First, the quality of the source and the problem of signing a contract in a different place In recent years, the rural order directed to the medical students enrollment admissions, enrollment scores have a downward trend, and the student's enthusiasm to apply for the examination is also decreasing year by year, affecting the quality of the source of medical students in higher education institutions. In addition, before being admitted to the rural order directed medical students must sign a directed employment agreement with the local health administrative department to ensure that the rural order directed medical students after graduation to the contracted primary health care institutions employment. However, from the current situation, due to the problem of talent demand and students' willingness to apply for admission, it is becoming more and more common for admitted students to sign employment agreements in different places, resulting in the implementation of the employment agreement after graduation is not in place, there is no substantive binding effect or even possible breach of contract and many other problems. Second, the teaching content and curriculum is not reasonable enough In the teaching process, many local medical schools on the rural order-oriented medical personnel training lack of training experience, resulting in the arrangement of teaching content and curriculum, did not take into account the reality of the grassroots medical and health care services, and non-rural order-oriented medical personnel training homogenization of the training, does not reflect the characteristics of rural order-oriented medical education and requirements of post-graduation work. In the curriculum system, the curriculum system of institutions of higher learning mostly focuses on theoretical education and ignores practical training, the proportion of theoretical knowledge and practical knowledge is imbalanced, leading to students in the employment, the face of practical problems at a loss, do not know how to get started, so that the students can not be trained to adapt to the needs of primary health care services. Third, the graduation and employment follow-up issues lack of protection Rural order-oriented free medical students due to policy reasons, in the graduation and employment on the handover of formalities involving a number of departments. Because the departments involved are many and messy, and the government has not developed a clear management system, so when the departments overlap or conflict, the lack of an effective coordination mechanism, greatly increasing the difficulty of students' employment.
And when students successfully graduate to work in the relevant healthcare sector, most of them are unable to get a job directly due to lack of practical experience. In addition, due to the uneven distribution of medical resources and people's medical habits, large hospitals are always gathered a lot of rural patients, resulting in the township hospitals to reduce the flow of people. Coupled with the fact that the income of rural hospitals is generally lower and there is less room for learning and promotion, most primary healthcare personnel will choose to jump to places and hospitals with relatively developed economy and perfect medical equipment to take up employment. This has led to a massive loss of rural medical personnel, and is also contrary to the original intent of the rural order-oriented medical education policy.