Background:

Workforce shortages in GP remain a major challenge in Bulgaria and across Europe.
Professional motivation and mobility are shaped not only by organisational and contractual
conditions, but also by individual psychological orientations such as locus of control.
Understanding how future physicians perceive responsibility and professional agency may
help explain early motivation towards, or away from, a career in GP.

Research questions:

Is locus of control among 5th-year medical students associated with motivation to pursue
a career in GP and with preferences for organisational and contractual factors related to GP
practice?

Method:

A cross-sectional, multi-cohort survey was conducted among Bulgarian medical students
in their 5th year of training using an anonymous online questionnaire administered via
Microsoft 365 Forms. Three academic-year cohorts were included: 2020–2021(n = 177),2021–2022(n = 140), and 2025–
2026 (n = 157), with response rates exceeding 87.5%. Locus of control was assessed using a validated forced-choice scale. Outcomes included
intention to work as a GP and selection of organisational and contractual factors perceived as increasing the attractiveness of GP practice. Descriptive and comparative analyses were performed across locus-of-control orientations and cohorts

Results:

Students with a predominantly internal locus of control more frequently expressed
intention to pursue a career in GP and prioritised professional autonomy and opportunities
for practice ownership. Students with a more external locus of control more often reported
uncertainty or lack of interest in a GP career and prioritised higher income, reduced administrative burden, and regulatory stability. Greater uncertainty was observed in the COVID-period cohorts.

Conclusions:

Locus of control is associated with motivation for a career in GP and with preferences for
organisational and contractual mechanisms among medical students. Based on three
comparable cohorts at the same stage of training, these findings provide relevant evidence
for GP workforce planning and recruitment strategies in Bulgaria.

Points for discussion:

How can GP reforms better match future physicians ’ motivations?