{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,18]],"date-time":"2026-04-18T13:38:49Z","timestamp":1776519529418,"version":"3.51.2"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T00:00:00Z","timestamp":1689292800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T00:00:00Z","timestamp":1689292800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Hum Resour Health"],"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Primary care services are key to population health and for the efficient and equitable organisation of national health systems. This is why they are often financed through public funds. Primary care doctors are instrumental for the delivery of preventive services, continuity of care, and for the referral of patients through the system. These cadres are also the single largest health expenditure at the core of such services. Although recruitment and retention of primary care doctors have always been challenging, shortages are now exacerbated by higher demand for services from aging populations, increased burden of chronic diseases, backlogs from the COVID-19 pandemic, and patient expectations. At the same time, the supply of primary care physicians is constrained by rising retirement rates, internal and external migration, worsening working conditions, budget cuts, and increased burnout. Misalignment between national education sectors and labour markets is becoming apparent, compounding staff shortages and maldistribution. With their predominantly publicly funded health systems and in the aftermath of COVID-19, countries of the European region appear to be now on the cusp of a multi-layered, slow-burning primary care crisis, with almost every country reporting long waiting lists for doctor appointments, shortages of physicians, unfilled vacancies, and consequently, added pressures on hospitals\u2019 Accident and Emergency services. This articles collection aims at pulling together the evidence from countries of the European Region on root causes of such workforce crisis, impacts, and effectiveness of existing policies to mitigate it. Original research is needed, offering analysis and fresh insights into the primary care medical workforce crisis in wider Europe. Ultimately, the aim of this articles collection is to provide an evidence basis for the identification of policy solutions to present and future primary health care crises in high as well as\u00a0lower-income countries.<\/jats:p>","DOI":"10.1186\/s12960-023-00842-4","type":"journal-article","created":{"date-parts":[[2023,7,14]],"date-time":"2023-07-14T00:02:39Z","timestamp":1689292959000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":46,"title":["The layered crisis of the primary care medical workforce in the European region: what evidence do we need to identify causes and solutions?"],"prefix":"10.1186","volume":"21","author":[{"given":"Giuliano","family":"Russo","sequence":"first","affiliation":[]},{"given":"Julian","family":"Perelman","sequence":"additional","affiliation":[]},{"given":"Tomas","family":"Zapata","sequence":"additional","affiliation":[]},{"given":"Milena","family":"\u0160antri\u0107-Mili\u0107evi\u0107","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2023,7,14]]},"reference":[{"key":"842_CR1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.p966","volume":"381","author":"C Sinnott","year":"2023","unstructured":"Sinnott C, Dorban-Hall B, Dixon-Woods M. Tackling the crisis in general practice. BMJ. 2023;381: p966.","journal-title":"BMJ"},{"key":"842_CR2","doi-asserted-by":"publisher","first-page":"1461","DOI":"10.1016\/S0140-6736(18)31829-4","volume":"392","author":"T Hone","year":"2018","unstructured":"Hone T, Macinko J, Millett C. Revisiting Alma-Ata: what is the role of primary health care in achieving the Sustainable Development Goals? Lancet. 2018;392:1461\u201372.","journal-title":"Lancet"},{"key":"842_CR3","doi-asserted-by":"publisher","first-page":"e715","DOI":"10.1016\/S2214-109X(22)00005-5","volume":"10","author":"K Hanson","year":"2022","unstructured":"Hanson K, Brikci N, Erlangga D, Alebachew A, Allegri MD, Balabanova D, et al. The Lancet Global Health Commission on financing primary health care: putting people at the centre. Lancet Glob Health. 2022;10:e715\u201372.","journal-title":"Lancet Glob Health"},{"key":"842_CR4","doi-asserted-by":"publisher","first-page":"e742","DOI":"10.3399\/bjgp13X674422","volume":"63","author":"D Kringos","year":"2013","unstructured":"Kringos D, Boerma W, Bourgueil Y, Cartier T, Dedeu T, Hasvold T, et al. The strength of primary care in Europe: an international comparative study. Br J Gen Pract. 2013;63:e742\u201350.","journal-title":"Br J Gen Pract"},{"key":"842_CR5","unstructured":"The Health and Social Care Committee. The future of general practice. London: House of Commons; 2022. https:\/\/committees.parliament.uk\/publications\/30383\/documents\/176291\/default\/."},{"key":"842_CR6","unstructured":"Benchairif S-T. Too far, too old, too few: Europe is running out of doctors. POLITICO. 2022. https:\/\/www.politico.eu\/article\/france-doctors-europe-too-far-too-old-too-few\/. Accessed 15 June 2023."},{"key":"842_CR7","unstructured":"World Health Organization. Regional Office for Europe. Health and care workforce in Europe: time to act. World Health Organization. Regional Office for Europe; 2022. https:\/\/apps.who.int\/iris\/handle\/10665\/362379. Accessed 22 June 2023."},{"key":"842_CR8","doi-asserted-by":"publisher","DOI":"10.1596\/978-1-4648-0224-9","volume-title":"Analyzing markets for health workers: insights from labor and health economics","author":"B McPake","year":"2014","unstructured":"McPake B, Scott A, Edoka I. Analyzing markets for health workers: insights from labor and health economics. Washington, DC: World Bank Publications; 2014."},{"key":"842_CR9","doi-asserted-by":"crossref","unstructured":"Mughal F, Mallen CD, McKee M. The impact of COVID-19 on primary care in Europe. The Lancet Regional Health\u2014Europe. 2021;6. https:\/\/www.thelancet.com\/journals\/lanepe\/article\/PIIS2666-7762(21)00129-0\/fulltext#back-bib0003. 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No other conflict of interest is declared.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"55"}}