Skip to main content
Download PDF

GP’s GP, general practitioner’s health and willingness to contract family doctors in China: a national cross-sectional study

BMC Primary Care volume 25, Article number: 253 (2024) Cite this article

Abstract

Objectives

General practitioners are trained to care for patients with a high level of responsibility and professional competency. However, there are few reports on the physical and mental health status of general practitioners (GPs) in China, particularly regarding help seeking and self-treatment. The primary aims of this study were to explore GPs’ expectations of their own family doctors and their reflection on role positioning, and to explore the objective factors that hinder the system of family doctors.

Study design

Cross-sectional study.

Methods

We conducted an online survey of Chinese GPs. Descriptive statistics were used to summarize the findings.

Results

More than half of the participants (57.20%) reported that their health was normal over the past year. A total of 420 participants (23.35%) reported having chronic diseases. For sleep duration, 1205 participants (66.98%) reported sleeping 6–8 h per day; 473 participants (26.29%) reported chronic insomnia. Two hundred thirty-one participants (12.84%) had possible depression. A total of 595 (33.07%) participants reported that they had contracted a fixed family doctor. In terms of preventing themselves from contracting for a family doctor, the following factors were identified: lack of sufficient time (54.81%), could solve obstacles themselves (50.97%), and embarrassment (24.24%). The proportion of the contract group (12.44%) taking personal relationship as a consideration was higher than that of the non-contract group (7.64%) (χ2 = 10.934 P = 0.01). Most participants (79.90%) in the non-signed group reported never having seen a family doctor. In terms of obstacles, more than half of the signed group thought that they could solve obstacles themselves, while the non-signed group (39.20%) was less confident in the ability of family doctors than the signed group (29.75%) (χ2 = 15.436, P < 0.01).

Conclusions

GPs work under great pressure and lack of self-care awareness, resulting in an increased prevalence of health conditions. Most GPs did not have a regular family doctor. Having a family doctor with a fixed contract is more conducive to the scientific management of their health and provides a reasonable solution to health problems. The main factors hindering GPs from choosing a family doctor were time consumption, abilities to solve obstacles themselves, and trust in the abilities of GPs. Therefore, simplifying the process of family doctor visits, Changing the GPs' medical cognition, and strengthening the policy of GP training would be conducive to promoting a family doctor system that enhances hierarchical diagnosis and treatment. International collaboration could integrate GP health support into global healthcare system.

Peer Review reports

Introduction

Global healthcare systems facing common challenges, such as doctor's health issues, stress management, and their illness behaviors. Despite differences in healthcare systems and cultural backgrounds, there are striking similarities in the pressures and health challenges faced by general practitioners (GPs) [1,2,3]. A large proportion of GPs suffer from burnout, mild depression, chronic illnesses and denial of their own health problems. And most GPs tend to self-treat.

Physicain health behaviors exert a direct influence on patient outcomes [4]. Current research indicates that many physicians resort to self-treatment for their health issues [5, 6], potentially delaying formal healthcare access [1, 7, 8] and increasing associated risks. And, self-treatment is more common among GPs than specialists [4]. Numerous studies across different countries have explored physician's health statuses and medical behaviors, revealing substantial variations attributable to diverse cultural backgrounds and healthcare systems [5, 6, 9]. In countries with well-defined step-care systems such as the UK, Australia, and New Zealand, GPs generally demonstrate higher health care awareness and are more likely to consult their own GPs, promoting adherence to preventive health behaviors [1, 10, 11]. Conversely, only 14% of doctors in Hong Kong consulted a GP [3], predominantly younger physicians or those with a non-Hong Kong University (HKU) medical degree. Specialists, other than those in general practice, are less likely to seek GP services [3]. Research from Germany indicates that the majority of GPs possess private health insurance and most family doctors are also self-employed. The GP is usually (but not necessarily) the patient's first point of contact. Gps are chosen because they have a wide range of medical knowledge, covering many different specialities [2, 12]. China’s family doctor system, which differs from that in other countries, does not strictly adhere to a “first visit GP system”. Patients may choose between consulting a GP or a specialist directly. Nonetheless, China's policy promotes the Family Doctor Contract Services [13], with public health insurance favoring GP services and encouraging contracts with family doctors. Such contracts cover not only consultation fees, but also preventive checkups, including lifestyle guidance, vaccinations, and specialist referrals [14].

