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.
Family doctor teams are key gatekeepers of residents' health; however, their development commonly faces bottlenecks such as formalistic contracting and mismatches between capacity and resources. Tianjin has designated the development of "Gold Medal Family Doctor Teams" as a 2025 people-centered initiative, yet gaps remain between policy implementation outcomes and the original design intent, warranting a systematic diagnosis.
To systematically identify barriers to the development of Gold Medal Family Doctor Teams and propose optimization strategies.
From May 2025 to October 2025, an interview guide was developed based on relevant literature and the study objectives. Using purposive sampling, data were collected through semi-structured interviews with 20 experts, and problems were identified using the ROCCIPI framework (Rules, Opportunity, Capacity, Communication, Interest, Process, Ideology).
The issues were not isolated; rather, they stemmed from three sets of underlying contradictions. At the institutional level, the decoupling of administrative recommendation from incentives undermined the credibility and value of the "gold medal" designation. At the operational level, a fixed pairing support model and fragmented information systems failed to meet real-world service needs. At the organizational level, limited team autonomy and excessive workload among members hindered substantive service delivery. These intertwined contradictions constrained the intended benchmarking role of Gold Medal teams. Accordingly, four strategies are proposed: (1) establish a developmental incentive mechanism featuring "dynamic accreditation linked to honorary recognition"; (2) build a flexible support system integrating a "specialty resource pool" with an intelligent referral platform; (3) grant teams greater autonomy supplemented with process-oriented management tools; (4) on the basis of policy standardization and public communication, explore pilot programs for paid service packages.
Based on the key informant evidence, this study extracts three sets of transferable contradictory structures: "Selection and Incentive" "Support and Synergy" and "Organization and Empowerment", and then constructs corresponding policy tool combinations, providing operational mechanism explanations and intervention paths for the benchmarking policy of grassroots teams from "plaque" to "quality improvement".
Primary-level traditional Chinese medicine (TCM)personnel serve as the cornerstone of China's TCM development. Strengthening this workforce is crucial for advancing the inheritance and innovation of TCM and safeguarding public health.
This study analyzes the formulation characteristics and implementation outcomes of China's primary-level TCM talent policies (2012-2024), reveals policy instrument preferences, and assesses workforce development status to optimize TCM service capacity at the grassroots.
Based on a three-dimensional "theme-instrument-evaluation" framework, we employed LDA topic modeling to analyze 47 policy documents publicly available on Chinese government websites, used NVivo coding to examine policy tool distribution, and evaluated policy implementation effectiveness using data from official sources including the National Administration of Traditional Chinese Medicine.
reveal that policy themes predominantly focus on talent utilization and cultivation (combined >65%). Instrument usage exhibits a capacity-building-dominated structure (47.0%)> regulatory (23.5%)> incentive (20.2%)> informational/persuasive (9.3%), yet demonstrates structural imbalances: economic incentives constitute merely 5%, while information provision and promotion tools each account for <5%. By 2023, China's primary-level TCM workforce reached 277 000 personnel, with rural doctors proficient in TCM or TCM-Western integrated practices surging to 128 000 (significant growth since 2012). Structural challenges persist: TCM practitioners comprise only 22.6% of health personnel in corresponding institutions (below the 25% target), per-capita allocation remains inadequate, and shortages of high-caliber professionals endure despite expanded service coverage.
Thematic analysis confirms policy prioritizes talent utilization and cultivation. Instrument deployment reveals a "capacity-building-led, regulation-supported, incentive-supplemented" framework, with training programs, standard-setting, and non-financial incentives as dominant sub-tools. However, insufficient economic incentives and underutilized informational constrain policy effectiveness. Implementation challenges persist: imbalanced talent distribution, regional disparities, and shortages of high-caliber professionals. While systemic policy architecture exists, optimizing instrument combinations and resource allocation remains crucial to enhance the accessibility and sustainability of grassroots TCM services.
