International Journal of Preventive Medicine (Int J Prev Med)2008-78021442023050827982798ENDepartment of Community and Family Medicine, School of Medicine, Guilan University of Medical Science and Health Services, RashtFarzanegan Nik Andish Institute for the Development of Knowledge and Technology, TehranUniversity of South Dakota Sanford School of Medicine, Sioux Falls Family Medicine Residency, Pierre Rural Family Medicine Residency program, VermillionReproductive Health Research Center, Department of Obstetrics and Gynecology, Al Zahra Hospital, School of Medicine, Guilan University of Medical Sciences, RashtHealth Network Administration Center, Undersecretary for Health Affairs, Ministry of Health and Medical Education, TehranHealth Department of Guilan University of Medical Sciences, RashtMedical Education Research Center, Education Development Center, Guilan University of Medical Sciences, RashtFarzanegan Nik Andish Institute for the Development of Knowledge and Technology, Tehran20230508The family physician program (FPP) is one of the most significant health care reforms in Iran; however, many studies showed that this program has not been able to achieve its intended objectives because of a variety of challenges. This program, despite the existing challenges, is going to be expanded across the country. To improve the likelihood of its success, identification of the structural and infrastructural challenges is necessary. This systematic review was conducted to assess the structural and infrastructural challenges of FPP in Iran. This systematic review of the literature was conducted in order to investigate the infrastructure and structure needs of the current program in Iran. All published articles related to the FPP in Iran were the subject of this study. The eligibility criteria included original articles, reviews, or case studies published in English or Persian during 2011–2021 related to the challenges in the referral system of FPP in Iran. Data were extracted based on Sample, Phenomenon of Interest, Design, Evaluation, Research type technique and were reported based on the structure of Preferred Reporting Items for Systematic Reviews and Meta‑Analyses. International credible scholarly databases were searched. The search strategy was defined based on keywords and the search syntax. This study identified different challenges of the referral system in the areas associated with legal structure, administration, and social structure. The identified challenges in this program should be addressed in order to ensure that this program will lead to improved quality of care and equity in Iran health care system.http://ijpm.mui.ac.ir/index.php/ijpm/article/view/2798http://ijpm.mui.ac.ir/index.php/ijpm/article/download/2798/717718639