Family Physicians as Street-Level Bureaucrats: An Interview-Based Study of Service Supply Challenges in Shanghai, China During Public Health Emergencies.

Objective: This study aims to analyze the service supply challenges for Family Physicians during public health emergencies through the lens of street-level bureaucracy. Methods: Guided by street-level bureaucracy theory within a three-tier analytical framework (micro-, meso-, and macro-levels), this qualitative study employed semi-structured interviews with 36 Family Physicians in Shanghai regarding their responses to a public health emergency. Interviews were recorded, transcribed verbatim using "iFlytek Hearing" software, manually reviewed, and analyzed thematically using NVivo 10. Results: The analysis revealed multi-level challenges. At the micro-level, Family Physicians faced dual role pressures as "state agents" and "public agents", leading to reduced discretionary power and a tendency for prosocial deviant behavior; their understanding of policies and effectiveness of communication with the public directly impacted policy implementation outcomes. At the meso-level, resource scarcity created supply-demand contradictions, triggering adaptive policy implementation, where Family Physicians innovatively met service needs under constraints and participated in community collaborative governance. At the macro-level, policy ambiguity was prominent, essential medicine supply chains faced difficulties, and training and career development pathways in general practice remained underdeveloped. Conclusion: This study provides a deep understanding of the service supply challenges faced by Family Physicians during public health emergencies, offering a scientific basis for optimizing service supply strategies, and this theoretical framework can be extended to the analysis of other street-level bureaucrats.