The Strategy Research On The Transition From Clinical Doctors In CHS To General Practitioners In China

Objective:The study is based on the relative studies of the community doctors at home and abroad, through the analysis and evaluation to the basic situation of the community health human resources as while as the practice demand, take use of the theory and the practice of the general practitioner abroad, then find out the problems of the transition from clinical doctors in CHS to general practitioners, analyze the influencing factors. After all of these, carry out a transition strategy framework which fits for China , and provide the decided basis to the relative departments during the establishment of the transition from doctors in CHS to general practitioners.Methods:The methods and theories of sociology, health service management, health law and statistics were used in this research, and qualitative analysis and quantitative analysis were applied. The main methods included:(1)Literature Reasearch Method;(2)Spot Investigation Method: To analyze the situation of ten citys of six provinces that are located in the eastern,the central, and the western of china by field investigation. At the same time, to analyze the all Community Health Service Institutions of 26 sections in these cities adopt the unified questionnaire the range of investigation.(3)Comparative Analysis: Through the domestic regions comparative analysis and the foreign comparative analysis, summed up the success and lessons experiences.(4)Normative Analysis: This method mainly adopts the theoretical analysis and logical analysis. The aim is to find the problems of this transition with the survey results.(5)Statistical Analysis on Morphology: The mainly adopt the general descriptive statistics, H test, chi-square test methods to analysis the collect data.Results:(1)The basic situation of the human resources in the urban community health: The structure of the human resources in the urban community health is not rational, and present a situation of"two low and one high", that is the low educational background, the low professional title and the high age, there is a lack of high quality personnel. The technical level and the total quality of the community doctor is low, which can not fit for the function of"six in one"in CHS.(2)The comparison of the 6 provinces and cities: In summary, the quality of the clinical doctors in CHS in Zhejiang, Shanghai is more sufficient than the other provinces in absolute amount, but when it goes to the educational background structure, the level of the educational background structure in Zhejiang is lower than the other provinces and cities, and the level in Shanghai is a little higher than the mean level on the whole. There are lower senior title doctors in Zhejiang where its junior title structure is upon the average level. The total professional titles structure is lower than the average level in the 6 provinces and cities,which in the other provinces and cities are higher. And there are more clinical doctors in CHS in Gansu with senior title.(3)The basic situation of the general practitioners in CHS: In the clinical doctors in CHS, there are 2.16 person in the CHS center and 0.7 person in the CHS spot who had passed the national general practitioner test and got the qualification, it takes 13.07% and 29.01% in these institutions. There is a significant difference around 6 provinces and cities(P=0.042). In summary, there are more clinical doctors in CHS have taken the general practitioner training in Sichuan than the others, secondly for Zhejiang, Shanghai and Hubei, and the Gansu province is the Lowest. The number of joining the training of general practitioners in ShangHai is biggest and the pass rate is higher than others, and ZheJiang has less number than ShangHai but has the lowest pass rate(50.81%).In HuBei and SiChuan ,the number is not big but the pass rate is higher than 95%.In GanSu ,the situation of this kind of training is worst :the number is lowest in these provinces and the pass rate is poor.(4)The basic situation of the general practitioner training in China: The education of the general practitioner is a little late in our country, there are majority 4 method of training. Most areas began to some kind of training, but all had bad effect because of a lot of reasons.(5)The basic situation of the general practitioner training abroad: There is a more mature and fixed mode of general practitioner training in the developed countries, which include three methods: medical education in high schools, medical education after the graduation and the continuing medical education. To undertake the work of diagnosis and treatment in the society , the doctor need a normative general practition education for 3 to 4 years.Conclusions:(1)There are enough clinical doctors in CHS in terms of absolute quantities, but deficient in terms of quantity. The general practitioners that can take a full function are inadequate extremely.(2)The gap of general practitioners in CHS is big, and the quality and the quantity can not be considerated. Because of lacking of the number of general practitioners in china, the majority areas only based on the amount demand of the quantity but ignore the quality.(3)There is less attraction by the Community Health Service Institutions, the stability of the community health staff is not stable.(4)The government take a bad management to the Community Health Service Institutions. One of them is inadequate input of state, lack of funds of general medical education and personnel training for community. Another is incompleted related policies and the lack of support policy.(5)The importance and the recognition degree to the general medical education do not be paid more attentions, and there are lots of problem to the general medical education course. (6)There are two aspects in the mental obstacle. One of them is the fake understand to the concept and social function of the CHS. Another is the low degree to the general practice cognitive level.Suggestions:(1)During the transition from clinical doctors in CHS to General Practitioners in china, the government should take some basic principles. First ,transition should adhere to the needs of the community health service, which to develop appropriate training objectives, content and methods;second ,transition should adhere to focus on training effectiveness and efficiency of evaluation and properly handle the relationship between quality and quantity; third ,transition should combine the general long-term development of medical education and the current actual demand; fourth, Transition should seek truth from facts, specific guidance, and actively develop and gradually improve.(2)Learning from foreign experience to develop China's general practitioners access law. At the same time, the government should implement job management system, improve the system of appointing staff, establish a sound job evaluation system, and establish the in-out mechanism of staff and so on.(3)Take a strict permit standard to the new-comer, and adopt various strategy of the clinical doctor in CHS who had got the qualification. The staff who has no qualification of General Practitioners, should be required to take full-time or half-time job training on community health services;the staff who has the qualification of General Practitioners, should be required each year to participate in certain units of the general medical education project, after evaluation of qualified, then linked to the wages and the promotions.(4)The government should strengthen macro-regulation, and establish Long-run Effective Mechanism of the government's investment to community health service. On the one hand , to strengthen the macroeconomic regulation of the government, and make related supporting policies for the Post Training for general practitioners. On the other hand, learning effective measures at home and abroad, improve their salaries to settle the problem of "difficulty in attracting talents and keeping talents". At the same time, the Government should come up with special funds for the training of community doctors, intensify the training of general practitioners investment, and ensure the operability and sustain ability about the training of general practitioners.(5)Make,improve and implement other related supporting policies, such as General practitioners employment and management mechanism, general medicine teacher qualification and management, and general medical quality evaluation system, and other areas. We should also strengthen the training of General Practitioners quality control, develop evaluation index system, strictly evaluate management.(6)Transform ideas and establish general medical education system with Chinese Characteristics. Including the development of training programs and establish training objectives, regulate the requirements of general medical knowledge and skill, the establishment of general medical education quality evaluation index system, strengthening teacher force, secure funding, and training base, and through an effective incentive mechanism to promote the process of training general practitioners .(7)Improve the peoples'senses of the importance of medical idea and social function of the CHS, and raising the general level of medical knowledge by propagation and education.