Sharing experience from Chinese General Practitioners to International colleagues on how to tackle COVID-19

Objective We aimed to investigate the number and distribution of general practitioners (GPs) in China, and to predict the number of GPs needed in the future. Methods From China Health Statistics Yearbook 2014, China Health Statistics Yearbook 2016 and China Statistical Yearbook 2016, we obtained the number of GPs and the populations in China and each of its regions from 2012 to 2015. IBM SPSS Statistics version 22.0 was used to conduct descriptive statistical analysis. Grey model GM(1, 1) and the manpower-to-population ratio method were used to predict the number of GPs needed in China from 2016 to 2020. Results The total number of GPs in China was 109,794 in 2012, 145,511 in 2013, 172,597 in 2014, and 188,649 in 2015. The number increased by 78,855 from 2012 to 2015, and the average annual growth rate was 19.77%. By the end of 2015, of the GPs in all of China and in eastern, central, and western China, those who had achieved a GP qualification certificate following training accounted for 63.76% (120,285/188,649), 60.06% (62,474/104,015), 65.20% (29,565/45,344), and 71.89% (28,246/39,290), respectively, of the total. The number of GPs per 10,000 population in all of China and in eastern, central, and western China was 1.37, 1.83, 1.05, and 1.06, respectively, and the number of GPs needed for all of China and the eastern, central, and western parts would be 86,275, 9787, 40,764, and 34,976, respectively, calculated on the basis of the standard of two GPs per 10,000 population. Grey model GM(1, 1) predicted that, in accordance with the natural growth trend of GPs, the number of GPs in China would be 220,314 in 2016, 253,728 in 2017, 293,101 in 2018, 339,928 in 2019, and 396,228 in 2020. Moreover, the number of GPs in China in 2020 would be 277,000–415,500 if the calculated number of GPs to the population ratio is based on the standard of two to three GPs per 10,000 population. Conclusion In recent years, although the number of GPs has increased rapidly, GPs are still greatly needed in all of China and in eastern, central, and western China. Moreover, the distribution of GPs is not balanced, and the number of qualified GPs is far from enough. Therefore, team building for GPs should be strengthened, and the training system for GPs should be improved. Significance statement Analysis of the number and distribution of general practitioners in China from 2012 to 2015 based on China Health Statistics Yearbook 2014, China Health Statistics Yearbook 2016 and China Statistical Yearbook 2016. Grey model and manpower-to-population ratio approach to predict future demand of general practitioners in China from 2016 to 2020.

Analysis on the relationship between professional identity and turnover intention among general practitioners: The mediating role of job burnout

Investigation is scare on job satisfaction among general practitioners (GPs) in China. This study aimed to investigate job satisfaction of GPs in China and explore its determinants. A multistage-stratified random sampling method was used to collect data with a structured self-administered questionnaire from 3236 GPs (response rate, 99.8%) working in community health institutions in China between October 2017 and February 2018. Multiple linear stepwise regression analysis was used to analyze the associated factors with job satisfaction among GPs. Among these respondents, 1215 (37.5%), 352 (10.9%), and 1669 (51.6%) GPs were dissatisfied, moderate, and satisfied for their current job, respectively. Male GPs, a higher education level, at a higher professional title, at a lower level of income, and those with heavy work stress had a lower job satisfaction. In addition, GPs who often worked overtime, who were at a higher level of emotional exhaustion, at a higher level of depersonalization, at a lower level of personal accomplishment, and who had less occupational development opportunities reported a lower level of job satisfaction. These findings suggest that job satisfaction among Chinese GPs is at a moderate level. Region, sex, professional title, education level, working overtime, income level, emotional exhaustion, depersonalization, personal accomplishment, work stress, and occupational development opportunities were significant predictors of job satisfaction.

<h3>Objectives:</h3> Investigation is scare on job satisfaction among general practitioners (GPs) in China. This study aimed to investigate job satisfaction of GPs in China and explore its determinants. <h3>Methods:</h3> A...

