Research productivity of practicing doctors is acknowledged worldwide as one of the driving determinants for the quality of healthcare. Subsequently, health authorities aspire to integrate research initiatives into clinical practice since this would lead to better health outcomes, more efficient healthcare services, and would create a culture of excellence in health service delivery. Published research shows that healthcare organizations which encourage, and foster research have generally a more positive outcome on most of the main quality indicators, even after adjustments are made for resources and staffing differences (1, 2). Further, meta-analysis reports demonstrate that when there is a strong research culture at the healthcare workplace, it produces numerous benefits, including higher staff retention rates, improved clinical decision-making and better patient satisfaction (3, 4). Building research capacity and scientific culture among health professionals, even in the relatively well-resourced high-income countries results in significant enhancements to both, individual and group work productivity (5).

In the Gulf Cooperation Council (GCC) countries, research publications have increased significantly over the past two decades. Nevertheless, such scientific productivity remains below the expected international standards. For instance, while studies from Kingdom of Saudi Arabia present a marked increase in health-related sciences research output, further constraints for improved gains remain in view of the shortness of the protected time that health professionals have, clinical workloads, and limited healthcare organizational incentives for conducting and publishing research (6–8).

Overall, studies conducted on health professionals in the GCC countries suggest a favorable attitudinal environment toward research but with limited support facilities to conduct physician-led research in the Arab Gulf region and undertaking and publishing research does not attain the needed support. The situation in the Kingdom of Bahrain is not much different, with only one published cross-sectional study that addressed doctors’ perceptions toward research but without investigating the determinants of doctors’ scientific productivity. Similarly, findings from the Kingdom of Saudi Arabia indicate that doctors identified structural and organizational barriers as the key reasons for their limited research involvement (6, 7, 9–11).

Several knowledge gaps remain in the literature on research capacity, culture, and productivity in the GCC countries since most existing studies in this region have focused on attitudes, perceived barriers rather than on individual doctors’ scientific productivity and its socio-demographic and professional determinants (6–11). Further, there is limited published research work examining how specific doctors’ traits—such as age, gender, years of experience, clinical setting (primary vs. secondary care), employment sector (government vs. private), and career level—relate to levels of scientific productivity among practicing physicians (12–15).

The research question addressed in this paper is “which individual and institutional-level characteristics are associated with high scientific publication productivity among practicing physicians in the Kingdom of Bahrain?”. This study seeks to guide healthcare policy makers to the most effective approaches for research capacity building at the level of individuals, healthcare institutions, and the national healthcare systems. Moreover, it is hoped that the findings of this study would provide practical insights for strengthening high-quality medical research.

Table 1 presents the socio-demographic characteristics of the doctors who responded to the survey (n = 239). Around two-thirds of the participants in the sample were females (66.5%) and this is similar to the gender distribution pattern of the doctors in the Kingdom of Bahrain. Most of the doctors were under the age of 40 years (64.0%) with work experience less than 15 years (61.1%). The largest proportion of doctors were employed in the governmental health sector (75.3%), working mainly in secondary healthcare (71.1%) and mostly at an advanced career level (46.0%). Interestingly, only one out of five doctors has published five or more papers during their entire medical career, while on the other hand one third of the doctors had no publication record at all.

The association between the doctors’ characteristics and higher publications productivity (publishing 5 research papers or more) is presented in Table 2. There were statistically significant relationships between publishing five papers or more and being a male doctor (p = 0.013), 40 years or older (p < 0.001), having a work experience of 15 years or more (p < 0.001), being at an advanced career level (p < 0.001) and employed in the secondary healthcare (p < 0.001). However, no significant relationship was found between the scientific productivity and the type of medical curriculum in the medical school from which the doctors have graduated (p = 0.964). In addition, there was no relation between the doctors’ employment sector and scientific productivity (p = 0.065).

