Job Performance of Medical Graduates with Compulsory Services in Underserved Rural Areas in China: A Cohort Study

Abstract Objective China started a national program in 2010 to train qualified general practitioners with compulsory services in rural and remote areas. While this compulsory services program (CSP) has shown positive effects on staffing primary health care in rural areas, very little is known about how well they perform in the rural service. This study aims to evaluate the job performance of those medical graduates from this program and how the program design has influenced their job performance. Methods A cohort study was conducted with medical graduates from CSP and non-CSP (NCSP) in four medical universities in central and western China. Baseline survey 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 of job performance. Comparisons were made between CSP and NCSP graduates. Multivariable regressions were used to identify factors affecting job performance. Results 2154 medical graduates were included in the sample, with 1586 CSP graduates and 568 NCSP graduates. CSP (90.6%) and NCSP (87.5%) graduates showed no difference in passing the NMLE (P=0.153). CSP graduates reported high job performance, similar to those NCSP graduates (CSP, 63.7; NCSP, 64.2). In the design of CSP, having officially budget posts improved job performance of CSP (β coefficient=4.87, P＜0.05). Working in hometown was also a significant factor that increase job performance when controlling the differences in contracting strategy (β coefficient=1.48, P＜0.05). Conclusion Medical students trained by CSP have demonstrated good job performance in primary healthcare systems in China. Compared to NCSP peers who work in urban areas in majority, CSP graduates’ high job performance could increase the accessibility of equal- or high-quality services in rural areas, which contributes to qualified workforce supply and health equity. Providing officially budgeted posts and working in hometowns can affect job performance and future retention. Early career support can have critical importance for CSP graduates.