OBJECTIVE: Explore the barriers and enablers related to employment models to attract and sustain rural generalist (RG) doctors emerging from a state-wide RG program. SETTING: Stakeholders across five rural regions in Victoria, associated with the Victorian Rural Generalist Program (VRGP). PARTICIPANTS: 36 stakeholders who responded from a list of 122 potential identified by a state-wide advisory group for the VRGP. Respondents included 13 program staff, nine people from related collaborative agencies, four state policy decision-makers and 10 RG employees/supervisors. DESIGN: In-depth interviews were thematically coded through ongoing reflection and sense-making and verified by an independent qualitatively trained researcher. RESULTS: There were four barriers to employment models to attract and retain RGs and three enablers. Barriers included health service competition, variability in health service leadership and executive capabilities/competencies regarding the RG workforce, specialist competition and supply-based planning. Enablers were a state-wide vision, improving regional-level planning and RG recognition and reward. CONCLUSION: The research offers insights about the need for state-wide, coordinated regional and local levels of strategy, planning and implementation to achieve employment models that attract and sustain RGs. Further, attracting and sustaining RGs depends on establishing and implementing clinical service models for the range of RGs needed in the community, using outpatient clinics and other networked service options across the region. It also relies on appropriate pay that recognises the additional skills that RGs have. The results might inform Australia's National Rural Generalist Pathway and the state and territory RG programs and their coordination units with progressing attractive and sustainable RG employment.