Objective To study the impact of policy external environmental changes on rural doctors'ranks,and to find out the adaptability between the two.Methods The purposeful sampling method was used to study 84 people of district H in Beijing by means of both field observation and individual in -depth interviews from July to August in 2016.The data acquired was analyzed by qualitative method, and interview results were categorized and analyzed by citing typical expressions of the respondents.In October 2016,rural doctors from 260 village clinics in 14 townships in district H were subject to a basic information survey,by means of general description.Results The changes of village governance model, strength of personal relationship made in adaptation between health policy and policy environment,retained the practice of senior village doctors.These people,though low in competence,were advantageous as being locals(237 of them being in the same village)and for their familiarity with health conditions, namely family disease history and diet habits,of local villagers.At the same time,health policies were not adaptive to the policy environment,as village committees tend to ignore management of doctors.12 of the 21 village leaders were not involved in the management.Conclusions Development of rural doctors ranks is highly challenging as making policies friendly to external policy environment, and the constraints of such environment on health policies deserves more attention.%目的 研究卫生政策外部环境变化对乡村医生队伍建设的影响,以及两者间的适应性.方法 2016年7—8月,采用质性研究中目的性抽样方法,对北京H区84人进行实地观察和个人深入访谈.采用主题框架法,对其中数据进行量化处理,并通过引用访谈对象的典型表述,对访谈内容进行归类并分析.2016年10月,对H区14个乡镇的260个村卫生室的乡村医生进行基本信息调查,采用一般性描述方法.结果 村落治理模式的转变,"差序格局"的强化,使年老体衰的乡村医生(平均年龄62岁)仍在村中执业,但他们因本乡本土(237人为本村人)而熟悉村民健康状况,有90%的乡村医生熟悉村民个人健康状况、家族病史、饮食情况等.同时,卫生政策与政策环境间存在某种不适应,村委会对乡村医生的管理有名无实,21名村干部中有12人不参与管理.结论 乡村医生队伍建设任重道远,其政策须与政策环境相适应;在关注卫生政策对政策环境改善的同时,还必须关注政策外部环境对卫生政策的制约作用.
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