Stress and retention challenges among rural and regional physicians: a mixed-methods systematic review and framework for action

Abstract

Introduction: Workplace stress among rural physicians is a pressing public health challenge, intensified by increasing workloads, demographic shifts, and constrained healthcare infrastructures. This systematic review examines the stress-related outcomes rural physicians face, identifies key contributing and mitigating factors, and proposes a transformative framework for sustainable intervention. Methods: A comprehensive search across five databases (January 2020–2025) yielded 1973 studies, with 24 meeting inclusion criteria focused on rural, remote, or regional physicians. Data were synthesised using PRISMA guidelines and quality-assessed with standardised checklists. Results: Across 11,130 rural physicians, burnout emerged as the most prevalent outcome. Excessive workloads, diminished autonomy, blurred work-life boundaries, and systemic under-resourcing drove emotional exhaustion (EE). Geographic isolation further compounded anxiety, depression, and sleep disruption. While job dissatisfaction led to absenteeism and turnover, protective factors included professional autonomy, recognition, and task diversity. Promising interventions included work-life balance strategies, continuous education, and context-responsive recruitment policies. Conclusions: Sustaining rural healthcare requires more than short-term solutions; it calls for systemic reform that centres physician well-being, autonomy, and community-rooted support. Equity-driven frameworks anchored in self-actualisation, collaboration, and culturally responsive remote care offer promising paths forward. Future research must prioritise context-specific, structural change across diverse rural landscapes.