【作者简介】罗 婧，黄馨怡，中国社会科学院

【文章来源】《社会学评论》2025年第6期

【内容提要】随着乡村医疗体系治理逻辑的演变，乡村医生的职业角色亦发生变化。他们既成为医疗市场主体、获得执业自主空间，又在基层医疗卫生体系重塑过程中被赋予健康“守门人”的责任。由此，乡村医生面临着复杂的医患互动情境，而这些多重变化使其陷入执业困境。本文基于对江西某县乡村医生执业境况的调查，发现在半行政化的制度环境、有限的商品化市场和流动的农村社会中，乡村医生对生计模式的构建与对职业道德的塑造难以匹配，其职业角色出现内在张力。本研究有助于厘清中国式现代化进程中乡村医疗体系的公益性与可持续机制，对于推动乡村医生整合私利和公利、形成内在一致的职业角色具有启示意义。

【关键词】乡村医生 / 职业角色 / 生计模式 / 职业道德 / 现代化

【全文链接】http://src.ruc.edu.cn/CN/Y2025/V13/I6/111

The Mismatch of Livelihood and Ethics:The Construction of the Professional Role of Rural Doctors

Abstract: The governance logic of the rural medical system has continuously evolved, leading to changes in the professional role of rural doctors. Contemporary rural doctors now function as market entities with professional autonomy. They have been assigned the responsibility of serving as health “gatekeepers” in the restructuring of the primary healthcare system. Thus, in the transition from a rural-based to an urban-rural China, they face complex doctor-patient dynamics. These multifaceted shifts have placed rural doctors in a professional dilemma. Using a county in Jiangxi Province as a case study, this paper explores potential solutions to their professional challenges. The findings reveal that, within a semi-administrative institutional framework, a constrained marketized environment,and a fluid rural society, rural doctors’livelihood strategies and professional ethics have become mutually mismatched, creating inherent role tensions. Therefore, it is imperative to realign the public welfare objectives and sustainability mechanisms of the rural medical system in the process of Chinese mordernization, enabling rural doctors to reconcile personal and collective interests, thereby fostering a coherent professional identity.