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

已完成5年本科教育和3年全科住院医师规范化培训（简称规培）的农村订单定向全科医生（简称"5+3"定向全科医生）是农村基层高层次卫生人才的重要来源。我国基层全科医生岗位吸引力仍需提高，有必要针对我国"5+3"定向全科医生使用和激励相关政策进展进行分析。

了解"5+3"定向全科医生在基层医疗卫生机构（简称定向单位）使用和激励政策进展与实践。

2024年8月，梳理2010年至今我国"5+3"定向全科医生使用与激励相关政策、各地典型做法；采用聚敛式混合方法设计，对中西部地区8个省9个县（市）"5+3"定向全科医生、定向单位院长和卫生行政部门管理人员进行问卷调查和半结构式访谈。

2018年以前我国"5+3"定向全科医生使用与激励政策主要为导向性表述，2018年以后相关政策要求更加具体，主要聚焦在提高薪酬水平、聘用与编制、职业发展和履约管理等。现场调查数据显示：2010—2015年调研县（市）共培养"5+3"定向全科医生209名，履约率为90.0%（188/209），其中2010~2012级履约率为84.0%（63/75），2013~2015级履约率为93.3%（125/134）；工作前履约率为91.4%（191/209），工作后履约率为98.4%（188/191）；服务期满全科医生共有63名，61.9%（39/63）的服务期满后续约。被调查的142名在岗"5+3"定向全科医生规培期间年均税后工资为5.4万元，在定向单位年均税后工资为5.7万元，14.1%（20/142）的全科医生期满后愿意续约。

"5+3"定向全科医生履约率逐年增高，实际续约率向好但续约意愿较低。存在全科医生培养与基层医疗卫生机构实际需求有差距、定向单位的工作条件与职业发展受限等问题。建议政府及相关部门从基层实际需求出发，统筹安排"5+3"定向全科医生培养，全面落实薪酬、职称晋升等相关激励政策，研究制订服务期满后续约方案。