Recruitment of general practitioners in China: a scoping review of strategies and challenges

Abstract

Background: China is rapidly expanding its general practitioner (GP) workforce as part of recent healthcare reform, with an extra 400,000 GPs by 2030. This scoping review identifies the published strategies for GP recruitment that are being implemented and the challenges encountered.

Methods: We searched six English and three Chinese databases from 2015 to April 2022, following Arksey and O'Malley's framework and the PRISMA ScR reporting guidelines.

Results: A total of 40 Chinese-language and 5 English-language records were included. We identified multiple policies, pathways and programmes focused on expanding GP recruitment. Twenty-two evaluations of these initiatives show varying degrees of effectiveness. Selecting general practice as a career is affected by many factors, including individual's background, remuneration and benefits, career prospects, working environment, self-fulfilment, and current national developments and reorganisations of primary care. The challenge most frequently reported was the adequate provision of qualified GP in rural regions. The targeting of students from rural areas and provision of free education in return for an obligatory six-years' working in their hometown upon graduation appears to be effective. Extracted records mostly studied views of trainees in a defined locality, and we identified a paucity of studies which explored the perspectives of organisations and institutions, similarly there were areas of China not contributing to the literature and there were no records taking a national perspective.

Conclusions: Long-term monitoring is required to assess policy changes and to systematically evaluate the effectiveness of the interventions nationally. The monitoring of the challenges influencing GP recruitment can be used to inform the design of future initiatives. Development of a minimum agreed standardised set of outcomes used to measure and report evaluations will help assess the relative contributions and cost effectiveness of different approaches being used to boost GP numbers. We provide suggestions for improving the benefits and rewards for GPs and how to promote recruitment to the more rural or less attractive areas.

Keywords: China; Family doctors; General practitioners; Healthy China 2030; Primary care; Recruitment.

Fig. 1

Three main pathways to work as GPs in China. (This is an adapted version of the original figure) Source: Lian S, Chen Q, Yao M, Chi C, Fetters MD. Training Pathways to Working as a General Practitioner in China. Fam Med. 2019;51(3):262–270. https://doi.org/10.22454/FamMed.2019.329090. Copyright Society of Teachers of Family Medicine. Used with permission

Fig. 2

PRISMA flow chart of included studies. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses; GP recruitment strategies and challenges in China