Abstract Background Healthcare Services Management (HSM) graduates are essential for enhancing healthcare system efficiency but face global employment challenges, including skill mismatches, limited job opportunities, and gender disparities. These barriers hinder their ability to meet workforce demands in diverse healthcare settings. This study investigates these challenges in Iran to inform global HSM education reforms. Methods A convergent parallel mixed-methods study at Zabol University surveyed 132 HSM graduates (2010–2022) using the validated “Job Search and Related Factors” questionnaire to quantify employment predictors, such as soft, hard, and academic skills. Concurrently, semi-structured interviews with 37 graduates explored job market experiences, focusing on barriers and facilitators. Quantitative data were analyzed using logistic regression to identify significant predictors, while qualitative data underwent thematic analysis to uncover key themes. Results Quantitatively, the employment rate was 63.6%, with Ph.D. holders achieving 85.7%. Soft skills (OR = 1.06, 95% CI 1.02–1.11, p = 0.007) and hard skills (OR = 1.14, 95% CI 1.01–1.29, p = 0.039) significantly predicted employment, unlike academic skills ( p = 0.51). Qualitatively, graduates emphasized reliance on social networks (e.g., family connections, veteran quotas), a persistent theory-practice gap in education, and regional isolation in a remote city in southeast Iran limiting opportunities. Women faced cultural barriers to leadership roles despite comparable employment rates. Conclusions Addressing skill gaps through practical training, fostering industry partnerships, and promoting gender equity are critical for enhancing HSM graduate employability. These findings offer globally relevant insights for reforming HSM education in less-developed regions, bridging the theory-practice divide.
Hedayati et al. (2026) studied this question.