Journal of health research in community

Introduction
The family physician program, as one of the most important policies in the health system, plays a vital role in providing health care services, improving community health, and preventing diseases. The family physician, as the axial force of the health team, plays a key role in the implementation of this program. However, their low persistence in rural areas is in contrast with the program’s main purpose, which is to establish continuous relations with the population under coverage. This can negatively impact the quality and continuity of health services and undermine the stability of the referral system. The aim of this study was to determine the effective factors in the persistence of family physicians at Golestan University of Medical Sciences in 2023. 

Methods
This was a cross - sectional study. The study population consisted of all physicians in rural health centers of Golestan University of Medical Sciences. Of 175 family physicians, 139 (79%) participated in the study. Data were collected using a questionnaire developed by Jamali et al. based on documents, scientific resources, and the opinions of experts, including their professional experiences. This questionnaire consisted of two parts: demographic characteristics and a questionnaire on factors affecting the persistence of family physicians. The questionnaire of effective factors in the persistence of family physicians consisted of 22 questions. The dimensions of the questionnaire included individual factors (10 questions), organizational factors (6 questions), and environmental factors (6 questions). The questionnaire was designed based on a Likert scale (very low, low, medium, high, and very high). For the “very low” option, 1 point was given; for a “low” option, 2 points; for a “medium” option, 3 points; for a “high” option, 4 points; and 5 points for the “very high” option. Data were analyzed using SPSS software, version 24. To analyze the data, descriptive statistics methods were used. Because of the non-normal distribution of the data, inferential statistics such as Spearman’s correlation, Mann-Whitney, and Kruskal-Wallis tests were also employed. The significance level was considered in all tests (P<0.05).

Results
In general, 139 family physicians working at Golestan University of Medical Sciences participated in this study. The mean age of participants was 35.78±10.63 years; 60.4% were women, and the remainder were men. The mean work experience was 6.06±6.33 years. The majority of participants were married (52.5%), and in terms of employment status, most were contractual (50.4%). The highest mean scores corresponded to the environmental dimension (3.49±0.79), followed by the individual dimension (2.97±0.57) and organizational dimension (2.79±1.06). The top-rated items included “physician satisfaction with communication and cooperation with other staff at the comprehensive health service center,” “interest in conducting medical visits,” and “serving disadvantaged populations as a major professional priority.” Significant relationships were found between physician gender and the organizational dimension (P=0.036), marital status and the individual dimension (P=0.006), and theavailability of 24-hour accommodation and the environmental dimension (P=0.026). 

Conclusion
Overall, this study showed that environmental factors have influence on the persistence of family physicians, followed by individual factors and then organizational factors. According to the findings, policymakers and health sector managers should pay special attention to environmental factors when developing executive guidelines for the family physician program. To improve the existing situation, more resources should be allocated to enhancing the environment, creating more suitable physical space for service delivery, strengthening communication and cooperation between physicians and other personnel through training and cultural development, providing appropriate vehicles for service improvement, upgrading supporting systems such as the lean system, and reviewing the tasks and responsibilities assigned to physicians to reduce workload. 

Ethical Considerations
Compliance with ethical guidelines
This study received ethical approval from the Ethics Committee of Golestan University of Medical Sciences (Code: IR.GOUMS.REC.1402.231).

Funding
This study was the result of Mohammad Hassan Mashhadi's general medicine thesis at the Faculty of Medicine and Golestan University of Medical Sciences (Grant No: 113579), and did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors contributions
Study design and supervision: Mohammad Javad Kabir; Initial draft preparation, Editing, and Review: Alireza Heidari; Data collection: Mohammad Hassan Mashhadi; Statistical analysis: Zahra Khatirnamani; literature review: Mohammadali Pourabbasi. All authors read and approved the final version of the manuscript.

Conflicts of interest
The authors declared no conflicts of interest.

Acknowledgments
The authors would like to thank all the physicians involved in the family physician program who participated in the study.
 

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