With the growing public awareness of health, residents' demand for medical and health services has increased dramatically, which in turn raises higher requirements for the service capacity of primary healthcare institutions. Strengthening the deployment of general practice talents in primary health facilities serves as an effective way to meet the basic health needs of residents.

Based on the iceberg model, this study analyzes the current status and interrelationship between the explicit and implicit competencies of primary care doctors in China, and identifies existing problems.

In August 2020, a multistage stratified cluster sampling method combined with typical sampling was adopted. First, the country was divided into eastern, central, and western regions according to the gradient distribution of socioeconomic development levels. Sample provinces and prefecture-level cities were selected from each region, and one district and one county (or county-level city) were chosen from each sample city as urban and rural survey sites. An online questionnaire survey was conducted among 8 537 primary care doctors. Differences in explicit and implicit competency levels between urban and rural areas, as well as across the eastern, central, and western regions, were compared. A negative binomial regression model was used to analyze the association between implicit and explicit competency levels.

A total of 8 469 valid questionnaires were collected, yielding an effective response rate of 99.2%. Among the respondents, 2 863 (33.8%) were urban primary care doctors, and 5 606 (66.2%) were rural ones. In terms of regional distribution, 2 953 (34.9%) were from the eastern region, 3 200 (37.8%) from the central region, and 2 316 (27.3%) from the western region. Regarding explicit competencies, five areas with the lowest proficiency levels among primary care doctors include use of simple medical devices (4 589/8 469, 54.2%), medical coordination (4 800/8 469, 56.7%), community rehabilitation guidance (5 166/8 469, 61.0%), traditional Chinese medicine service capacity (5 613/8 469, 66.3%), and diagnosis and treatment of common diseases (6 497/8 469, 76.7%). In terms of implicit competencies, 8 167 out of 8 469 physicians (96.4%) possessed humanistic literacy, and 5 768 (68.1%) possessed learning ability. Rural primary care doctors showed higher proficiency rates in most health service competencies than their urban counterparts (P<0.05). The overall competency level of physicians in the western region was relatively low. Furthermore, implicit competencies (humanistic literacy and learning ability) were significantly and positively associated with the comprehensive level of explicit competencies (P<0.001).

The overall level of health service competencies among primary care doctors in China is not high and exhibits regional disparities. Notable weaknesses exist in medical services and learning capacity. Implicit competency is found to be a potential key factor in enhancing the comprehensive level of explicit competency. Therefore, it is recommended that the government strengthen the construction of the primary care workforce in the western region, promote the sharing and flow of medical resources in rural areas, accumulate practical experience, provide targeted skills training, and simultaneously focus on cultivating the intrinsic qualities of primary care doctors, thus improving the overall service capacity.

随着社会健康意识的提高，居民对医疗卫生服务的需求也日益增长，对基层医疗卫生机构服务能力的要求也随之变化，加强基层医疗卫生机构全科医学人才的配置是满足居民基本健康需求的有效途径。

基于冰山模型，分析我国基层医生显性和隐性能力的具备现状及其关联，发现存在的问题。

2020年8月，本研究采用多阶段分层整群抽样，并结合典型抽样的方法，首先依据我国经济社会发展水平的梯度分布将全国划分为东、中、西部三大区域，从各区域选取样本省和地级市，在每个样本市分别选择一个区和一个县（市）作为城市和农村样本调查点。对基层医疗卫生机构的8 537名医生开展线上问卷调查，比较城市和农村以及东、中、西部基层医生显性与隐性能力具备情况之间的差异，并运用负二项回归模型分析隐性与显性能力水平之间的关联情况。

调查共回收有效问卷8 469份，有效回收率为99.2%。城市基层医生有2 863名（33.8%），农村基层医生有5 606名（66.2%）；在区域分布上，东部基层医生有2 953名（34.9%），中部和西部分别有3 200名（37.8%）和2 316名（27.3%）基层医生。显性能力方面，我国基层医生具备水平最低的前五位是医疗服务能力中的简易医疗器械使用[4 589/8 469（54.2%）]、医疗协同[4 800/8 469（56.7%）]、社区康复指导[5 166/8 469（61.0%）]、中医药服务能力[5 613/8 469（66.3%）]和常见病诊治能力[6 497/8 469（76.7%）]。隐性能力方面，基层医生具备人文素养的有96.4%（8 167/8 469），具备学习能力的有68.1%（5 768/8 469）。农村基层医生在多数卫生服务能力的具备率上高于城市地区（P<0.05），西部基层医生各项能力水平总体偏低，且隐性能力（人文素养、学习能力）与显性能力综合水平呈显著正向关联（P<0.001）。

我国基层医生卫生服务能力总体水平不高且存在区域差异，并面临医疗服务、学习能力不足等明显短板，同时发现隐性能力是提升显性能力综合水平的潜在重要因素，因此建议政府应当加强西部基层医生队伍建设，促进农村地区医疗资源共享流动，强化实践经验积累和针对性的技能培训，同时注重基层医生内在素质的培养，以提升基层医生的整体服务能力。