While patient care and healthcare systems have been extensively studied globally, there are clear gaps in the literature on personal health management by GPs themselves, particularly in non-Western countries. Most existing research has focused on patient outcomes and system efficiency, ignoring how GPs manage their own health needs under the pressures of their role. Given the direct impact that the well-being of GPs has on the quality of patient care and the sustainability of the healthcare system, this oversight is essential. Our research addresses this gap by exploring the health behaviours, challenges and support systems of GPs in China, a major non-Western country with a unique healthcare system. In doing so, it provides valuable insights into how to better support the health of GPs, contributing to the broader discussion about improving the quality of healthcare worldwide.

Methods

Study design

We conducted an online survey among GPs practicing in general practice in China. A questionnaire was developed based on a literature review and exploratory qualitative study. The questionnaire contained three sections: a sociodemographic section, questions that focused on GPs’ physical and mental health status, and questions focused on GPs' willingness to contract with family doctors. The survey was distributed through WeChat, the most popular social chat app among Chinese people.

Procedures and data collection

Eligible GPs received a study information sheet, informed consent form, questionnaire, and assurance that their responses would remain anonymous. They were informed that their participation was completely voluntary. We designed a comprehensive questionnaire and adjusted it after conducting a pilot test with eight GPs. We asked the participants to sign the consent form and complete and return the questionnaire within four weeks.

Eligibility

To take part in the survey, participants had to be a GP practicing in China, who were GP-qualified in China and provide the sighned consent form. Participants who accessed the survey from outside of China or who were still not in full practice (e.g., still in clinical rotation or training, interns, and trainee students), were excluded.

Data analysis

Descriptive statistics were used to summarize the findings. Continuous variables were expressed as median and interquartile range (IQR), and categorical variables as frequencies and percentages. The χ2 test was performed to investigate whether there were group differences.

Results

Respondents

Responses from 1808 participants were recorded. Of these, 9 were excluded because they did not indicate consent to take part in the survey. The remaining 1799 responses were used in the analysis. Responses were obtained from GPs from almost all the provinces in China (Fig. 1).

Fig. 1
figure 1

Geographic distribution of responding GPs (n = 1799)

Full size image

The age distribution was mainly concentrated between the ages of 26 and 50. The number of female participants (60.92%) was higher than the number of male participants (39.08%). Educational background showed that the most common background was a bachelor's degree (66.76%). The main workplaces were community health service centers (36.46%) and tertiary hospitals (33.69%). The training modes were mainly residence training (5 + 3) (30.62%) and transfer training(40.19%). The practice registration category was mainly western medicine (80.66%). The top five provinces by region were Guangdong, Xinjiang, Zhejiang, Jiangxi and Shandong (Table 1).

Table 1 Responents sociodemographic information (n = 1799)
Full size table

Patterns of physical and mental health status

More than half of all the participants (57.20%) reported that they described their health as normal over the past year. When asked about their family relationships, most of them (60.20%) agreed they were harmonious with no pressure. Similar results were found in the responses to questions about interpersonal relationships in the work environment, in which more than half of the participants (51.81%) agreed that they get along well with colleagues and patients. Regarding eating habits, 1297 participants (72.10%) reported consuming a combination of meat and vegetables. However, almost half of the participants (44.41%) reported that their frequency of exercise was less than once a week, and methods of exercise varied. The participants reported various results regarding their enthusiasm for traveling. In addition, 410 participants (22.79%) said that they had never travelled, but when it came to choosing travel companions, most chose to travel with family members or friends instead of traveling alone. Among them, 88.99% never smoked, 45.3% never drank, and 40.36% drank occasionally (< once per month) (Table 2).

