Equity in the distribution of general practitioners and specialists in Iran: a health needs-adjusted analysis using...

Physicians are among the most vital healthcare resources. The equitable distribution of human resources could help policymakers to reach equity as the most important health care goal. In Iran, addressing the shortage of qualified healthcare personnel requires policymakers to consider the population's health needs. The present study evaluated the equity in the distribution of general practitioners (GPs) and specialists (SPs) in Iran, both before and after adjusting for health needs. Disability-adjusted life years (DALYs) and mortality were used as indicators of health needs.

This study is based on a retrospective cross-sectional design and looks at the distribution of GPs and SPs across Iranian provinces over 14 years (2006-2019) by the Robin Hood index. Data on the number of GPs and specialists, as well as provincial mortality, were obtained from the Statistical Center of Iran. DALYs were sourced from the Global Burden of Disease (GBD) study. Additionally, Lorenz curves were plotted to visualize the distribution by use of Excel 2016. The R.4.5.1 software (package EconGeo) was used to analysing the data.

During the study period, the Robin Hood index for GPs, based on population size, mortality, and DALYs, was 0.104, 0.127, and 0.111, respectively; for SPs, the corresponding values were 0.118, 0.133, and 0.124. The greatest equity in the distribution of GPs and SPs was observed in 2016 and 2019, respectively. Overall, less than 13% of the physicians should be redistributed to reach equity. Tehran exhibited both the lowest disparity in SP distribution and the highest disparity in GP distribution, relative to mortality and DALYs.

Overall, the distribution of GPs and SPs in Iran was close to the equity line; however, SP distribution was closer to the equity line than that of GPs. The distribution appeared more equitable when evaluated using population size, DALYs, and mortality, respectively. Using population size alone as a planning tool can be misleading. Instead, health workforce policies should take a broader view-one that includes how people use services, how demographics are changing, and how local socioeconomic conditions shape health needs. Effective strategies-including financial incentives, career pathway development, implementation of post-graduation "return-to-service" programs, adoption of telemedicine, and integration of artificial intelligence-can support physician retention and, in turn, foster a more equitable distribution of medical professionals.