The Determinants of Workforce Crisis in Healthcare: A Systematic Review

Abstract

Healthcare workforce instability encompasses intentions to leave, completed departures, reduced working hours, and uneven deployment, yet these outcomes are conflated. Evidence on contributing factors is dispersed across professions, settings, and study designs, complicating comparisons and policy interpretation. This paper maps the determinants investigated in healthcare workforce research while distinguishing their associated employment outcomes. A structured narrative evidence map assembled 58 candidate publications with digital object identifiers from 2015 to 2025 through targeted discovery, reference tracing, and bibliographic reconciliation. Publications were classified by determinant domain and workforce outcome, with interpretations differentiated by study design. Forty-six publications, representing 79.3 percent of the catalogue, primarily examined intention to leave; three addressed completed attrition and three combined stated and completed outcomes. Remaining publications examined hypothetical job preferences, planned working-hour reductions, or workforce presence and deployment. Reported determinants included workload, burnout, job satisfaction, leadership, rewards, workplace safety, professional development, digital conditions, and rural placement. The proposed framework integrates determinant levels with distinct workforce outcomes without equating associations with causation. Because reproducible searching, independent screening, and formal risk-of-bias appraisal were unavailable, future research should validate this map and prioritize recorded employment outcomes for workforce policy evaluation.