Turnover among general practitioners (GPs) has become a significant public health concern worldwide. This study aimed to investigate the interrelationships between job satisfaction, professional identity, burnout, and turnover intention among GPs in China and to assess the mediating effect of job satisfaction on the association between burnout and turnover intention and the moderating effect of professional identity on the association between burnout and job satisfaction. A cross-sectional study was conducted to collect data from 3,236 GPs in eastern, central, and western China between October 2017 and February 2018 using a self-administered questionnaire. Pearson's correlation analysis and hierarchical regression were used to identify the relationships between job satisfaction, professional identity, burnout, and turnover intention among Chinese GPs. Among these respondents, 65.02% reported a medium or high level of emotional exhaustion (EE), 35.38% reported a moderate or high level of depersonalization (DP), and 62.05% reported reduced personal achievement (PA). Overall, 71.08% of GPs expressed a relatively high intention to seek another position (turnover intention). We found all 3 dimensions of burnout contributed to job dissatisfaction while turnover intention arising from burnout was associated with EE and DP. Job satisfaction had a direct negative impact on turnover intention and partially mediated the impact of EE and DP on turnover intention. Professional identity played a partial moderated role between EE and job satisfaction. The prevalence of burnout and turnover intention among GPs is high in China. The effect of EE and DP on turnover intention is mediated by job satisfaction, and the effect of EE on job satisfaction is moderated by professional identity.

Objective This study aimed to identify the distribution and equity trends for general practitioners (GPs) in China from 2012 to 2015 and to provide evidence to guide the discipline’s development of general practice and for policy-making. Methods On the basis of data from the National Health Statistics yearbooks, the distribution and equity trends for GPs from 2012 to 2015 were analyzed with the Lorenz curve and Gini coefficient as indictors of health equity. Results From 2012 to 2015 the number of GPs increased at rates ranging from 9.3% to 32.5%, while the number of registered GPs increased at rates ranging from 32.6% to 37.2%. In 2015 the average number of GPs was 1.38 per 10,000 people (among the 31 provinces the highest rate was 3.90 per 10,000 people in Zhejiang and the lowest rate was 0.50 per 10,000 people in Xizang) and 1.98 per 100 km2 (among 31 provinces the highest rate was 89.23 per 100 km2 in Shanghai and the lowest rate was 0.01 per 100 km2 in Xizang). From 2012 to 2015 the Gini coefficients weighted by population were 0.31, 0.29, 0.26, and 0.25 respectively, while the Gini coefficients weighted by geographical area were 0.74, 0.72, 0.72, and 0.72 respectively. Conclusion The number of GPs increased rapidly in China; however, the proportion of registered GPs was unsatisfactory, and there were inequities among the different provinces. The government should launch integrated strategies to encourage GP trainees to become registered GPs and optimize the distribution and equity of GPs.

BackgroundOccupational stress among general practitioners (GPs) is a public health concern. This study aimed to investigate the prevalence and factors associated with occupational stress among GPs in China.MethodsA cross-sectional design was used. Data were collected from 3,236 GPs in eastern, central, and western China (response rate, 99.75%) between October 2017 and February 2018 using a structured self-administered questionnaire. An ordinal logistic regression model was used to identify the factors associated with occupational stress among GPs.ResultsAmong these respondents, 313 (9.67%), 1,028 (31.77%), and 1,895 (58.56%) of GPs had a low, medium, and high level of occupational stress, respectively. GPs from central China, with temporary work contracts, without management responsibility, receiving a moderate level of income, and with moderate occupational development opportunities had a lower level of occupational stress. GPs with greater than 40 working hours per week and those who worked overtime occasionally or frequently had a higher level of occupational stress.ConclusionsThe prevalence of occupational stress among GPs is high in China. Substantial regional variation in determinants of occupational stress among GPs was observed. These findings should inform the design of policies to reduce the occupational stress of GPs.

Elderly individuals' trust in general practitioners (GPs) is conducive to enhancing their health outcomes and promote healthy ageing. However, this trust has been declining in recent decades. Social capital is associated with patients' trust in healthcare providers in several countries, which make it a potential path for improving the trust of the elderly people in GPs in China, but it is not yet validated. The objective of this study was to explore how social capital influences elderly individuals' trust in GPs in China. The data were collected through a survey conducted with 2,754 people aged 60 and over in China, 2018. Multilevel regression models were employed to analyse the impact of social capital on the trust of the elderly people in GP in China. The results revealed that individual social capital (ISC) and community social capital (CSC) had significant positive correlations with the trust of the elderly people in GPs in China. In addition, CSC has more impact than ISC on the trust of the elderly people in GP. Additionally, older people, women and patients whose highest level of education was junior high school and who had participated in the New Cooperative Medical Scheme tended to have higher trust in GPs. In conclusion, more social capital, especially CSC, contributed more trust of the elderly people in GPs in China.

Since 1997, China has been carrying out general practice education and has promulgated and implemented the “General Practitioner System”, conducting general practice job transfer training and “5+3” standardized training. However, the continuing education of general practitioners in China was the weakest. This study looked insights in the barrier of continuing education for General Practitioners in China: There was no unified mode and standard for continuing education for general practitioners, lacked of management system covering the entire practice cycle of general practitioners, the focus of post graduation training was unclear, the overall level of the teaching staff was not high, and the enthusiasm of general practitioners to participate in continuing education was poor. In response to these issues, the authors constructed and implemented a full cycle general practitioner continuing education model guided by job competence. Based on summarizing the 10 core job competencies of general practitioners, they constructed a general practitioner training faculty, established general practitioner related systems (continuing education system, practice management system, and professional title promotion system), designed training courses, and conducted hierarchical training, We organized multi-path scientific research training and conducted comprehensive quality management for the continuing education of general practitioners, achieving satisfactory results. Our raining model provided a useful reference for the current continuing education of general practitioners in China and is worth promoting and applying.

BackgroundThere is a shortage of rural general practitioners (GPs) in China. Training programs have been initiated to meet the needs of GP workforce in the rural areas; however, there is an absence of validated tool to assess their competencies.ObjectiveThis study aimed to develop a competency model for rural general practitioner (CMRGP) after training in China and to examine its validity and reliability.MethodsA multistage process was adopted to develop the CMRGP comprised literature review, panel discussion and expert consultation, and the initial version of CMRGP was reduced from 10 domains and 77 items to 7 domains and 54 items. A pilot study was conducted among 202 rural GPs for the psychometric evaluation and application of the initial version of CMRGP, in which a questionnaire on the importance of items and self-evaluation was completed by the GPs.ResultsIn the pilot study, 132 completed questionnaires (65.3%) were returned. Acceptability and face validity of the CMRGP were supported by high importance scores of the items, in which 52 out of 54 items achieved score higher than 4.00 (possible score from 0 to 5). Factor analysis supported the construct validity. After the modification, the final version of CMRGP contained 6 domains and 47 items. Good reliability was supported by internal consistency reliability (Cronbach’s α was 0.98) and split-half reliability (Spearman–Brown coefficient was 0.99).ConclusionsThe CMRGP demonstrated good reliability and validity. Pilot study showed its potential for application in the rural general practice and training program.

As the World Health Organisation calls for urgent, aggressive actions to combat COVID-19, China has been making positive contributions in the fight against the pandemic during the past few months....

BackgroundStudies on professional identity and related factors among Chinese general practitioners (GPs) are unavailable. The objective of this study was to investigate the professional identity level of GPs in China and explore factors associated with GPs’ perceptions of their professional identity.MethodsA multistage stratified random sampling method was used to collect data with a structured self-administered questionnaire from 3236 GPs working in community health service institutions (CHIs) in China between October, 2017 and February, 2018. Professional identity was measured by the 13 items scale. Descriptive statistics were calculated and groups’ differences were estimated using nonparametric tests. Multiple linear stepwise regression analysis was used to analyze factors associated with professional identity among GPs.ResultsBased on a total score of 65 on the professional identity scale, the average score for GPs’ professional identity was 51.23 (SD = 6.56). Multiple linear stepwise regression analysis showed that GPs who practiced in Central China, with an administrative responsibility, at a moderate or higher income level, who frequently worked overtime, had more occupational development opportunities, with a higher level of job satisfaction and older GPs had higher levels of professional identity.ConclusionsProfessional identity level among GPs in China is high. Region, administrative responsibility, income level, working overtime, occupational development opportunities, age, and job satisfaction were significant predictors of professional identity.