To identify doctors’ traits that are independently associated with a higher number of scientific research publications (publishing five research papers or more), a multivariate regression modelling analysis was conducted – Table 3. There were statistically independent significant relationships between publishing 5 papers or more and being employed in secondary healthcare (odds ratio for secondary healthcare = 7.364, CI (1.992, 27.225), p < 0.003). In addition, a doctor who was employed in the private sector is less likely to have published five papers or more compared with doctors employed in the government (odds ratio for private sector = 0.634, CI (0.259, 1.553), p = 0.319) but the difference was not statistically significant. A trend was also noted in gender (odds ratio for female gender = 0.449, CI (0.197, 1.024), p = 0.057), with male doctors being more likely to produce higher number of scientific publications compared to their female counterpart.

This study provides one of the first physician-level analyses of traits associated with high scientific productivity in an Arab Gulf population. It is disappointing to find that among surveyed doctors, only one in five had published five or more research papers during their entire medical career, whereas nearly one-third of doctors had no publication record at all. Scientific productivity was higher among male doctors, older age groups (≥40 years), those with 15 or longer years of experience, physicians working in secondary healthcare, and those at advanced career levels in the univariate analyses. In the multivariable modelling, employment in secondary care and working in the government sector were associated with publishing 5 or more articles, while a trend indicated that male doctors are more likely than female doctors to achieve this high level of productivity. These findings suggest that in Bahrain, scientific publishing is concentrated among a relatively small subset of experienced, hospital-based physicians, often in advanced positions with gender and sectoral disparities in research output.

Our findings have direct implications for the quality of healthcare and the role of research in enhancing health systems. Studies from western countries show that research-active organizations tend to have better clinical outcomes in the form of lower mortality rates and better key health outcome (1, 2, 17–19). Research-engaged clinicians are more likely to adopt evidence-based therapies which would obviously improve the quality of health services (1–3, 19). Thus, it is alarming that research productivity is concentrated in a narrow subset of secondary healthcare physicians since this would unfortunately limit the extent to which these system-level benefits are enjoyed across the whole healthcare sector (primary and secondary healthcare).

The particularly low proportion of highly research productive physicians in primary care in our sample is noteworthy. Primary healthcare is critical for the prevention of diseases, management of chronic disorders, and patient-centred care. In addition, primary healthcare research is essential for generating context-relevant evidence on the whole health sector rather than only hospital-based data (9, 20–22). The under-representation of primary care physicians among the highly productive researchers in this study gives the impression that we are missing opportunities to generate locally relevant data on primary care patients, population health interventions, and continuity of care. This finding is in line with previously published work from Bahrain and Saudi Arabia demonstrating that there are several structural barriers to research in primary healthcare—such as lack of time, limited mentorship, and weak incentives—despite primary healthcare doctors exhibiting positive attitudes toward research (6, 7, 9, 11, 23–25).

Furthermore, the observed association between advanced career level and higher productivity highlights how research can reinforce professional development. Internationally, research output is a major determinant of academic promotion, leadership roles, and access to competitive funding (12, 13, 26). We believe that aligning promotion criteria and leadership selection processes with transparent and equitable recognition of research contributions could both reward existing productivity and incentivize broader engagement in research across health professionals career stages.

Our findings support prior evidence from within the GCC countries as well as other Arab populations. Studies from Saudi Arabia have shown that research productivity among faculty members varies widely, with higher outputs associated with senior academic rank, access to resources, and affiliation with research-intensive institutions (6, 7, 27, 28). The pattern observed in this study of greater scientific research productivity among older, more experienced physicians working in secondary healthcare mirrors this direction and suggests that similar structural determinants operate in Bahrain as well.

At the regional level, there is currently an uneven growth in medical research output across the Arab countries, with a concentration of publications in a small number of institutions and persistent deficiencies in research infrastructure and funding (8, 14, 27, 28). Our physician-level data from Bahrain provide micro-level corroboration of these macro-level patterns in the Arab world, showing that even within a single country with a relatively small population like Bahrain, research activity is not evenly distributed across specialties, sectors, or career stages.

The strong independent association between working in secondary healthcare and high research publication reflects that hospital-based settings often provide greater access to research data, infrastructure, collaborators, and academic networks compared with primary healthcare (3, 5, 9, 24, 25). Similarly, the higher odds ratio of publishing five or more research articles among physicians employed in the government sector compared to those in the private sector (although it was not statistically significant), may suggest differences in organizational culture, flexibility, or incentives for research between the two healthcare sectors. Another plausible explanation is that doctors employed in the government sector in Bahrain need to publish research papers to advance their clinical and academic careers.

