Current situation of family doctor contracting program: A survey of the perspective of general practitioners

Research on family doctor contract services has predominantly focused on residents, with limited attention to the general practitioners (GPs) regarding the current situation of family doctor team contracting. This study aims to assess the current status of family doctor contract services in primary health care facilities in Guangdong Province from the GPs' perspective and to identify factors influencing the number of people contracting with family doctor teams. A multi-stage stratified cluster sampling method was used to select GPs from primary health care facilities in Guangdong Province from July 5 to July 31, 2021. A self-developed survey questionnaire was used to collect data. The number of people contracted with family doctor teams under different characteristics of GPs and their teams was compared, and a two-level Logistic regression model was developed using R 4.2.2 software to determine the factors that influence whether enrollment numbers in family doctor teams exceed 2,000. A total of 3,252 valid responses were collected from family doctor teams with a contracting count above 100. In 2020, the median number of contracts per family doctor team, as reported by GPs, was 1,400(IQR = 2,499). Comparisons of the number of people contracted with family doctor teams among GPs of different genders, ages, educational levels, managerial positions, employment forms, years of professional experience, working facilities, practicing regions, training received, and annual income showed statistically significant differences (P<0.05). Variables including the number of team members, the population under jurisdiction, the intention for specialist doctors within the health group to join the team, the availability of hospital beds, and guidance from higher-level hospitals also exhibited significant variations (P<0.05). Zero model fitting results highlighted that the distribution of contracted individuals was regionally clustered among the practicing regions of GPs (P<0.05). The comprehensive analysis using a two-level Logistic regression model revealed several key findings: GPs holding a college diploma OR (95%CI) = 2.79 (1.84, 3.74) or a vocational school/high school certificate OR (95%CI) = 2.83 (1.80, 3.86) were more likely to manage teams with over 2,000 contracted individuals, compared to those with a master's degree or higher. GPs in managerial positions were less likely OR (95%CI) = 0.66 (0.33, 0.99) to oversee teams exceeding 2,000 contracted individuals, in contrast to those without any managerial role. Formal employment status was associated with a higher likelihood OR (95%CI) = 2.02 (1.53, 2.51) of managing larger numbers of contracted individuals compared to temporary employment. Team size showed a positive correlation with contracting capacity; teams with 4-6 members OR (95%CI) = 1.31 (1.05, 1.57), 7-10 members OR (95%CI) = 2.06 (1.75, 2.37), 11-19 members OR (95%CI) = 3.67 (3.31, 4.03), and ≥20 members OR (95%CI) = 3.46 (2.74, 4.18) were increasingly likely to surpass 2,000 contracted individuals. Teams managing larger populations—2,001-9,999 OR (95%CI) = 2.37 (2.12, 2.62), 10,000-29,999 OR (95%CI) = 2.92 (2.65, 3.19), and ≥30,000 OR (95%CI) = 2.86 (2.55, 3.17)—were more likely to exceed 2,000 contracts compared to those managing ≤2,000 people. The absence of hospital bed resources within a team was positively associated OR (95%CI) = 1.38 (1.14, 1.62) with surpassing the 2,000 contracted individuals threshold. The study findings suggest that a larger family doctor team size and larger population size of jurisdiction positively impact the capacity for contracting with family doctor teams. GPs with higher educational levels, managerial roles, and access to hospital bed resources possess a more profound understanding and control over family doctor contract service policies, leading to optimized management of contracted individuals. Compared to their temporarily employed counterparts, formally employed GPs within family doctor teams are more likely to engage in contracting activities.