Table 2 Responents physical and mental health status
Full size table

Four hundred and twenty participants (23.35%) reported having chronic diseases. The top three chronic diseases were hypertension (34.76%), hyperlipidemia (25.24%), and chronic gastrointestinal disease (20.48%) (Fig. 2). In terms of sleep, 1205 respondents (66.98%) participants reported sleeping 6–8 h per day, 518 (28.79%) reported sleeping 4–6 h per day, 9 (0.5%) reported sleeping less than 4 h per day, and 67 (3.72%) participants reported sleeping for more than 8 h per day. A total of 473 (26.29%) participants reported chronic insomnia. Among those with insomnia, 141 (29.81%) participants needed medication to help them sleep. The problem of depression among GPs should not be underestimated, with 231 participants (12.84%) possibly having depression.

Fig. 2
figure 2

The chronic disease spectrum of the respondents (n = 420)

Full size image

Contracting a regular family doctor

A total of 595 (33.07%) participants reported that they had contracted a fixed family doctor. We found no statistically significant associations between these varibles in those with chronic conditions. The two groups of participants, with and without a regular family doctor, had the same expectations of family doctors in the following aspects. They hoped that family doctors would have high professional skills (96.55%), high professional vision (45.91%), and high education (28.9%). They hoped that their family doctor would address the following issues: common illnesses (74.32%), disease assessment and prevention (69.98%), chronic conditions management (59.31%). In terms of preventing them from contracting for a family doctor, the following factors were identified: lack of sufficient time (54.81%), could solve obstacles themselves (50.97%), and embarrassment (24.24%) (Table 3).

Table 3 Variables related to the presence of chronic conditions and illness behaviour variables depending on contracted a fixed family doctor
Full size table

Two hundred forty-three (40.84%) participants with regular contract family doctors wanted family doctors to have a greater social impact. The group with regular contracted GPs was more likely to choose themselves (42.52%) and their colleagues (19.33%) as family doctors, whereas the group without contracted GPs was more likely to choose GPs from superior hospitals (41.53%) and themselves (33.06%). Among the family doctors who signed the contract, the signing group was mainly themselves (42.86%) and their colleagues (41.51%), and the non-signing group was themselves (56.73%) and GPs of superior hospitals (22.18%). In addition, a small number of uncontracted GPs (4.98%) chose specialists from superior hospitals. Among the factors to be considered in choosing a family doctor, most participants in both groups thought that professional skills were the most important especially those in the non-contract group (89.12%) when compared with those in the contract group (83.36%) (χ2 = 11.84, P = 0.01). The proportion of the contract group (12.44%) that took personal relationship as a consideration was higher than that of the non-contract group (7.64%) (χ2 = 10.934, P = 0.01). Most participants (79.90%) in the non-signed group reported never having seen a family doctor. Participants with a regular family doctor consulted their doctor significantly more often. In terms of the mode of consultation, contracted GPs preferred formal consultations (32.27%). However, among the non-signed group, a small number of participants (8.72%) indicated that there were other methods, in this regard further qualitative research is needed. More than half of the participants in both groups felt able to self-treat their acute illnesses. However, the signed group (17.14%) was more likely to consult their family doctor than the non-signed group (5.81%) (χ2 = 59.106, P < 0.01). By contrast, the uncontracted group was more likely to consult a specialist at the same hospital. However, approximately 10% still chose to consult a specialist at another hospital. In terms of obstacles, more than half of the signed group thought that they could solve obstacles themselves, while the non-signed group (39.20%) was less confident in the ability of family doctors than the signed group (29.75%) (χ2 = 15.436, P < 0.01) (Table 3).

