Department of Public Health, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran , fadaei.n88@gmail.com
Abstract: (180 Views)
The family medicine and the referral system program is among the cornerstone strategies for improving population health and promoting equity within Iran’s health system. However, its sustainability faces a critical challenge: the retention and stability of physicians. Frequent turnover and departures following the completion of mandatory service obligations have led to managerial instability, interruption of continuity of care, reduced quality, and declines in health indicators. A significant proportion of physicians are temporary service providers with limited experience in health management, insufficient familiarity with network structures and lack of professional motivation exacerbate the problem. Evidence suggests that reliance on temporary staffing cannot ensure sustainability; A paradigm shift is needed from compulsory service toward developing stable, career-based positions in primary care. Regional economic, cultural, and managerial disparities further influence physician recruitment and retention. Achieving this requires reform of medical education and employment structures, performance-based incentives, and region-specific support packages. Revising the general medical curriculum, strengthening managerial and communication skills training, and providing adequate welfare and psychosocial support are essential to the effectiveness of this national program.
Keywords: Mandatory-service Physician, Family Medicine and Referral System, Physician Retention, Comprehensive Health Service Centers.
Type of Study: Letter to Editor |
Subject:
Health Services Management
Received: 2026/03/2 | Accepted: 2026/06/5
Received: 2026/03/2 | Accepted: 2026/06/5
References
1. Mehrolhassani MH, Jahromi VK, Dehnavieh R, Iranmanesh M. Underlying factors and challenges of implementing the urban family physician program in Iran. BMC health services research. 2021;21(1):1336. doi: [DOI:10.1186/s12913-021-07367-3]
2. Shirjang A, Mahfoozpour S, Asl IM, Doshmangir L. Challenges and strategies of implementation rural family physician in iran: a qualitative study. Depiction of Health. 2020;11(1):62-73. doi:
https://doi.org/10.34172/doh.2020.07 [DOI:10.34172/DOH.2020.07]
3. World Health Organization. Regional Office for the Eastern Mediterranean. Conceptual and strategic approach to family practice: towards universal health coverage through family practice in the Eastern Mediterranean Region. World Health Organization. Regional Office for the Eastern Mediterranean. 2014 [cited 2016]. Available from: https://iris.who.int/handle/10665/250529.
4. Pouraghasi L, Manavi S, Foruzanfar F, Olyaeemanesh A. Achieving universal health coverage; implementation of the 'supporting physician retention in deprived areas' programme in Iran. BMJ Global Health. 2024;9(8). doi: [DOI:10.1136/bmjgh-2023-014951]
5. Anisimowicz Y, Miedema B, Easley J, Bowes AE. Factors influencing Family Medicine resident retention and newly graduated physicians' first practice location. Journal of New Brunswick Studies/Revue d'études sur le Nouveau-Brunswick. 2017;8. Available from: http://w3.stu.ca/stu/sites/jnbs
6. Trabulsi FA, Alqurashi MT, Alharbi RA, Alghamdi AS, Kinsara AF, Khairy AM. The relationship between quality of work Life and turnover intention of primary health care physician in Saudi Arabia 2024. The review of diabetic studies. 2024;86-95. doi: [DOI:10.70082/khd53480]
7. Knight JC, Mathews M, Aubrey-Bassler K. Relation between family physician retention and avoidable hospital admission in Newfoundland and Labrador: a population-based cross-sectional study. Canadian Medical Association Open Access Journal. 2017;5(4):E746-52. doi: [DOI:10.9778/cmajo.20170007]
8. Mohammadibakhsh R, Sohrabi R, Aghighi N, Alihosseini S, Behzadifar M, Martini M,Aryankhesal A. Barriers and challenges of establishing family physician policy for urban population; evidence from a qualitative study in Iran. Journal of preventive medicine and hygiene. 2024;65(3):E434. doi: [DOI:10.15167/2421 4248/jpmh2024.65.3.3346]
9. Heidarzadeh A, Hedayati B, Alvandi M, Rezaei M, Farrokhi B, Dadgaran I, Huntington MK, Sirous S, Mirkazemi R. Referral system challenges of the family physician program in Iran: a systematic review. Medical journal of the Islamic Republic of Iran. 2023;37:49. doi: [DOI:10.47176/mjiri.37.49]
10. Sogai D, Shikino K, Yamauchi K, Araki N, Katsuyama Y, Aoki S, Muroya Y, Miyamoto M, Kamata Y, Ito S. Influencing physician distribution through education: a qualitative study on retention in Japan's rural hospitals. BMC Medical Education. 2024;24(1):1147. doi: [DOI:10.1186/s12909-024-06135-1]
11. Moldestad M, Sayre G, Rinne S, Kaboli PJ, Reddy A, Sanders KM, Mao J, Henrikson NB, Sterling R, Nelson KM, Wong ES. Perspectives on training and working in the VHA: implications for primary care physician recruitment and retention. Academic Medicine. 2022;97(8):1175-83. doi: [DOI:10.1097/ACM.0000000000004619]
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