Background:

Bulgaria faces a critical shortage of GPs, with over 50% aged 55+ and underserved rural areas. The National Framework Contract (NFC) regulates financing, service scope, and administrative workload in general practice, yet its influence on GP motivation and workforce retention remains underexplored. Understanding how contractual conditions shape both extrinsic and intrinsic motivation is essential for strengthening primary care systems.

Research questions:

What are the demographic and motivational characteristics of Bulgarian GPs, and how does the NFC influence their willingness to work and remain in general practice?

Method:

This four-phase mixed-methods study will integrate policy, workforce, and psychosocial analyses:

Results:

Results are expected to provide actionable insights on how contractual conditions affect GP motivation and retention.

Conclusions:

The study will generate practical recommendations for strengthening GP retention and primary care sustainability in Bulgaria, with potential relevance for other European systems.

Points for discussion: