The training of rural order-oriented medical students is an important initiative to alleviate the shortage of medical human resources in rural areas. As of October 2023, three batches of order-oriented medical graduates have completed their required service obligations. However, there is still a lack of systematic research and definitive conclusions regarding their career development and whether they will continue to serve in rural areas after fulfilling their service commitments.

Based on eight years of panel data from a cohort of rural order-oriented medical students, this study aims to analyze their early career development characteristics and identify key factors influencing their retention in primary healthcare institutions. The findings are intended to provide policy recommendations for the training and management of order-oriented medical graduates in China.

Since 2010, a dynamic follow-up cohort has been established, involving order-oriented medical graduates from Qinghai University, Guangxi Medical University, Jiujiang University, and Gannan Medical University. This study utilized data from 2 041 graduates from the 2015-2019 cohorts, collected through annual online surveys conducted over eight years. The surveys tracked their career development, including professional title promotion, administrative role acquisition, average monthly income, and the proportion of performance-based pay. Descriptive analysis was used to summarize the characteristics of career development, while Logistic regression models were employed to explore factors influencing retention in primary healthcare institutions after the contractual period.

Among the 2 041 order-oriented medical graduates included, 1 068 (52.3%) were male and 973 (47.7%) were female. By the eighth year after graduation, 92.0% (69/75) of graduates had obtained the title of attending physician, and 24.0% (18/75) held administrative positions. The median monthly income was 5 214.0 yuan, with median performance-based pay accounting for 42.5% of the total. As of December 2023, with 232 graduates remaining in their positions after contract completion, resulting in a 37.5% retention rate in primary healthcare settings. Among the 386 graduates who left primary healthcare settings, 136 (35.2%) transitioned to hospitals above the county level, representing the largest proportion, followed by 107 (27.7%) moving to county-level hospitals, and 29.0 (7.5%) pursuing graduate studies. Multivariate Logistic regression analysis revealed that contract placement in home county/city (OR=2.74, 95%CI=1.57-4.78, P=0.001) and holding administrative positions (OR=2.02, 95%CI=1.14-3.59, P=0.016) were significant facilitators of retention in primary healthcare settings post-contract completion among order-oriented medical graduates. Conversely, passing the national medical licensing exam within two years of graduation (OR=0.37, 95%CI=0.15-0.94, P=0.036) emerged as a barrier to retention.

Order-oriented medical graduates show rapid career progression, with over half choosing to remain in county-level or lower primary healthcare institutions after fulfilling their contracts. This strengthens human resource capacity and improves care quality in primary healthcare settings. Notably, order-oriented medical graduates who obtained physician qualification within two years post-graduation exhibited significantly higher occupational mobility in primary healthcare settings.

培养农村订单定向医学生是缓解农村医疗人力资源短缺的重要举措。截至2023年10月，已有三批订单定向医学毕业生完成了规定服务义务。然而，这些毕业生的职业发展情况及服务期满后是否继续留任基层，尚缺乏系统研究与明确结论。

基于订单定向医学生队列的8年面板数据，分析其职业生涯初期的职业发展特点及影响基层医疗卫生机构留任的关键因素，为我国订单定向医学毕业生的培养和管理提供政策建议。

自2010年起，选取青海大学、广西医科大学、九江学院和赣南医学院的订单定向医学毕业生，建立动态追踪队列。本研究使用2015—2019届毕业生的数据，共纳入2 041名。队列通过年度线上问卷随访，连续8年追踪其职称晋升、职务任职、平均月收入及绩效工资占比等职业发展情况，分析合同期满后基层留任与流失的情况。采用描述性分析总结职业发展特点，通过多因素Logistic回归分析探讨订单定向医学毕业生基层留任的影响因素。

纳入的2 041名订单定向医学毕业生中男1 068名（52.3%）、女973名（47.7%）。至毕业第8年，92.0%（69/75）的订单定向医学毕业生获得主治医师职称，24.0%（18/75）担任行政职务，月收入中位数为5 214.0元，其中绩效工资占比中位数为42.5%。截至2023年12月，共有618名订单定向医学毕业生完成合同，其中232名毕业生完成合同后留任，基层留任率为37.5%。在离开基层的386名毕业生中，进入县级以上医院136名，占比最高，为35.2%；其次是县级医院107名（27.7%）；攻读研究生29名（7.5%）。多因素Logistic回归分析结果显示，签约工作地是家乡所在县（市）（OR=2.74，95%CI=1.57~4.78，P=0.001）以及担任行政职务（OR=2.02，95%CI=1.14~3.59，P=0.016）是订单定向医学毕业生完成合同后基层留任的促进因素，毕业两年内通过执业医师资格考试（OR=0.37，95%CI=0.15~0.94，P=0.036）则是订单定向医学毕业生完成合同后基层留任的阻碍因素。

订单定向毕业生职业晋升速度快，超过半数合同期满后选择留在县级及以下基层医疗卫生机构，有助于加强基层卫生人才队伍建设和提升基层医疗卫生服务水平。但需关注，毕业两年内获得执业医师资格的订单定向毕业生表现出更高的基层执业流动性。