Keywords: health workforce; primary health care; health inequities

Background:

Family medicine forms the cornerstone of primary healthcare in the Federation of Bosnia and Herzegovina (FBiH), delivered through 80 health centers across ten cantons. Despite uniform institutional presence, notable regional disparities exist in the availability of family physicians and specialists, as well as in physicians’ salaries. A comprehensive understanding of these variations is essential to support equitable access and optimize workforce planning.

Research questions:

What are the regional differences in the distribution of family medicine physicians and specialists across FBiH cantons? How do these differences correlate with population size, trends in family medicine specialization and salary disparities?

Method:

This descriptive cross-sectional study utilized 2023 administrative health data from all ten cantons in FBiH. We analyzed the number of family physicians, specialists, and physicians in training for family medicine, calculating physician-to-population ratios to identify geographic disparities. Regional salary differences were assessed using official payroll data. Age distribution of specialists was also examined to assess workforce demographic structure.

Results:

The study revealed substantial regional variation in family medicine workforce density. Urban cantons demonstrated higher ratios of specialists per 100,000 inhabitants, ranging from 5.18 to 33.68 per 100,000 across regions. The total number of family medicine specialists in FBiH is 417, with 157 physicians currently in residency training. The age profile is skewed towards older cohorts, with over half of specialists aged 55–64, and relatively few under 35, highlighting upcoming workforce challenges. Significant salary differences exist, with physicians earning up to 30% more in some cantons, potentially affecting workforce distribution and retention.

Conclusions:

Marked regional disparities in family medicine workforce distribution and salaries highlight the need for targeted interventions. These findings underscore the need for strategic workforce planning and enhanced support for specialist training in underserved cantons. This study provides a robust evidence base to inform policy and ensure equitable, sustainable delivery of primary care across the Federation.

Points for discussion: