Policy Tailwinds Strengthen: General Practitioners as the Litmus Test for Healthcare Reform Success

Medical professionals are a crucial support for safeguarding the health of the entire population and building a Healthy China. With economic development, changes in residents’ lifestyles, and environmental shifts, demand for public health and healthcare services continues to grow, further unleashing the need for medical services. In the context of advancing the tiered diagnosis and treatment system under the new healthcare reform, new requirements have been put forward for the development of general practice talent.

Recently, the National Health and Family Planning Commission (NHFPC) formulated and issued the “13th Five-Year Plan” for National Health and Family Planning Talent Development. In alignment with the overall deployment of the Healthy China initiative, and adhering to the principles of meeting service demands, innovating mechanisms, optimizing structures, and improving quality, the 13th Five-Year Talent Plan outlines five key indicators, seven major tasks, and institutional and mechanistic innovations in four areas. Strengthening the workforce of grassroots health and family planning personnel has been designated as the top priority, with measures proposed such as raising income levels for grassroots physicians and adjusting their professional title evaluation system. Meanwhile, the subsequently released “Guiding Opinions on Deepening the Reform of the Professional Title System” further put forth reform recommendations for the career development of medical and health professionals, providing specific methods to implement adjustments to the professional title evaluation system for grassroots physicians.

Accelerating and improving supply-side reform in the healthcare sector requires robust primary care institutions and an adequate allocation of general practitioners. Based on the aforementioned indicators, China currently faces a severe shortage of personnel in primary care settings, with a need for 930,000 village doctors, 300,000 general practitioners, pediatricians, and psychiatrists, as well as 4 million nurses and various other senior healthcare professionals. Addressing the talent shortfall in primary care institutions necessitates not only facilities that meet basic requirements but also improved compensation for primary care physicians and lowered criteria for their professional title evaluations. Once adequate staffing in primary care institutions is ensured, implementing targeted health insurance policies at the grassroots level—significantly increasing reimbursement rates—will effectively redirect patients from large hospitals to primary care facilities. This approach represents the most effective solution for advancing tiered diagnosis and treatment.

Since 2011, the Chinese government has continuously issued policy documents to support the training of general practitioners. For instance, the “Guiding Opinions of the State Council on Establishing a General Practitioner System” released on July 2, 2011; the “Decision on Standardized Residency Training” issued by seven ministries and commissions in December 2013; and the recent establishment of the National Expert Committee on Graduate Medical Education have all provided institutional support for the standardized training of healthcare professionals. Furthermore, the recent release of the “Talent Development Plan” and the “Opinions on Professional Title Reform” has concretely implemented measures to improve physicians’ compensation and reform the methodology for evaluating their professional titles.

In China, general practitioners (GPs) are primarily sourced through several channels: retraining of incumbent primary care physicians, deployment of hospital-based specialists to primary care settings, targeted training under the “5+3” model, and rehiring of retired physicians. The majority of these GPs serve at the primary care level. While medical specialties in Chinese medical schools have become increasingly specialized, leading to marked improvements in doctors’ professional competencies within their respective fields and ever-more proficient surgical skills through continuous clinical practice, there remains a severe shortage of GPs who are urgently needed by primary healthcare institutions. The development of a robust GP training system should therefore emerge as a new frontier in medical science and the main battleground for healthcare service delivery.

Currently, some higher medical institutions have established general practice education systems and launched general practice programs. However, it is still necessary toEstablish well-developed clinical departments of general practice, standardized training bases for general practitioners, and management systems for general practitioners in major hospitals; cultivate a cohort of localized academic leaders and key professionals in the discipline of general practice; and build a specialized workforce of general practitioners dedicated to serving communities.Currently, there are still some issues in the standardized training of general practitioners. The status of general practitioners is low, with low salary levels and difficulties in professional title promotion, making it hard for grassroots medical institutions to retain talent.

By 2020, the number of general practitioners (GPs) was to reach 300,000. This set specific implementation targets for all provinces and municipalities across China. Only through a coordinated approach—including the active implementation of standardized residency training in general practice, the advancement of assistant GP training, and the execution of job-transfer training for GPs—can this goal be ultimately achieved.

The "13th Five-Year National Plan for the Development of Health and Family Planning Personnel" points out that full consideration should be given to the long training cycle, high occupational risks, significant technical challenges, and heavy responsibilities inherent in the medical industry. Efforts should be made to mobilize the enthusiasm, initiative, and creativity of healthcare professionals by improving their compensation, career development opportunities, practice environment, and social status.Further improve the performance-based pay system for primary healthcare institutions, with a focus on frontline staff, especially general practitioners. A certain proportion of the approved surplus from revenue and expenditure in primary healthcare institutions shall be allocated as employee welfare and reward funds, outside the total amount of performance-based pay.Only by establishing a compensation system for medical personnel that aligns with the characteristics of the healthcare industry can the value of their technical labor be properly reflected.

For a long time, the evaluation of doctors’ professional titles has been constrained by rigid requirements such as research publications, foreign language proficiency, and computer skills. Most primary healthcare institutions at or below the county hospital level in China lack the necessary conditions for conducting scientific research, yet they are still required to use research papers as a criterion for title evaluation. The predominant focus on writing papers and taking foreign language exams has left doctors exhausted, making the career advancement path for primary care physicians particularly arduous.“Opinions on Deepening the Reform of the Professional Title System” relaxes the requirements for academic papers, foreign language proficiency, and computer skills, instead accepting work summaries, lesson plans, medical records, technical promotion summaries, engineering project proposals, and patent achievements as alternative criteria for professional title evaluation.The proposal of reform opinions has undoubtedly cleared the obstacles for the promotion and development path of grassroots general practitioners, thereby enabling the retention of talent at the primary care level.

Following the government’s implementation of a series of combined measures aimed at “enhancing capabilities, raising salaries, and evaluating professional titles,” the curtain has gradually risen on primary healthcare reform. These policies are expected to steadily strengthen the workforce of primary care physicians. As a critical component of primary healthcare, general practice must become the main arena for medical services in order to transform the current medical order and delivery models. The target of cultivating 300,000 general practitioners by 2020 is an arduous task. Whether the training of general practitioners proves successful—achieving comprehensive improvements in their numbers, qualifications, and compensation—will serve as the litmus test for the overall success of healthcare reform.