Physicians on the move: qualitative evidence on physician attraction and retention in remote primary health care
1
Center for Education in Public Health (NESCON), Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
2
Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Brazil
3
Pontifical Catholic University of Minas Gerais (PUC-Minas), Belo Horizonte, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A3549
ABSTRACT
INTRODUCTION:
Attracting and retaining physicians in remote Amazonian territories remains a persistent challenge that reinforces health inequities. In the Lower Amazon (Pará, Brazil), extreme geographic distances, river-based mobility, and seasonal isolation destabilize the medical workforce. This study examined the drivers of physician attraction, retention, and turnover across three municipalities with varying degrees of remoteness.
METHODS:
A qualitative multi-site study was conducted in late 2025, combining direct observation with 12 semi-structured interviews with primary health care physicians and health managers: four in a regional hub and eight in municipalities classified with high or moderate shortage. Site selection was guided by a shortage index, which incorporates secondary data on physician supply, social vulnerability, and other contextual indicators. The regional hub was included to capture regional perspectives on regulation and medical training.
RESULTS:
Physician turnover was primarily driven by structural determinants. In Santarém, the workforce was pressured by the city’s role as a regional hub absorbing cross-territorial demand. In Alenquer and Curuá, the federal More Doctors Program (Programa Mais Médicos—PMM) was indispensable for ensuring regular medical presence but often functioned as a stepping stone for early-career physicians, sustaining municipal dependency on federal provision. While financial stipends supported recruitment, long-term retention was more strongly associated with local origin, family ties, and statutory (permanent) employment. Major barriers included precarious contracts, lack of career pathways, limited diagnostic support, and deterrents such as seasonal isolation and poor access to basic education for physicians’ children.
CONCLUSIONS:
Physician placement policies are necessary to ensure short-term access but insufficient for long-term stability. Sustainable workforce strategies require integrated regional policies, stable public employment, adapted career pathways, and sustained investment in primary health care infrastructure. Addressing these structural constraints is essential for advancing Universal Health Coverage in remote, river-based health systems.
Attracting and retaining physicians in remote Amazonian territories remains a persistent challenge that reinforces health inequities. In the Lower Amazon (Pará, Brazil), extreme geographic distances, river-based mobility, and seasonal isolation destabilize the medical workforce. This study examined the drivers of physician attraction, retention, and turnover across three municipalities with varying degrees of remoteness.
METHODS:
A qualitative multi-site study was conducted in late 2025, combining direct observation with 12 semi-structured interviews with primary health care physicians and health managers: four in a regional hub and eight in municipalities classified with high or moderate shortage. Site selection was guided by a shortage index, which incorporates secondary data on physician supply, social vulnerability, and other contextual indicators. The regional hub was included to capture regional perspectives on regulation and medical training.
RESULTS:
Physician turnover was primarily driven by structural determinants. In Santarém, the workforce was pressured by the city’s role as a regional hub absorbing cross-territorial demand. In Alenquer and Curuá, the federal More Doctors Program (Programa Mais Médicos—PMM) was indispensable for ensuring regular medical presence but often functioned as a stepping stone for early-career physicians, sustaining municipal dependency on federal provision. While financial stipends supported recruitment, long-term retention was more strongly associated with local origin, family ties, and statutory (permanent) employment. Major barriers included precarious contracts, lack of career pathways, limited diagnostic support, and deterrents such as seasonal isolation and poor access to basic education for physicians’ children.
CONCLUSIONS:
Physician placement policies are necessary to ensure short-term access but insufficient for long-term stability. Sustainable workforce strategies require integrated regional policies, stable public employment, adapted career pathways, and sustained investment in primary health care infrastructure. Addressing these structural constraints is essential for advancing Universal Health Coverage in remote, river-based health systems.
| eISSN: | 2654-1459 |
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