Discussion

Innovation of the study

This study is a cross-sectional survey covering almost all the provinces in China. It has made significant progress in understanding the health behaviors of general practitioners (GPs) in China, setting a precedent for its application on a global scale. It uniquely addresses an often overlooked aspect of GP self-care by combining quantitative data with a comprehensive policy-oriented discussion, which is rare in the existing literature. By focusing on the specific health needs and behaviours of GPs and making tailored policy recommendations, our research fills a critical gap. It not only sheds light on common challenges faced by healthcare professionals worldwide, but also pioneers practical solutions that can be applied to different healthcare systems, strengthening the global discourse on the well-being of healthcare providers.

Main findings of the study

Currently, despite the extensive training of a large number of GPs in various formats [15], both the quality and quantity of GPs fall short of expectations. This discrepancy results in GPs facing substantial workload [16, 17]. The physical and mental well-being of these practitioners is often overlooked [17, 18]. Although most GPs perceive their health as normal, many actually suffer from chronic conditions. Similar to studies in other countries, doctors tended to deny their own illnesses [1]. There are reasons for professional confidence, but also the desire to project a healthy and strong image in front of patients [4]. In terms of lifestyle, most GPs maintain healthy eating habits and abstain from tobacco and alcohol. However, they frequently neglect sufficient physical activity, as indicated by low exercise frequency. If GPs do not adequately address the psychological pressures of their role, through exercise, leisure activities, and work-life balance, they may face significant health challenges, such as depression [19]. Consequently, it is imperative that GPs have their own regular family doctors for ongoing health management [20, 21]. Fortunately, the mental health of GPs is better than that of specialists [6].

Most GPs did not have their own regular family doctor which had much to do with their understanding of the role and trust in the abilities of the family doctor [22, 23]. Many GPs resolve their health issues through self-diagnosis, a practice common in various countries [5], but criticized for its lack of objectivity and susceptibility to bias. Studies indicate that doctors who engage with a GP were more likely to receive preventive care [10, 24]. These doctors were three times more likely to visit a doctor for health maintenance than those who did not have a family doctor [11]. So GPs must adjust their ideas accordingly. Family doctors must address the problems of common diseases in patients, early screening for diseases, chronic disease management, and mental health problems. This study showed that GPs who had their own regular contracted family doctor consulted their doctor more frequently, and they would choose the formal method of consultation, which was also more conducive to their own health management [25].

When choosing a contracted family doctor, the convenience of medical treatment and personal rapport would also be considered [26, 27]. This finding is consistent with previous studies [9, 28]. Distrust in the abilities of GPs is an important aspect that hinders the advancement of the family doctor system [25]. Participants reflected that time factor would affect their choice; therefore, simplifying the process would be conducive to promoting the family doctor system. Governments utilizing electronic information technology could ease access to GP services, while the efficient management of electronic records could improve the family doctor system effectiveness. The results of our study showed that 50.97% of respondents believed that they could solve their health problems independently. However, this perception must be corrected. Based on the experience of other countries, efforts to inculcate more rational help-seeking behaviour should probably start in medical schools [7].

Financial factor, as one of the obstacles to signing contracts, also accounted for 18.84 percent. Although not one of the main factors, it also reflects a certain situation. The Chinese government has significantly reduced healthcare cost over the past decade, particularly through initiatives like the Family Doctor Contract Services, which have made healthcare more affordable [14, 29, 30]. However, costs remain a complex barrier, encompassing direct and indirect expenses such as fees, lost wages, and business insurance access, even among doctors who typically belong to higher socioeconomic groups [1].

Our study revealed some surprising results. Doctors are also well aware that GP has a greater role to play in the prevention and management of chronic conditions than dealing with the acute illnesses. But interestingly, our results showed no significant difference between the contracted group and the non-contracted group with chronic conditions. The reasons for this need to be further explored.

Policy implications to global healthcare systems

Our study underscores the need for robust health support systems tailored to GPs, applicable both in China and globally. Recognizing universal challenges like stress and self-treatment among GPs, we advocate for structured support programs that include regular health assessments and mental health services specifically designed for medical professionals. Policymakers should also introduce incentives for GPs to engage more actively in their own health care, such as subsidizing healthcare costs or offering dedicated services, alongside establishing mandatory, regularly scheduled health checks.

