Abstract: Background　To improve the subjective initiatives of family physician team members，it is necessary to establish an effective incentive mechanism. Different incentive factors may have different effects on these team members. Objective　To compare the level of satisfaction with and preference of incentives in family physician team members in different positions，providing a basis for further improving and refining the incentive mechanism for the team. Methods　Using a questionnaire designed by research group，a survey on demographics，basic characteristics of the working environment，the incentive mechanism，and the preference for incentive factors was conducted in all 676 incumbent family physician team members（consisting of family physicians，nurses and public health workers） from 27 community health centers in Xiamen，Hangzhou，Shanghai，and Beijing from July to September 2019，Chi-square test or analysis of variance was used for comparing the demographics and preferred incentives among the members in different positions. Results　A total of 676（96.6%） cases who handed in responsive questionnaires were finally included. There were significant differences in the proportion of family doctor special fund and contracted service fee in the monthly income and total income of family doctor team members in different positions（P<0.001），and the proportion of clinical medical workers was higher than that of nursing and public health workers（P<0.016 7）. There were significant differences in the evaluation of the matching degree between income and work value of family doctors among different positions of family doctors（P<0.05）；the proportion of public health workers who thought that the matching degree of income and work value was higher than that of nursing workers（P<0.016 7）. There was no significant difference in the satisfaction of family doctor team members in different positions（P=0.204）. There were significant differences in the participation of family doctor team members in different positions（P<0.05）；the proportion of clinical medical workers participating in staged refresher training was higher than that of nursing and public health workers（P<0.016 7）. The proportion of clinical medical workers participating in relevant professional courses training was higher than that of nursing workers（P<0.016 7）. There was no significant difference between the promotion of family doctor team members and the promotion of professional title among different positions（P>0.05）.  The majority of family physician team members believed that personal income and welfare were the most important motivators，including 95.6%（387/405） of family physicians，95.7%（180/188） of nurses and 98.8%（82/83） of public health workers. Training opportunities，social recognition and respect，title promotion opportunities ranked the second，third and fourth，respectively. The fifth incentive factor was unit management for family physicians，workload for nurses，and working conditions for public health workers. Conclusion　The incentive mechanism varies for family physician team members in different positions. Members engaged in clinical medicine have higher levels of income，welfare and training than those engaged in nursing and public health. Moreover，different family physician team members have different preferences for incentive factors. We should continue to optimize the salary structure of family physician team members，increase family physicians' income and contract service fee，and improve financial incentives；strengthen training，and improve the service capacity at primary health care institutions；protect the rights and interests of medical personnel，and raise their social recognition.

Key words: Family physician team, Family physician, Nurse, Public health worker, Incentive factors, Preference

摘要： 背景　要提高家庭医生团队成员工作的主观能动性，需要建立有效的激励机制，不同激励因素对家庭医生团队成员的影响不同。目的　比较不同岗位家庭医生团队成员激励因素现状、满意度及激励因素偏好，为进一步细化完善家庭医生团队激励机制提供依据。方法　于2019年7—9月在厦门市、杭州市余杭区、上海市长宁区、北京市西城区和房山区共选择27家社区卫生服务中心，采用课题组自行设计的问卷对所有在岗的家庭医生团队人员676人（包括临床医生、护理人员和公共卫生人员）进行普查，调查内容主要包括家庭医生团队人员的个人基本情况和工作环境基本特征、激励机制及激励因素偏好情况。对不同岗位家庭医生团队成员的基本情况及激励因素差异进行分析。结果　共收回有效问卷676份，有效回收率为96.6%。不同岗位家庭医生团队成员的月收入、总收入中家庭医生专项资金占比和签约服务费占比比较，差异有统计学意义（P<0.001），从事临床医疗工作者高于从事护理和公共卫生工作者（P<0.016 7）。不同岗位家庭医生团队成员对收入与家庭医生工作价值匹配程度的评价比较，差异有统计学意义（P<0.05）；从事公共卫生工作者认为收入与工作价值匹配的比例高于从事护理工作者（P<0.016 7）。不同岗位家庭医生团队成员对福利待遇的满意度比较，差异无统计学意义（P=0.204）。不同岗位的家庭医生团队成员参加阶段性进修培训、相关专业课程培训情况比较，差异有统计学意义（P<0.05）；从事临床医疗工作者参与阶段性进修培训者占比高于从事护理与公共卫生工作者（P<0.016 7）；从事临床医疗工作者过去1年参加相关专业课程培训者占比高于从事护理工作者（P<0.016 7）。不同岗位的家庭医生团队成员过去3年职务提升与职称提升比较，差异无统计学意义（P>0.05）。3种岗位的家庭医生团队成员绝大多数都认为个人收入和福利是最重要的激励因素，这一比例在家庭医生、护士和公共卫生成员中分别是95.6%（387/405）、95.7%（180/188）和98.8%（82/83）；培训机会、社会认可和尊重、职称晋升机会排在第2位、第3位和第4位；但对家庭医生来说单位管理制度是排名第5的激励因素，对护士来说工作量是排名第5的激励因素，对公共卫生人员来说排名第5的则是工作条件。结论　不同岗位家庭医生团队成员的激励机制现状存在较大差异，从事临床医疗工作的家庭医生团队成员收入、福利待遇与培训学习情况优于从事护理和公共卫生工作的人员，且不同家庭医生团队成员对激励因素的偏好有所不同。应当继续优化家庭医生团队成员薪酬结构，提升家庭医生团队的收入及签约服务费，完善经济激励措施；加强基层培训学习力度，提升基层医疗卫生机构服务能力；保障医疗卫生人员权益，提高基层医务人员的社会认可度。

关键词: 家庭医生团队, 家庭医生, 护士, 公共卫生人员, 激励因素, 偏好