title: Postgraduate training at the ends of the earth - a way to retain physicians?
abstract: BACKGROUND
  The recruitment and retention of health workers, crucial to health service delivery, is a major challenge in many rural and remote areas. Finnmark, the most remote and northern county in Norway, has faced recurrent shortages during the last 5 decades, especially of primary care physicians.
  
  
  METHODS
  This article describes a postgraduate training model for family physicians and public health/community medicine physicians, based on group tutorial and in-service training in rural areas. The effect of the training programs on physician retention in Finnmark is evaluated by a longitudinal cohort study.
  
  
  RESULTS
  In total, 65-67% of the physicians from the programs are still working in the county 5 years after completion of the group tutorial. Rural practice provides good learning conditions when accompanied by appropriate tutelage, and in-service training allows the trainees and their families to 'grow roots' in the remote area while in training. The group tutorial develops peer support and professional networks to alleviate professional isolation.
  
  
  CONCLUSIONS
  On the basis of these findings, traditional centralistic training models are challenged. Postgraduate (vocational) training (residency) for primary care physicians can be successfully carried out in-service in remote areas, in a manner that enhances retention without compromising the quality of the training.
authors.affiliation: County Governeor's Office, County Medical Office of Finnmark, Finnmark, Norway. karinstraume@hotmail.com
authors.forename: Karin
authors.initials: K
authors.lastname: Straume
authors.forename: Mona S
authors.initials: MS
authors.lastname: Søndenå
authors.forename: Peter
authors.initials: P
authors.lastname: Prydz
mesh_terms: D001110:Arctic Regions; D004502:Education, Medical, Continuing; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008507:Medically Underserved Area; D017146:Models, Organizational; D010558:Personnel Loyalty; D010821:Physicians, Family; D012423:Rural Health