To reduce unhealthy lifestyles in China, it is critical to implement effective strategies. Counseling provided by physicians is important for assisting patients in improving their lifestyles, and general practitioners (GPs) are the main providers of lifestyle counseling to patients. However, few studies have focused on the lifestyle counseling practices by GPs in China, particularly in regard to nutrition and physical activity. The aims of this study are: (i) to examine the current practice of Chinese GPs in counseling patients regarding nutrition and physical activity; (ii) to understand the common barriers to such counseling by Chinese GPs; and (iii) to study the association between GPs' personal lifestyle choices and their practices in lifestyle counseling. A cross-sectional, self-reported online questionnaire was conducted among GPs in Hunan province, China. A total of 198 GPs completed the questionnaire. The majority of GPs provide nutrition and physical activity counseling to less than 40% of their patients, spending less than three minutes per counseling session. The main reported barriers to counseling on nutrition and physical activity are inadequate time and a lack of knowledge or experience. GPs primarily acquire knowledge through medical books and journals, followed by science popularization. Furthermore, GPs who maintain healthier lifestyle habits, possess a better understanding of lifestyle guidelines, conduct longer office visits, and exhibit higher self-efficacy are more likely to provide counseling to patients. This study highlights the need for improvement in nutrition and physical activity counseling among Chinese GPs. GPs' personal nutrition and physical activity habits may measurably influence their counseling practice. We recommend that GPs themselves adopt healthier lifestyle habits to potentially improve their counseling practice. Moreover, proactive measures should be taken to assist GPs in overcoming barriers encountered with lifestyle counseling.

This study aimed to analyze the status of general practitioners in China regarding health education activities, knowledge management practices, and community innovation, and subsequently proposed improvement strategies to enhance community health levels. The research employed descriptive research design, involving 467 general practitioners in Shenzhen using a carefully designed questionnaire. Results showed that the general practitioner group was predominantly young, with a balanced gender distribution and diverse work experience. In terms of health education, the overall implementation level was moderate, with better performance in child vaccination and maternal and child health care, but relatively weak in daily diagnosis and treatment health education. Knowledge management practices encompassed various aspects such as innovation culture and technology application, positively impacting service quality improvement, although there was room for improvement in organizational culture and technology integration. Community innovation took various forms, covering health services, social interaction, environmental protection, and culture. Its success depends on community member participation, leadership ability, social capital, and external support, but faced challenges such as resource scarcity and social differentiation. The study also found significant positive correlations among health education, knowledge management, and community innovation. Based on these findings, a series of improvement suggestions were proposed: policymakers should increase support for health education and ensure resource accessibility; healthcare institution managers should optimize knowledge management systems and enhance team collaboration and technology application efficiency; community workers should actively participate in health education and improve their own capabilities; researchers should delve into the impact of demographic characteristics on health education and innovate models; community leaders should promote resident participation in health projects and create an innovative environment. The findings of this study provided important references for enhancing the role of general practitioners in community health work.

BackgroundWith the implementation of health care reforms in China, primary care is on a journey to provide care for most patients with type 2 diabetes. While Chinese general practitioners (GPs) have described challenges in communication with diabetes patients in their daily practice, little is known about patients’ experiences in communicating with their GPs.MethodsFive focus groups (of 4–5 participants each) were used to explore views from patients with type 2 diabetes. Purposive sampling was used to recruit a spread of participants from general practices in Guangzhou city, China. Focus groups were audio-recorded, transcribed, and thematically analyzed using the Framework Method.ResultsTen males and 12 female patients from five general practices participated in focus group discussions, with a mean age of 57.3 years and 7.3 years of diabetes duration. Five main themes emerged: patients’ understanding about diabetes, diabetes medication, communication with GPs, physician-patient relationships, and healthcare systems and context. Patients generally searched for information on the internet, but they weren’t always sure if it was trustworthy. Several communication needs were described by diabetes patients, such as explanation of blood glucose monitoring, medication information support, communication in the risk of diabetes complications and cardiovascular disease, and language barriers. Communication was frequently brief and not tailored to their concerns, and some described being scolded or panicked by GPs. Participants acknowledged the pressures within the health system, such as short consultation times, an incoherent GP-hospital interface and high demand.ConclusionsKey issues from the patients’ perspective for the development of primary care based management of diabetes in China were identified. People with type 2 diabetes require more access to trustworthy diabetes information and wish for better channels of communication with their GPs. Strategies may be required to improve GPs’ communication skills with their patients that also consider the context of the wider health system environment in China.