Assessing the impact of workload factors on self-assessed sustainability among rural internationally trained physicians.

INTRODUCTION

Rural and remote communities across Canada face persistent physician shortages. Internationally trained physicians (ITPs) have become a critical component of the rural physician workforce, yet little is known about how specific workload characteristics influence physicians' perceptions of workload sustainability and long-term rural retention. Objectives of this study were to identify workload-related factors associated with perceived workload sustainability among ITPs practicing in rural Saskatchewan.

METHODS

We conducted a secondary cross-sectional analysis of prospectively collected survey data from 87 ITPs practicing in rural Saskatchewan between January and December 2024. Perceived workload sustainability was measured using a three-level ordinal outcome. Descriptive statistics, bivariate analyses, and multivariable ordinal logistic regression were used to examine associations between workload characteristics and perceived sustainability. Open-ended survey responses underwent reflexive thematic analysis and were integrated with the quantitative findings using an explanatory-triangulation approach.

RESULTS

Among the 87 ITPs, 22 (25.3%) perceived their workload as sustainable, while 43 (49.4%) reported it as somewhat sustainable. In our adjusted analyses, access to post-call recovery time, fewer than nine ED shifts per month, and the absence of dual or overlapping clinic duties during ED shifts were independently associated with greater perceived workload sustainability. Perceived adverse effects of workload on physician wellness and quality of care demonstrated the strongest associations with lower perceived workload sustainability. Our qualitative findings further reinforced these quantitative results, highlighting excessive workload, burnout, overlapping clinical responsibilities, staffing pressures, administrative burden, and adaptation over time.

CONCLUSION

Perceived workload sustainability among rural ITPs is shaped by several modifiable organizational factors, including scheduling practices, opportunities for post-call recovery, and workload distribution. Targeting these factors may improve physician wellbeing and support long-term rural workforce sustainability and retention. Our findings provide practical evidence to inform physician support strategies and rural workforce planning.