Patterns of family physician employment in health systems in the world: A scoping review

Abstract

Objevtive(s) : The family physician, as a cornerstone of primary health care, plays a vital role in improving community health, reducing healthcare costs, and promoting equity in access to services. Considering the diversity of family physician employment models and their impact on the quality and efficiency of healthcare services, this study aimed to review and compare various models of family physician employment across health systems worldwide. Methods : This scoping review was conducted based on the six-stage framework of Arksey and O’Malley. Relevant Persian and English sources were searched in major databases including PubMed, Scopus, Web of Science, Wiley, Science Direct, Magiran, and Google Scholar. Eligible articles were selected according to predefined inclusion criteria, and qualitative data were analyzed thematically using Braun and Clarke’s approach with MAXQDA software. Results : Of 5,069 identified articles, 53 studies met the inclusion criteria. Eighteen family physician employment models were identified and categorized into six main groups: clinic-based, team-based, performance contract, community-based, integrated, and government-financed models. The main advantages included improved efficiency, accessibility, quality, and health equity. The main challenges were found in management, human resources, and service delivery. Success factors were categorized as internal (structural) and external (political, economic, social, and technological). Conclusion: The efficiency of family physician employment models depends on the structural and contextual characteristics of each health system. Selecting an appropriate model requires consideration of available resources, policies, and population needs. The findings can guide policymakers in optimizing family physician programs and strengthening primary health care.