Call for international collaboration

Furthermore, there is a critical need for international collaboration in developing policies that support GP health, sharing successful strategies and outcomes to craft effective support mechanisms adaptable across different healthcare systems. For instance, benchmarking systems that have successfully integrated GP health support into their healthcare policies could serve as models for others to follow [31, 32]. By integrating these policy recommendations into national and international health agendas, we can enhance the sustainability of healthcare systems and the well-being of GPs worldwide, ultimately improving the overall quality of healthcare delivery.

Strengths and limitations

The study was innovative in exploring from the perspective of GPs their reasons for not signing up for family doctors, and analyzing their responses regarding the capabilities that family doctors need to have. It uniquely addresses an often overlooked aspect of GP self-care by combining quantitative data with a comprehensive policy-oriented discussion, which is rare in the existing literature. However, China is a vast country with an uneven distribution of GPs, and their number varies from region to region; therefore, there are limitations to conducting such a large-scale survey at the national level. The participants were distributed all over the country but the sample distribution was biased. Therefore, more rigorous and stratified sampling studies are required. As the survey was anonymized and cross-sectional, no further data could be tracked. In addition, some answers from non-signed doctors need to be further explored through qualitative research methods.

Conclusions

General practitioners work under great pressure, experience mental tension, and lack self-care awareness, resulting in an increased prevalence of health conditions. Most GPs thought they had normal health but, in fact, they suffered from chronic diseases and were not optimistic. Most GPs did not have a family doctor. Having a family doctor with a fixed contract is more conducive to the scientific management of their health and provide a reasonable solution to health problems. GPs’ expectations of family doctors include higher clinical professional abilities, comprehensive professional knowledge, and higher educational background. The main factors hindering GPs from choosing family doctors were time consumption, abilities to solve obstacles themselves, and trust in the abilities of GPs. Therefore, simplifying the process of family doctor visits, Changing the GPs’ medical cognition, and strengthening the policy of GP training are conducive to promoting a family doctor system that enhances hierarchical diagnosis and treatment. International collaboration could integrate GP health support into global healthcare system.

Availability of data and materials

No datasets were generated or analysed during the current study.

References

  1. Kay M, Mitchell G, Clavarino A, Doust J. Doctors as patients: a systematic review of doctors’ health access and the barriers they experience. Br J Gen Pract. 2008;58(552):501–8.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Schulz S, Hecker F, Sauerbrey U, Wolf F. Illness behaviour and influencing aspects of general practitioners in Germany and their use of the health care system: a qualitative study. BMJ Open. 2022;12(9):e051404.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Chen JY, Tse EYY, Lam TP, Li DKT, Chao DVK, Kwan CW. Doctors’ personal health care choices: a cross-sectional survey in a mixed public/private setting. BMC Public Health. 2008;8(1):183–9. https://doi.org/10.1186/1471-2458-8-183.

  4. Morishita M, Iida J, Nishigori H. Doctors’ experience of becoming patients and its influence on their medical practice: a literature review. Explore. 2020;16(3):145–51.

    Article  PubMed  Google Scholar 

  5. Schulz S, Meissner F, Wolf F, Freytag A: Health care utilization and self-treatment by primary care physicians and specialist physicians. Deutsch Ärztebl Int. 2023;120:688–9. https://doi.org/10.3238/arztebl.m2023.0160.

  6. Catapano A, Chiu YL, Kao S, Lin HC, Tsai MC, Lee CZ. Healthcare service utilization for practicing physicians: a population-based study. Plos One. 2016;11(1).

  7. Hem E, Stokke G, Tyssen R, Grønvold NT, Vaglum P, Ekeberg Ø. Self-prescribing among young Norwegian doctors: a nine-year follow-up study of a nationwide sample. BMC Med. 2005;3(1):16.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Montgomery AJ, Bradley C, Rochfort A, Panagopoulou E. A review of self-medication in physicians and medical students. Occup Med. 2011;61(7):490–7.

