Abstract
BACKGROUND OR CONTEXT: Primary healthcare (PHC) workforce shortages remain a critical global and national challenge, threatening progress toward Universal Health Coverage. Limited research has examined career-stage-specific motivations and deterrents. This study explores how perceptions of PHC careers differ between final-year medical students and current PHC providers, offering insights for targeted recruitment and retention strategies. DESIGN, SETTING AND PARTICIPANTS: We conducted semi-structured face-to-face and online interviews (November 2023 to December 2024) with final-year medical students and primary healthcare providers (PCPs) from Greater Bay Area institutions. Participants were purposively sampled to ensure diversity in key characteristics. Interviews continued until thematic saturation was reached. Data were analysed thematically using Braun and Clarke's six-step framework. RESULTS: Interviews with 17 PCPs and 13 students identified five themes: systemic and institutional factors, education and training, professional development, community perceptions and personal motivations and trade-offs. The analysis identified common barriers across the participant groups, including inadequate resources, fragmented health information systems, unstructured career pathways and inequitable pay-for-performance mechanisms. Career-stage differences were notable: students associated success with hospital-based specialisation and viewed PHC as a fallback option, influenced by limited PHC training exposure, unclear advancement pathways and prevailing stigma. In contrast, PCPs described professional fulfilment through developing niche expertise and fostering continuity of care, increasingly perceiving PHC as an innovative platform for specialised practice. PCPs with prior hospital experience described their transition from hospital settings as motivated by burnout and the pursuit of better work-life balance, an opportunity often overlooked in workforce planning. CONCLUSIONS: Career-stage-specific recruitment strategies are essential to strengthen the PHC workforce. Policies that address early-career and mid-career needs, establish structured development pathways and enhance the societal value of PHC will be critical to building a resilient primary care system. Findings offer practical implications for health system reforms in China and other countries advancing toward Universal Health Coverage.