Background: In healthcare settings, specialists from different fields may follow the most well-known, reliable, and easy-to-understand medical guidelines. This study aimed to determine Iraqi physicians' adherence to treatment guidelines, to specify which treatment guidelines are utilized for each disease and identify their barriers to follow the guidelines.

Methods: This was qualitative study including face-to-face and virtual semi-structured interviews with specialist physicians from different disciplines. The interviews were conducted between December 2021 and May 2022 in Kirkuk province, Iraq. The qualitative data generated through interviews was analyzed using thematic analysis.

Result: The study recruited 48 specialists (27 male and 21 female) from seven medical specialties at two large government hospitals. Most physicians (38 /44) revealed that healthcare settings implement treatment guidelines in more than half of cases.  American guideline was the most used among the participating physicians. European and British guidelines and textbooks were also used by some specialties. Unfortunately, most (43 out of 47) physicians were unaware of Iraqi treatment guideline. Most seniors often followed the same guidelines for one branch, with little variation in approach based on their experience and flexibility. Almost all participating physicians believed that shortages in treatment (46/47) and investigation/lab materials (45/47) and low patient adherence (44/47) are major barriers to implement the guideline(s). Six out of seven specialties experienced shortage in the essential medications that recommended by the guidelines

Conclusions: Most physicians followed well-known international guidelines. Each specialty follows different guidelines relying on the disease. Medication shortage in the public hospitals was the main barrier facing physicians to implement treatment guidelines. Enhancing physician awareness of the Iraqi guidelines should be encouraged. Finally, securing essential medicines in public hospitals is pivotal to adopt evidence-based guidelines effectively.