    Article  CAS  Google Scholar 

  9. Horne IMT, Veggeland F, Bååthe F, Drewes C, Rø KI. Understanding peer support: a qualitative interview study of doctors one year after seeking support. BMC Health Serv Res. 2023;23(1):324.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Gross CP, Mead LA, Ford DE, Klag MJ. Physician, heal thyself? Regular source of care and use of preventive health services among physicians. Arch Intern Med. 2000;160(21):3209–14.

    Article  CAS  PubMed  Google Scholar 

  11. Kay MP, Mitchell GK, Del Mar CB. Doctors do not adequately look after their own physical health. Med J Aust. 2004;181(7):368–70.

    Article  PubMed  Google Scholar 

  12. Schulz S, Einsle F, Schneider N, Wensing M, Gensichen J. Illness behaviour of general practitioners-a cross-sectional survey. Occup Med (Lond). 2017;67(1):33–7.

    Article  CAS  PubMed  Google Scholar 

  13. Li Z, Li J, Fu P, Chen Y, Jing Z, Yuan Y, Yang S, Yan C, Li W, Li J, et al. Family doctor contract services and health-related quality of life among patients with chronic diseases in rural China: what is the role of socioeconomic status? Int J Equity Health. 2021;20(1):191.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Li Z, Ma Z. Construction and scale development of willingness to utilize primary care services: a study from China. Risk Manag Healthc Policy. 2023;16:2171–85.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Liu Y, Ren W, Qiu Y, Ren J. The Beliefs and usage of social media among general practitioner trainers from eleven provinces of China: a cross-sectional survey. Telemed J E Health. 2019;25(1):11–7.

    Article  PubMed  Google Scholar 

  16. Li P, Xing K, Qiao H, Fang H, Ma H, Jiao M, Hao Y, Li Y, Liang L, Gao L, et al. Psychological violence against general practitioners and nurses in Chinese township hospitals: incidence and implications. Health Qual Life Outcomes. 2018;16(1):117.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Feng J, Lei Z, Yan S, Jiang H, Shen X, Zheng Y, Yu M, Meng X, Di H, Xia W, et al. Prevalence and associated factors for workplace violence among general practitioners in China: a national cross-sectional study. Hum Resour Health. 2022;20(1):42.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Zhang J, Song S, Zhang M, Wang R. Influencing factors for mental health of general practitioners in Hebei Province under the outbreak of COVID-19: a cross-sectional study. Int J Clin Pract. 2021;75(11):e14783.

    Article  CAS  PubMed  Google Scholar 

  19. Feng J, Jiang H, Shen X, Lei Z, Li L, Zhu Y, Zhang M, Yang T, Meng X, Di H, et al. Occupational stress and associated factors among general practitioners in China: a national cross-sectional study. BMC Public Health. 2022;22(1):1061.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Yu Y, Ye A, Chen C, Dai W, Liu X. The impact of family doctor system on patients’ utilisation of general practitioner in primary care facilities-evidence from Hangzhou, China. Int J Health Plann Manage. 2022;37(6):3089–102.

    Article  PubMed  Google Scholar 

  21. Zhao Y, Lin J, Qiu Y, Yang Q, Wang X, Shang X, Xu X. Demand and signing of general practitioner contract service among the urban elderly: a population-based analysis in Zhejiang Province, China. Int J Environ Res Public Health. 2017;14(4):356.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Liu X, Tan A, Towne SD Jr, Hou Z, Mao Z. Awareness of the role of general practitioners in primary care among outpatient populations: evidence from a cross-sectional survey of tertiary hospitals in China. BMJ Open. 2018;8(3):e020605.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Li L, Gan Y, Yang Y, Jiang H, Lu K, Zhou X, Nie Z, Opoku S, Zheng Y, Yu F, et al. Analysis on professional identity and related factors among Chinese general practitioners: a national cross-sectional study. BMC Fam Pract. 2020;21(1):80.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kahn KL, Goldberg RJ, DeCosimo D, Dalen JE. Health maintenance activities of physicians and nonphysicians. Arch Intern Med. 1988;148(11):2433–6.

