Primary care reform and concurrent changes in the regional distribution and equity of the ministry of health family medicine workforce in Saudi Arabia: a descriptive longitudinal analysis, 2014–2022

BackgroundSaudi Arabia's Vision 2030, with family medicine positioned as the organising specialty of primary care. Whether this transformation has translated into a more equitable distribution of family medicine across the Kingdom remains under-examined. This study aimed to evaluate whether the primary-care reform altered the regional distribution and equity of the FP workforce across the fourteen health administrative units of the Kingdom.MethodsA retrospective, longitudinal panel was constructed from Saudi Ministry of Health Statistical Yearbooks (2014–2022) across three reform phases: pre-reform (2014–2016), transformation (2017–2020), and post-reform (2021–2022). FM density per 10,000 population was the primary outcome. Inequality was assessed by the Gini coefficient, Theil index, and coefficient of variation, (bootstrap 95% Cis: 1,000 resamples). Phase comparisons used by Kruskal–Wallis with Bonferroni-adjusted Mann–Whitney pairwise tests; temporal trends by Mann–Kendall. Regional trajectories by Ward hierarchical clustering on z-standardised density paths. Because an administrative reclassification in 2021 depressed the national count, trend results are reported both for the full series and with 2021 excluded, and the artifact-adjusted estimates are treated as the primary ones. Only MOH-employed family physicians are covered; private, military and university providers are outside the data source.ResultsNational FP density rose from 0.96 to 1.47 per 10,000 (+53.0%), with absolute headcount increasing from 2,625 to 4,273 (+62.8%). Mean regional density grew faster than national density (+82.4%), indicating proportionally larger gains in less populous regions. All three inequality measures were higher in 2022 than in 2014: Gini +31.5%, Theil +39.1%, and coefficient of variation +28.6%. The Mann–Kendall trend for the Gini coefficient and the coefficient of variation was only marginally significant (p = 0.048), did not hold once 2021 was excluded (p = 0.108), and the Theil trend was not significant (p = 0.118); the widening is therefore suggestive rather than statistically robust. Phase-level mean densities differed significantly across phases (Kruskal–Wallis H = 15.21, p < 0.001), with each successive phase associated with higher density and a more unequal distribution. Hierarchical clustering identified three trajectory groups: a cluster of large urban units with stagnant or declining MOH density (Jeddah, Makkah, Al-Ahsa, Hail, Hafar Al-Batin), a strong-growth peripheral cluster (Bisha +262.1%, Northern Borders +122.9%, Madinah, Tabuk, Qassim, Taif, Asir, Eastern), and Riyadh as a singleton with a peak-and-decline trajectory.ConclusionsThe health reform period was accompanied by substantial absolute growth in the MOH family medicine workforce and by an increase in regional inequality between 2014 and 2022 that is suggestive but not statistically robust. Within the MOH workforce, gains concentrated in peripheral units while the major urban corridors stagnated, a pattern that differs from the urban bias reported in most international settings; because non-MOH providers are concentrated in those same cities and are not captured here, this should not be read as a reversal of urban bias in total family physician supply. Translating Vision 2030's quantitative gains into the equitable workforce envisioned under “a family physician for every family” will require region-specific retention and deployment strategies rather than further aggregate growth alone.