Summary table of results.

BackgroundThe declining trend in the number of primary care physicians worldwide has led to shortages especially within socioeconomically deprived areas. Socioeconomically deprived areas in the context of this review are defined by regions where there are lower levels of income and access to essential services such as primary healthcare compared to other areas. This shortage contributes to a higher incidence of preventable hospital admissions, unnecessarily straining healthcare infrastructure and negatively affecting patient outcomes. Previous studies have often been limited in scope, focusing on isolated factors or specific regions. Therefore, the objective of this systematic review is to synthesise current research to provide a better understanding of the underlying causes of this high turnover, ultimately informing strategies to address the global shortage of primary care physicians.MethodsThis systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Refer to S1 Table for the PRISMA 2020 checklist. A comprehensive search was conducted across PubMed (1970 to September 2024) and Embase (1974 to September 2024). The eligibility criteria included quantitative empirical studies that included a measurement of at least one of the factors behind increased primary care physician turnover or retention within socio-economically deprived or disadvantaged areas. However, the included studies were required to employ a specific methodology for classifying or defining socioeconomic deprivation. The references were screened, the studies selected, the data extracted, and the risk of bias assessed using the ROBINS-I tool, with both reviewers in agreement.ResultsThirteen studies were identified. The factors measured in the studies driving increased turnover in deprived areas included region of work (n = 7), income (n = 2), burnout (n = 2) and social values (n = 2). Some studies found additional challenges specific to socioeconomically deprived areas, such as familial concerns about regional safety, limited employment opportunities for spouses, or personal career development challenges. However, some studies identified increased hours and sickness presenteeism as stronger contributors to burnout. However, this link can be presumed to be stronger in deprived areas due to staffing shortages, though none of the studies in this systematic review have directly measured this correlation. Though longer-term methods of retention within socioeconomically deprived areas included more collaborative working environments and flexible working hours, this can also be applied to benefit healthcare settings across all regions.ConclusionsThe studies reviewed have consistently highlighted the repeating cycle of persistent staff shortages contributing to an increased turnover rate within disadvantaged areas internationally. Therefore, implementation of targeted policies by governments and healthcare organisations is required to retain primary care physicians within these areas to ultimately improve and standardise patient care.背景 全球范围内初级保健医师数量呈持续下降趋势，尤其在社会经济欠发达地区引发了严重的医师短缺问题。本综述所定义的社会经济欠发达地区，指相较于其他区域，收入水平更低、可获取的基本医疗服务（如初级保健服务）更为匮乏的区域。该医师短缺状况会导致可预防的住院收治发生率上升，不必要地加重医疗基础设施负担，并对患者转归产生负面影响。既往相关研究往往存在研究范围局限的问题，多聚焦于单一影响因素或特定区域。因此，本系统综述旨在整合现有研究成果，以深入理解该类地区初级保健医师高离职率的潜在成因，最终为应对全球初级保健医师短缺问题提供策略参考。 方法 本系统综述遵循《系统综述与Meta分析首选报告规范》（Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA）的指南要求，PRISMA 2020核查表详见附表S1。本研究在PubMed（1970年至2024年9月）与Embase（1974年至2024年9月）两大数据库中开展了全面检索。纳入标准为：定量实证研究，且至少测量了社会经济欠发达或弱势地区中，与初级保健医师离职率升高或留存率相关的至少一项影响因素；同时，纳入研究需采用特定方法对社会经济匮乏程度进行分类或界定。本研究通过筛选参考文献、遴选研究文献、提取数据，并采用ROBINS-I工具评估偏倚风险，且两位评审员的评估结果保持一致。 结果 本综述共纳入13项研究。针对欠发达地区医师离职率升高的影响因素，相关研究测量的维度包括工作地域（n=7）、收入水平（n=2）、职业倦怠（n=2）及社会价值观（n=2）。部分研究还发现了社会经济欠发达地区特有的其他挑战，例如家属对区域安全的顾虑、配偶就业机会有限，或是个人职业发展受限等问题。不过，另有部分研究指出，延长工作时长与带病出勤是加剧职业倦怠的更强诱因。不过，由于人员短缺，该关联在欠发达地区可能更为显著，但本系统综述纳入的研究均未直接测量该相关性。尽管针对社会经济欠发达地区的长期留存策略包括构建更具协作性的工作环境与推行弹性工作制，但这类措施同样可惠及所有区域的医疗保健机构。 结论 纳入本综述的研究均一致证实，全球范围内弱势地区持续存在的医护人员短缺与医师高离职率之间形成了恶性循环。因此，各国政府与医疗保健组织需制定针对性政策，以留住这些地区的初级保健医师，最终改善并统一患者的医疗服务质量。