    Article  CAS  PubMed  Google Scholar 

  25. Yin T, Yin D, He H, Zheng X, Li R, Yang H, Wang L, Chen B. The awareness and attitude of contracted service among general medical practitioners in community health service centers in urban China: a cross-sectional study. Front Public Health. 2021;9:572311.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Zhong C, Zhou M, Luo Z, Liang C, Li L, Kuang L. Association between doctor-patient familiarity and patient-centred care during general practitioner’s consultations: a direct observational study in Chinese primary care practice. BMC Fam Pract. 2021;22(1):107.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gu L, Deng J, Xu H, Zhang S, Gao M, Qu Z, Zhang W, Tian D. The impact of contract service policy and doctor communication skills on rural patient-doctor trust relationship in the village clinics of three counties. BMC Health Serv Res. 2019;19(1):187.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Liu Z, Tan Y, Liang H, Gu Y, Wang X, Hao Y, Gu J, Hao C. Factors Influencing residents’ willingness to contract with general practitioners in Guangzhou, China, during the GP policy trial phase: a cross-sectional study based on Andersen’s behavioral model of health services use. Inquiry. 2019;56:46958019845484.

    PubMed  Google Scholar 

  29. Liu Y, Kong Q, Yuan S, van de Klundert J. Factors influencing choice of health system access level in China: a systematic review. PLoS One. 2018;13(8):e0201887.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Yip W, Fu H, Chen AT, Zhai T, Jian W, Xu R, Pan J, Hu M, Zhou Z, Chen Q, et al. 10 years of health-care reform in China: progress and gaps in Universal Health Coverage. Lancet. 2019;394(10204):1192–204.

    Article  PubMed  Google Scholar 

  31. Trost M, Wanke EM, Ohlendorf D, Klingelhofer D, Braun M, Bauer J, Groneberg DA, Quarcoo D, Bruggmann D. Immigration: analysis, trends and outlook on the global research activity. J Glob Health. 2018;8(1):010414.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ellonen N, Pasanen M, Wiss K, Mielityinen L, Lahteenmaki E, Joronen K. Health promotion actions and school violence-a cluster analysis from Finnish comprehensive schools. Int J Environ Res Public Health. 2022;19(19):12698.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

The authors wish to thank the study participants for their contribution to the research, as well as current and past investigation and staff.

Funding

Chinese National General Medicine Education and teaching research topic in 2021, research on upgraded navigational multipath general practitioner training model based on post competency, project number: A-YXGP20210201-08.

Author information

Authors and Affiliations

  1. Department of General Practice, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310000, China

    Guoshu He, Jingjing Ren, Xiaoyang Chen, Qi Pan & Tianyuan Pan

Authors
  1. Guoshu He
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jingjing Ren
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiaoyang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Qi Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Tianyuan Pan
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Jingjing Ren designed the work; Guoshu He, Xiaoyang Chen, Qi Pan and Tianyuan Pan collected the datas; Guoshu He did analysis and interpretation of datas; Guoshu He wrote the main manuscript text; Jingjing Ren has substantively revised it and has approved the submitted version; All authors reviewed the manuscript.

Corresponding author

Correspondence to Jingjing Ren.

Ethics declarations

Ethics approval and consent to participate

All methods were carried out in accordance with relevant guidelines and regulations in the declaration. All participants were provided with a plain language statement explaining the study and gave written informed consent in the questionnaire survey. The study was approved by The First Affiliated Hospital of Zhejiang University School of Medicine Ethics Committee( 20230469).

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

He, G., Ren, J., Chen, X. et al. GP’s GP, general practitioner’s health and willingness to contract family doctors in China: a national cross-sectional study. BMC Prim. Care 25, 253 (2024). https://doi.org/10.1186/s12875-024-02492-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s12875-024-02492-4

Keywords

BMC Primary Care

ISSN: 2731-4553

Contact us