Identifying Factors That Influence the Recruitment or Retention of Family Physicians: A Systematic Review

Problem

Primary care services are facing a workforce crisis worldwide, with maintaining the number of family doctors required to meet population needs a particular problem. Countries have taken different approaches to address this, for example increasing postgraduate training posts in primary care to meet the shortage of family physicians; developing the professional roles of nurses and physician’s assistants. However, such initiatives take time to produce new doctors in the system. It is therefore important to understand what factors influence doctors to choose, or stay, in family medicine in the first place in order to develop strategies to encourage them to remain. The aims of this research are to review the existing international literature on the factors that increase or decrease the recruitment and retention of family physicians and compare those factors between different countries.

Approach

A systematic review of published papers, examining the recruitment or retention of family physicians working in non-hospital settings, published in English from 2000 onwards were considered for inclusion. Qualitative, quantitative, mixed methods and systematic reviews were included. Studies focused on medical students, rural practices or community care centres were excluded. Studies were assessed for quality; data extraction was guided by the Systems Theory Framework of career development to identify important personal and system-levels factors.

Findings

Out of 14,859 initial search results, 50 studies were included: eight qualitative, five mixed-methods, two systematic reviews, one secondary data analysis, and the remainder observational studies. Most were conducted in Europe, mainly the United Kingdom (29 studies). Analysis found that personal factors such as gender, marital status, and having children play an important role in initial recruitment and later decisions to remain. System-levels factors including long working hours, administrative tasks, and long out-of-hours work have an adverse effect on the recruitment and retention. Exposure to family medicine during medical school or vocational training can have both positive or negative impacts on recruitment and retention. Political decisions that change the nature of general practice/family medicine also have a negative impact, for example changing the payment system, appraisal and revalidation. The use of the Systems Theory Framework has been a useful lens to apply to this literature, but also requires some refinement, e.g. considering the effects of health systems more explicitly.

Consequences

Using a theoretical framework that addresses personal, health systems, and policy levels has shown that personal factors are only part of the issue. System-level factors are as important as personal factors in promoting family medicine as a career. Policies should address family physicians’ working conditions and create an attractive environment to improve their recruitment and retention. Improving such conditions could mitigate the effect of some personal factors that affect recruitment and retention.