Table 1 Available GP recruitment strategies and corresponding evaluation studies

2014

Guidance on establishing a standardized training system for GP residents [34, 36,37,38,39, 41, 62]

A 3-year residency training program after graduation, which includes 3 months of general practice related theory, followed by 26-month rotation in clinical departments and a 7-month internship in primary care

Seven papers evaluated training programmes in Henan, Zhejiang, Shanghai and Yunnan. A training centre was established in 2015 at First Affiliated Hospital of Zhengzhou University in Henan [34]. Before the training, 187 respondents (83.5%) had no knowledge of general practice; after the training, 166 (83%) had a good understanding and 159 (95.8%) were willing to engage in the field. Among 51 graduates completing training, 26 found employment but only 8 (30.8%) chose to work as GPs. Another study on trainees in an unspecified training centre in Zhengzhou found that 97 (66.4%) were willing to become GPs [39]. Similarly, a study at Zhejiang University found that 55 (87.3%) trainees worked in general practice after training [41]. In contrast a study in Henan found that among 332 graduates from 56 medical organizations across the province, only 111 (36%) worked in general practice [38]. In another study, based in 11 training centres in Shanghai, [36] 165 (79%) trainees expressed willingness to become GPs after training [37]. In the Yunnan study, 43.3% trainees expressed willingness to work in general practice after the training

2010

Job-Transfer-to-GP Training [22, 59, 62]

One of the approaches to boosting the number of qualified GPs is the Job-Transfer-to-GP scheme. Licensed doctors and assistant GPs working in community health facilities and secondary or above hospitals who intend to become GPs are eligible to receive GP training at appointed training centres and are then assessed by provincial departments of health. Those that pass are eligible to register as GPs or assistant GPs. This scheme reduces the training time from three years to two years or less, to help with meeting the urgent need for GPs

Three papers reported outcomes of job-transfer training and showed that the programme was not effective in recruiting GPs. In Chongqing, 36 people signed up for the training but only six registered as GPs when the program ended. The remainder (83.3%) did not become GPs and reported reasons including that “it was not required by their employers”, “intend to register, but not taking action yet”, “did not meet registration requirement”, “having concerns about becoming a GP”, “no general practice in the current workplace” and “considering to resign from the current workplace” [22]. In the second study from Yunnan [59] among 282 job-transfer trainees, 198 were unwilling or unable to register as GPs. Over half failed to meet GP registration requirements (58.6%), 9.6% lacked confidence in GP career development, 8.1% were concerned about impact on future job transfer opportunities, 2.5% were unwilling to become GPs. Of the 84 progressing to work as GPs the primary reasons chosen by those who decided to register as GPs were willingness to become GPs (67.9%), job appointment requirements (15.5%), departmental administrative requirements (8.3%), preferential state policies (7.1%) and others (1.2%). Similarly, a study in an unidentified city in Henan found that between 2015–2019, more than 130 doctors completed either standardized training or job-transfer training, but only 45 registered as GPs

2014

Eight Incentive Measures [54]

The policy implemented by the regional government of Pudong New Area, Shanghai provides incentives to healthcare personnel including GPs working at 12 “farther rural” community health centres (CHCs), 11 rural CHCs, and 10 suburban CHCs to tackle the shortage of health personnel in rural areas. GPs working at farther rural, rural and suburban areas receive monthly incentive of RMB6000, 4000, 2000 (approximately USD 927, 618, 309) respectively. GPs moving to rural areas for at least 5 years receive a bonus of RMB150,000 (USD 23,170) or 200,000 (USD 30,894) according to their seniority

An institutional investigation on the quantity information of the GP’s inflow and outflow at CHCs in Pudong between 2012 and 2016 [54] found that before the incentive policy, the population of GPs in father rural and rural CHCs grew on average by 2.3 and 8.5% annually but after the introduction of incentives growth increased to 6.8 and 14.3%, confirming the benefit of the incentive policy on manpower growth

2011

Masters’ degree in GP: “5 + 2 + 1 joint medical education model for general practitioners” [63]

In 2011, Guangzhou Medical University launched a Master degree program, including five years undergraduate clinical education, two years training of clinical rotations in hospital and one year community healthcare training (reduced to six month in 2012 with the nationwide implementation of standardized training system for residents) [63]

The program recruited 45 students between 2012–2016, and 37 graduated. Among graduates, 31 were employed in secondary and tertiary hospitals (two in a department of general practice and 29 in emergency and internal medicine), one in health management and one in an urban community health service centre. Four were unemployed. Of eight students yet to graduate, only one was considering a career in GP. Semi-structured interviews with all 45 students found that the low success rate promoting General Practice was attributed to: the relatively low salary and poor working conditions of GPs (41, 91%); low social status; concerns about career prospects(45, 100%); not able to focus on medical work because of multiple roles including preventive medicine, public education etc. (42, 93%); the living conditions at the working locations are not desirable (43, 95%)

2010

Rural-on-Demand-Oriented-bonded-GP Training Programme [21, 53, 55,56,57,58, 60]

Students enrolled in this five-years programme are predominantly recruited from rural areas, and priority is given to those from areas designated most in need of health care. Students are exempt from tuition and accommodation fees and central government provides 6,000 Yuan (approximately USD913) per year for living expenses. On course completion graduates are obligated to serve in a rural primary medical and health institutions for a minimum of 6 years or pay a penalty

Six studies [21, 53, 56,57,58, 60] [55] from Guangxi, Zhejiang, Yunnan, Anhui and one unspecified locations report on the outcome of this programme. Three studies [21, 56, 57] reported that the majority of the students were willing to or did become GPs after graduation. One study reported that only one out of 380 graduates broke the contract [55]. A longitudinal study in Anhui reported 97.5% of graduates between 2015 and 2017 served their bond at the designated workplace. In another study, from an unspecified location, [53, 60] found that less than half of the students were willing to work at primary care. A study from Zhejiang [57] described 17 graduates out of 91 breaching the contract because of difficulties improving their professional skills in primary care (58.9%), unpromising career prospects (52.9%), a lack of sense of achievement (47.1%), unsatisfactory remuneration and poor working conditions (41.2%)

Unknown

Including general practice courses in the curriculum for undergraduate medical students [33, 40, 47, 61]

At some medical schools, the traditional curriculum has been expanded to include a module “Introduction to General Practice” or offer practicing opportunities in general practice to boost students’ understanding of general practice. For example, in Shangqiu Medical College second year students have 16 h of theoretical teaching and 8 h of practical education on this topic [33]

Two survey-based studies [33, 47] evaluating the impact of broadening the curriculum found that students undertaking the “Introduction to General Practice” course had different perceptions of general practice. In Shangqiu Medical College [33] 82% of students who took the course thought that GPs had career development potential compared to 76% amongst controls. More students in the intervention group (70.5%) were willing to work in primary care institutions after graduation, compared to controls (61.5%). Another survey study [47] from Nanjing University of Chinese Medicine showed that after including the “Introduction to General Practice” into the curriculum 30% of the students were willing to consider working at a primary health care institution. Of the others, the majority (67.3%) felt that they could not make a decision until later, and a minority was explicitly unwilling (2.4%). The study from Shanghai University of Traditional Chinese Medicine found that among students who took courses in general practice, only 14 (12%) considered participating in standardized training to become a GP as their first career choice after graduation, 83 (71%) will participate in the trainning only if they do not have other options, and 20 (17%) expressed unwillingness to become GPs [40]