，而且也是未来各医疗机构，尤其是基层医疗机构长远发展的宝贵财富。我国存在基层卫生人力资源长期短缺问题，相关制度成因决定了解决此问题的系统性和复杂性。本文根据2017年4月原国家卫生计生委施行的《医师执业注册管理办法》内容和国务院办公厅2018年1月下发的《关于改革完善全科医生培养与使用激励机制的意见》精神，结合北京市基层卫生人力资源制度建设现况，应用问卷调查和深入访谈的方法，对北京市全科医师职业状况和职业预期进行了调查分析。归纳出5条严重影响基层卫生人力资源合理分配的因素：（1）医师执业注册中的执业范围限制；（2）职称晋升体系的限制；（3）事业单位原有人事制度中“人治因素”限制；（4）基层卫生人才长期短缺所导致管理者本位的主观限制；（5）北京特有的户籍制度制约。给出了5条对策建议：（1）规范培养、提升薪酬，建立良好职业预期；（2）变革人事管理制度，建立双向转岗机制；（3）完善相关法律制度，明确人事权力边界；（4）依法增加执业范围，打通人才进出通道；（5）借鉴三级医院经验，构建人才流动机制。

关键词: 全科医生, 社区卫生服务, 人员开发, 制度建设, 影响因素分析