Backgrounds Globally, the most rural healthcare systems are lagging behind those of urban healthcare systems. Especially in rural and remote areas, the essential resources to provide principal health services are inadequate. It is purported that physicians have an important role in healthcare systems. Unfortunately, there is a paucity of studies on physician leadership development in Asia, especially on how to enhance physician leadership competencies in rural and remote low-resource settings. This study aimed to investigate doctors’ perceptions of existing and needed physician leadership competencies based on their experiences in primary care settings in low-resource rural and remote areas are in Indonesia.

Methods We performed a qualitative study with a phenomenological approach. Eighteen primary care doctors, who worked in rural and remote areas of Aceh, Indonesia, purposively selected, were interviewed. Prior to the interview, participants were asked to select the top-five skills they deemed most essential for their work based on the five domains of the ‘Lead Self’, ‘Engage Others’, ‘Achieve Results’, ‘Develop Coalitions’ and ‘Systems Transformation’ (LEADS) framework. We then performed a thematic analysis of the interview transcripts.

Results We identified the following qualities a good physician leader in low-resource rural and remote settings should possess: (1) cultural sensitivity skills; (2) a strong character that includes courage and determination; and (3) creativity and flexibility skills.

Conclusions Local cultural and infrastructural factors create a need for several different competencies within the LEADS framework. A profound amount of cultural sensitivity was considered the most important in addition to the ability to be resilient, versatile and ready for creative problem-solving.