Background China started a national program in 2010 to train qualified general practitioners with compulsory services program (CSP) in rural and remote areas. While the program has shown positive effects on staffing primary healthcare (PHC) in rural areas, very little is known about how well they perform. This study aims to evaluate the job performance of medical graduates from this program and the influence of program design on job performance. Methods A cohort study was conducted with graduates from CSP and non-CSP (NCSP) from four medical universities in central and western China. Baseline and three waves of follow-up surveys were conducted from 2015-2020. The pass rate of China National Medical Licensing Examinations (NMLE) and self-reported job performance were used as measurements. Multivariable regressions were used to identify factors affecting job performance. Results 2154 medical graduates were included, with 1586 CSP and 568 NCSP graduates. CSP (90.6%) and NCSP (87.5%) graduates showed no difference in passing the NMLE (P= .153). CSP graduates reported similar job performance with NCSP graduates (CSP, 63.7; NCSP, 64.2); in the multivariable regression, CSP graduates scored 0.32 and 1.36 points lower in the total sample and graduates of 2015-2017, respectively, but not significantly. Having formally funded positions improved the job performance of CSP (β coefficient = 4.87, P< .05). After controlling for Qinghai which adopted a different contracting strategy, “working in hometown” showed significant influence on job performance (β coefficient = 1.48, P< .05). Conclusion CSP graduates have demonstrated as good job performance as NCSP, proving the competency to provide high-quality care for remote and rural areas. The contracted township health centers (THCs) should provide guidance for CSP graduates, especially in the first few years after graduation. The local government should provide formally funded positions on time and prioritize signing contracts with hometowns or places nearby.
World Health Organization (WHO). Increasing Access to Health Workers in Remote and Rural Areas Through Improved Retention: Global Policy Recommendations. Geneva: WHO; 2010.
Weller B. Guidelines: Incentives for Health Professionals. Geneva: Global Health Workforce Alliance; 2008.
Rowe AK, de Savigny D, Lanata CF, Victora CG. How can we achieve and maintain high-quality performance of health workers in low-resource settings? Lancet. 2005;366(9490):1026-1035. doi:1016/s0140-6736(05)67028-6
Aluttis C, Bishaw T, Frank MW. The workforce for health in a globalized context--global shortages and international migration. Glob Health Action. 2014;7:23611. doi:3402/gha.v7.23611
Ahmed SM, Hossain MA, Rajachowdhury AM, Bhuiya AU. The health workforce crisis in Bangladesh: shortage, inappropriate skill-mix and inequitable distribution. Hum Resour Health. 2011;9:3. doi:1186/1478-4491-9-3
Dieleman M, Kane S, Zwanikken P, Gerretsen B. Realist Review and Synthesis of Retention Studies for Health Workers in Rural and Remote Areas. J Am Coll Surg. 2010;216(3):353-362.
Humphreys J, Wakerman J, Pashen D, Buykx P. Retention Strategies and Incentives for Health Workers in Rural and Remote Areas: What Works? Australian National University (ANU); 2017.
Richards HM, Farmer J, Selvaraj S. Sustaining the rural primary healthcare workforce: survey of healthcare professionals in the Scottish Highlands. Rural Remote Health. 2005;5(1):365.
Dywili S, Bonner A, Anderson J, L OB. Experience of overseas-trained health professionals in rural and remote areas of destination countries: a literature review. Aust J Rural Health. 2012;20(4):175-184. doi:1111/j.1440-1584.2012.01281.x
Wilson NW, Couper ID, De Vries E, Reid S, Fish T, Marais BJ. A critical review of interventions to redress the inequitable distribution of healthcare professionals to rural and remote areas. Rural Remote Health. 2009;9(2):1060.
