Background:

Uruguay has one of the highest physician densities in Latin America; however, medical professionals remain disproportionately concentrated in Montevideo, with persistent shortages in non-capital regions. This territorial imbalance compromises access, diagnostic timeliness and continuity of care, particularly within the public sector.

Objective:

To critically synthesize international and national evidence on strategies for attracting, settling and retaining physicians in non-capital settings, and to assess their applicability to the Uruguayan health system.

Method:

A narrative review with a structured approach was conducted. The search was performed in PubMed, Scopus, Web of Science, SciELO and LILACS (1990–2026), complemented by grey literature, national and international technical documents, and local press reports. Studies evaluating interventions aimed at improving the geographical distribution of the medical workforce were included. The evidence was organised into five categories: educational, regulatory, financial, community/organisational strategies, and multidimensional approaches.

Results:

Educational strategies, including recruiting students from rural backgrounds and decentralizing medical training, demonstrated the most consistent and sustained impact on physicians’ settlement in non-capital regions. Regulatory measures improved short-term coverage but had limited effectiveness in retention unless linked to clear training and career pathways. Financial incentives increased initial attraction but showed reduced effectiveness without contractual stability and supportive community environments. Family and social factors emerged as key determinants of retention. Multidimensional approaches showed the greatest overall effectiveness, particularly in middle-income settings.

Conclusions:

Strengthening physician settlement and retention in Uruguay’s non-capital regions requires integrated, intersectoral and sustained policy approaches. Expanding decentralized training, strengthening telemedicine, improving working conditions and addressing community-level determinants are central to achieving a more equitable distribution of the medical workforce. Isolated interventions are unlikely to succeed without an integrated policy framework.

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