Table 5 Obstacles to practice

Workplace frustration: bureaucracy, accreditation, healthcare reform, demands from government, alienation by changes to working life, low job control, low organizational justice, poor teamwork and workforce shortages

Brett [51]; Crowson [6]; Evans [43]; Fletcher and Schofield [38]; Heponiemi [44]; Hill [24]; Kendell and Pearce [85]; Lee [87]; McGuirt and McGuirt [89]; Mears [41]; Newton [26]; Sansom [23]; Sutinen [35]; Van Greuningen [17]

Workload pressures: patient demands, long hours, demanding on-call schedules and sacrifice of family/free time, work-life balance

Brett [51]; Chambers [69]; Draper [80]; Evans [43]; French [36]; Joyce [42]; Mears [41]; Meghea and Sunshine 549]; Newton [26]; Goldberg [57]; Sibbald [32]; Onyura [19]; Sansom [28]; Shanafelt [53]; Van Greuningen [17]

Career dissatisfaction: lost interest in work

Brett [51]; Chambers [69]; Crowson [6]; Evans [43]; Hill [24]; Joyce [42]; Luce [7]; Orkin [34]; Ritternhouse [33]; Sibbald [32]; Landon [49]; Van Greuningen [17]

Health: excessive stress, health and mental health concerns (thoughts of suicide, emotional exhaustion), and spousal health

Dodds [35]; Draper [80]; Goldberg [57]; Hall [5]; Hill [24]; Luce [7]; Newton [26]; Pit and Hansen [16]; Sansom [28]; Van Greuningen [17]

Finances: pension, economic concerns, costs of continuing to practice, retirement not being written into partner agreements, general guidance, insurer policies affecting payment

Evans [43]; French [36]; Grondin [75]; Hall [5]; Lee [78]; Orkin [34]; Sansom [28]; Van Greuningen [17]; Wakeford [18]

Skills and competencies: worry over competencies amidst technological advancements and new modalities of diagnosis or treatment

Crowson [6]; Draper [80]; Goldberg [57]; Grauer and Campbell [50]; Hall [5]; Sansom [28]