The gender gap pattern observed in our study—a higher proportion of male doctors among those with five or more publications and a trend toward lower odds ratio of high productivity among women doctors —is also in line with the global and regional literature. A recent systematic review across academic medicine demonstrated that women faculty have consistently lower h-indices than men across specialties and ranks (12, 29, 30). Another study found that men are substantially more likely to reach full professorship at a shorter duration than women, even after adjusting for academic productivity and years in practice (13, 29, 30). This gender disparity in research publications may reflect unequal access to protected research time during working hours, lack of mentorship along with traditional family duties of female physicians in Bahrain. Given that our study has identified a similar trend in this sample of doctors from Bahrain suggests that gender inequities do exist in research opportunities which should require immediate amendments in health policy.

The generally low overall research productivity in our sample is disappointing and is consistent with earlier studies from Bahrain and Saudi Arabia that report positive attitudes but relatively modest research output among clinicians (6, 7, 9–11). Barriers for conducting research that were commonly reported in those studies—including lack of protected time, insufficient methodological training, absence of mentorship, and limited institutional incentives—are likely to underlie the patterns that were observed in our study and should be considered in future capacity-building strategies. This differential access to mentorship, disproportionate caregiving responsibilities, or biases in authorship and grant opportunities (12, 13, 15). Evaluations of targeted interventions—such as structured mentoring programs, tailored research skills workshops, and transparent promotion criteria—would provide much-needed evidence on strategies to promote gender equity in scientific productivity in the Bahraini context.

Within the process of critical thinking, one of the main findings of this study namely the low scientific productivity among physicians in general and among female doctors in particular aligns with recent published reports from other Asian countries, e.g., Pakistan (31, 32). Research has identified several factors that have contributed to such poor scientific productivity including, the limited protected time available for doctors to conduct research activities, lack of organizational or academic incentives and the unavailability of targeted mentorship programs (31, 32). From a policy perspective, gender-focused research is warranted to identify specific barriers faced by female physicians in Bahrain the study’s findings underscore the need for a coordinated national strategy to strengthen research capacity across the health system. Within this context, implementation of structured outcomes-based mentorship programs that specifically target women physicians, particularly in the primary healthcare sector is essential. In addition, providing protected research time and research methodological support is necessary.

This study has several strengths. It is, to our knowledge, the first to systematically explore the traits associated with high scientific productivity among practicing physicians in Bahrain, using individual-level data. The sample included doctors from multiple sectors (government and private), clinical settings (primary and secondary healthcare), and career stages, thereby providing a broad picture of the medical workforce. Further, the use of multivariable regression allowed the identification of independent associations between specific traits and high publication output.

On the other hand, there are some limitations to be acknowledged. The cross-sectional design cannot distinguish whether working in secondary healthcare enables greater research productivity or whether more research-oriented physicians tend to select such settings. The adjusted odds ratios for the subgroups in the multivariable analysis had wide confidence intervals. Hence, physicians’ categories were collapsed into two sub-groups to obtain better precision of the risk estimates. While the relationships between the factors linked to high research productivity among physicians were in the same direction of the univariate analysis, only employment in secondary healthcare remained statistically significant in the logistic regression model. We also note that the quantity of publications was measured rather than quality or impact (e.g., journal impact factors, citation counts, or h-index) which may be considered in future research (12–14, 26, 29, 30). However, while this study was conducted in Bahrain, there is no reason to believe that the situation would be different in other Arab countries and the findings are likely to have relevance for other healthcare systems seeking to strengthen clinician-led research (6–9, 14, 15, 27, 28).

In conclusion, this cross-sectional study of physicians’ scientific productivity in the Kingdom of Bahrain reveals that high scientific productivity is concentrated among a relatively small group of mainly male, older, more experienced, hospital-based doctors. An urgent need exists within the healthcare system for a more inclusive research culture that spans primary and secondary healthcare, government and private sectors, and male and female physicians alike. Within this context, we believe that our study offers a roadmap to address the gaps in the scientific research productivity in the Arab Gulf region.