Recruitment and retention of general practitioners in European medical deserts: a systematic review

Introduction: Despite policies aiming at universal health coverage by ensuring availability and accessibility of general practitioners (GPs), medically underserved areas are still present in Europe. This systematic review aims to summarize and compare literature on interventions and their potential effectiveness of GP recruitment and retention in these underserved areas ('medical deserts') from 2011 onwards.Methods: PubMed and Embase were used to identify publications, applying a two-stage selection process. All types of study designs, published in the past 10 years, were included if they discussed a possible intervention for GP recruitment or retention covering an underserved area in an EU-27/EEA/EFTA country (part of the European Union, the European Economic Area or the European Free Trade Association). Exclusion criteria were abstracts or full text not available, conference abstracts, poster presentations, books or overlapping secondary literature. Identified interventions were classified into four categories: 'education', 'professional and personal support', 'financial incentives' and 'regulation'. Eligible articles were critically appraisal by two authors (JB, LF), independently, by using the Joanna Briggs Institute checklist. Results: Of the 294 publications initially retrieved, 25 publications were included. Of them, 14 (56%) described educational interventions, 13 (52%) professional and personal support, and 11 (40%) financial or regulatory interventions. Overlapping categories were often described (56%). The effectiveness of educational or supportive interventions has mainly been evaluated cross -sectionally, whereby causal inference on future GP availability cannot be implied. Few and mixed results were found for the effectiveness of financial and regulatory interventions, because period co-interventions were not taken into account during the study.Conclusion: In the past 10 years, educational and supportive interventions to improve GP recruitment and retention have been reported most frequently, but often overlapping strategies are seen. While multiple strategies have potential to be effective, their limited evaluation makes it difficult to provide suggestions for policymakers to adapt their GP recruitment and retention strategies aiming at a best-practice approach in European medical deserts.