Abstract: Background　The training of rural order-oriented medical students is an important initiative to address the shortage of medical human resources in rural areas. As of October 2023, three batches of order-oriented medical graduates have completed their prescribed 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. Objective　Based on eight years of panel data from a cohort of rural order-directed 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-directed medical graduates in China. Methods　Since 2010, a dynamic follow-up cohort has been established, involving order-directed 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 career development patterns, while logistic regression models were employed to explore factors influencing retention in primary healthcare institutions after the contractual period. Results　By the eighth year after graduation, 92% of graduates had obtained the title of attending physician, and 24% held administrative positions. The average monthly income was 5,573.4 yuan, with performance-based pay accounting for 45.7% of the total. The retention rate in primary healthcare institutions was 37.5%. Among those who left, 35.2% moved to hospitals above the county level, 27.7% joined county hospitals, 7.5% pursued graduate studies, and 23.8% were unemployed. Multivariate analysis revealed that being assigned to a work location in one’s hometown （OR=2.6） and holding an administrative position （OR=2.0） significantly increased the likelihood of remaining in primary healthcare institutions after completing the contract. Conversely, passing the medical licensing exam within two years of graduation （OR=0.4） significantly reduced the likelihood of retention （P<0.05）. Conclusion　Order-directed 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 contributes to strengthening the primary healthcare workforce and improving healthcare service delivery at the grassroots level.

Key words: Medical graduates, General practitioners, Retention, Career development, Order-Directed

摘要： 背景　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。目的　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。方法　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2041人。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logistic回归模型探讨基层留任的影响因素。结果　至毕业第八年，92%的订单定向毕业生获得主治医师职称，24%担任行政职务，平均月收入为5573.4元，其中绩效工资占比为45.7%。完成合同后的基层留任率为37.5%，未留任者中，35.2%选择县级以上医院，27.7%转至县级医院，7.5%攻读研究生，23.8%待业。多因素分析发现签约工作地是家乡所在县（市）（OR=2.6）、担任行政职务（OR=2.0）显著提高留任基层的可能性，而毕业两年内通过执业医师资格考试（OR=0.4）显著降低留任可能性（P<0.05）。结论　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机构，有助于增强基层卫生人才队伍和提升基层医疗卫生服务水平。

关键词: 医学毕业生, 全科医生, 保留, 职业发展, 订单定向