Belaid L, Dagenais C, Moha M, Ridde V. Understanding the factors affecting the attraction and retention of health professionals in rural and remote areas: a mixed-method study in Niger. Hum Resour Health. 2017;15(1):60. doi:1186/s12960-017-0227-y
Mbemba G, Gagnon MP, Paré G, Côté J. Interventions for supporting nurse retention in rural and remote areas: an umbrella review. Hum Resour Health. 2013;11:44. doi:1186/1478-4491-11-44
Morell AL, Kiem S, Millsteed MA, Pollice A. Attraction, recruitment and distribution of health professionals in rural and remote Australia: early results of the Rural Health Professionals Program. Hum Resour Health. 2014;12:15. doi:1186/1478-4491-12-15
Frehywot S, Mullan F, Payne PW, Ross H. Compulsory service programmes for recruiting health workers in remote and rural areas: do they work? Bull World Health Organ. 2010;88(5):364-370. doi:2471/blt.09.071605
Stenger J, Cashman SB, Savageau JA. The primary care physician workforce in Massachusetts: implications for the workforce in rural, small town America. J Rural Health. 2008;24(4):375-383. doi:1111/j.1748-0361.2008.00184.x
Matsumoto M, Inoue K, Kajii E. Policy implications of a financial incentive programme to retain a physician workforce in underserved Japanese rural areas. Soc Sci Med. 2010;71(4):667-671. doi:1016/j.socscimed.2010.05.006
Dolea C, Stormont L, Braichet JM. Evaluated strategies to increase attraction and retention of health workers in remote and rural areas. Bull World Health Organ. 2010;88(5):379-385. doi:2471/blt.09.070607
Li H, Yuan B, Wang D, Meng Q. Motivating factors on performance of primary care workers in China: a systematic review and meta-analysis. BMJ Open. 2019;9(11):e028619. doi:1136/bmjopen-2018-028619
Yuan BB, Meng QY, Song KM. Preference for working motivation and its influencing factors among rural health workers[J]. Chinese J Public Health. 2012;28(11):1407-1410. doi:11847/zgggws2012-28-11-05
Antonio CT, Guevarra JP, Medina PN, et al. Components of compulsory service program for health professionals in low- and middle-income countries: a scoping review. Perspect Public Health. 2020;140(1):54-61. doi:1177/1757913919839432
Hatcher AM, Onah M, Kornik S, Peacocke J, Reid S. Placement, support, and retention of health professionals: national, cross-sectional findings from medical and dental community service officers in South Africa. Hum Resour Health. 2014;12:14. doi:1186/1478-4491-12-14
Lehmann U, Dieleman M, Martineau T. Staffing remote rural areas in middle- and low-income countries: a literature review of attraction and retention. BMC Health Serv Res. 2008;8:19. doi:1186/1472-6963-8-19
Sánchez Del Hierro G, Remmen R, Verhoeven V, Van Royen P, Hendrickx K. Are recent graduates enough prepared to perform obstetric skills in their rural and compulsory year? a study from Ecuador. BMJ Open. 2014;4(7):e005759. doi:1136/bmjopen-2014-005759
Putthasri W, Suphanchaimat R, Topothai T, Wisaijohn T, Thammatacharee N, Tangcharoensathien V. Thailand special recruitment track of medical students: a series of annual cross-sectional surveys on the new graduates between 2010 and 2012. Hum Resour Health. 2013;11:47. doi:1186/1478-4491-11-47
Meng Q, Mills A, Wang L, Han Q. What can we learn from China's health system reform? BMJ. 2019;365:l2349. doi:1136/bmj.l2349
Li X, Lu J, Hu S, et al. The primary health-care system in China. Lancet. 2017;390(10112):2584-2594. doi:1016/s0140-6736(17)33109-4
Yip W, Fu H, Chen AT, et al. 10 years of health-care reform in China: progress and gaps in universal health coverage. Lancet. 2019;394(10204):1192-1204. doi:1016/s0140-6736(19)32136-1
National Health Commission. China National Health Statistical Yearbook 2020. Peking Union Medical College Press; 2020.
Meng Q, Yin D, Mills A, Abbasi K. China's encouraging commitment to health. BMJ. 2019;365:l4178. doi:1136/bmj.l4178
Ma X, Wang H, Yang L, Shi L, Liu X. Realigning the incentive system for China's primary healthcare providers. BMJ. 2019;365:l2406. doi:1136/bmj.l2406
Li X, Krumholz HM, Yip W, et al. Quality of primary health care in China: challenges and recommendations. Lancet. 2020;395(10239):1802-1812. doi:1016/s0140-6736(20)30122-7
Zhang H, Wei B, Zhao Y, Zhang Z. Exploration and practice on the training mode of compulsory services program (in Chinese). China Higher Medical Education. 2012; (8):1-2,4.
Zhang Z, Zhang C, Huang M, et al. Two-year follow-up analysis of targeted admission medical graduates in rural areas. Chin J Health Policy. 2018;11(9):34-39. [Chinese].
Zhang C, Chen C, Zhang Z, et al. Study on the current employment situation of targeted admission medical graduates in rural areas. Chin J Health Policy. 2017;10(5):27-33. [Chinese].
Wang Z, Hu D, Zhang B, et al. Analysis on the targeted admission medical graduates and their work preference in rural areas: a three-year survey conducted in four medical schools. Chin J Health Policy. 2020;13(11):57-62. [Chinese].
Han X, Li X, Cheng L, Wu Z, Zhu J. Performance of China's new medical licensing examination for rural general practice. BMC Med Educ. 2020;20(1):314. doi:1186/s12909-020-02234-x
Sutton E, Richardson JD, Ziegler C, Bond J, Burke-Poole M, McMasters KM. Is USMLE Step 1 score a valid predictor of success in surgical residency? Am J Surg. 2014;208(6):1029-1034. doi:1016/j.amjsurg.2014.06.032
Tamblyn R, Abrahamowicz M, Brailovsky C, et al. Association between licensing examination scores and resource use and quality of care in primary care practice. JAMA. 1998;280(11):989-996. doi:1001/jama.280.11.989
Gauer JL, Jackson JB. The association between United States Medical Licensing Examination scores and clinical performance in medical students. Adv Med Educ Pract. 2019;10:209-216. doi:2147/amep.s192011
Koopmans L, Bernaards CM, Hildebrandt VH, Schaufeli WB, de Vet Henrica CW, van der Beek AJ. Conceptual frameworks of individual work performance: a systematic review. J Occup Environ Med. 2011;53(8):856-866. doi:1097/JOM.0b013e318226a763
Motowildo SJ, Borman WC, Schmit MJ. A theory of individual differences in task and contextual performance. Hum Perform. 1997;10(2):71-83. doi:1207/s15327043hup1002_1
Han Y, Liao J, Long L. Construction and Empirical Research of Employee Job Performance Structure Model. Hubei Changjiang Publishing Group; 2007.
Kirton MJ. Adaptors and innovators—why new initiatives get blocked. Long Range Plann. 1984;17(2):137-143. doi:1016/0024-6301(84)90145-6
Belbin RM. Team Roles at Work. Oxford, Boston: Butterworth-Heinemann; 2010.
Zhao S. Study on the Current Situation and Relationship of Work Attitude and Performance of Health Techinical Personnel in Township Health Centers of Three Provinces in China [dissertation]. Shandong University; 2015. [Chinese].
Wei Y, Wei X. Relationship between leadership of general team leaders and work performance: a structural equation model analysis. Chinese Gen Pract. 2019;22(S1):16-20. [Chinese].
Wei Y, Wei X. Study on the influencing factors of work performance of general practitioner team members in Shanghai. Chinese Gen Pract. 2019;22(S2):22-25. [Chinese].
Yao X, Wang X, Ren X, Zhai P, Hao Q. Effect of post competency on the work performance of rural doctors: a study in Shanxi province. Chinese Gen Pract. 2021;20(1):61-66. [Chinese].
Sidibé CS, Touré O, Broerse JEW, Dieleman M. Rural pipeline and willingness to work in rural areas: mixed method study on students in midwifery and obstetric nursing in Mali. PLoS One. 2019;14(9):e0222266. doi:1371/journal.pone.0222266
Kroezen M, Dussault G, Craveiro I, et al. Recruitment and retention of health professionals across Europe: a literature review and multiple case study research. Health Policy. 2015;119(12):1517-1528. doi:1016/j.healthpol.2015.08.003
Carson DB, Schoo A, Berggren P. The 'rural pipeline' and retention of rural health professionals in Europe's northern peripheries. Health Policy. 2015;119(12):1550-1556. doi:1016/j.healthpol.2015.08.001
Pagaiya N, Kongkam L, Sriratana S. Rural retention of doctors graduating from the rural medical education project to increase rural doctors in Thailand: a cohort study. Hum Resour Health. 2015;13:10. doi:1186/s12960-015-0001-y
Matsumoto M, Inoue K, Kajii E. Characteristics of medical students with rural origin: implications for selective admission policies. Health Policy. 2008;87(2):194-202. doi:1016/j.healthpol.2007.12.006
Rabinowitz HK. A program to recruit and educate medical students to practice family medicine in underserved areas. JAMA. 1983;249(8):1038-1041.
Min Z, Yuanyi C, Xiaohong C. Investigation on the situation of the clinical staff in township hospitals taking part in the examination for the qualifications of (assistant) medical practitioners. Chinese J Health Stat. 2016;33(3):420-3. [Chinese].
Li, M., Wang, Z., Zhang, B., Wei, T., Hu, D., & Liu, X. (2022). Job Performance of Medical Graduates With Compulsory Services in Underserved Rural Areas in China: A Cohort Study. International Journal of Health Policy and Management, 11(11), 2600-2609. doi: 10.34172/ijhpm.2022.6335
MLA
Mingyue Li; Ziyue Wang; Baisong Zhang; Tiantian Wei; Dan Hu; Xiaoyun Liu. "Job Performance of Medical Graduates With Compulsory Services in Underserved Rural Areas in China: A Cohort Study". International Journal of Health Policy and Management, 11, 11, 2022, 2600-2609. doi: 10.34172/ijhpm.2022.6335
HARVARD
Li, M., Wang, Z., Zhang, B., Wei, T., Hu, D., Liu, X. (2022). 'Job Performance of Medical Graduates With Compulsory Services in Underserved Rural Areas in China: A Cohort Study', International Journal of Health Policy and Management, 11(11), pp. 2600-2609. doi: 10.34172/ijhpm.2022.6335
VANCOUVER
Li, M., Wang, Z., Zhang, B., Wei, T., Hu, D., Liu, X. Job Performance of Medical Graduates With Compulsory Services in Underserved Rural Areas in China: A Cohort Study. International Journal of Health Policy and Management, 2022; 11(11): 2600-2609. doi: 10.34172/ijhpm.2022.6335