title: Obstacles faced by general practitioners in Loreto Department, Peru in pursuing residency training.
abstract: BACKGROUND
  The Department of Loreto, one of the poorest regions of Peru, has an insufficient number of physicians, particularly specialists, needed to provide adequate health care for its population. The majority of Loreto physicians are GPs who have completed a one-year internship after medical school, followed by a mandatory year of rural service, with no subsequent training. Currently there are no residency training programs available in Loreto. The Loreto Ministry of Health recognizes the value in retaining its own medical school graduates and is, therefore, considering building residency programs in the 4 'basic specialties': internal medicine, pediatrics, general surgery, and obstetrics/gynecology. The objectives of this study were to: (1) characterize the population of currently practicing GPs in Iquitos and Requena in terms of demographics, current medical practice, and educational goals; (2) determine the obstacles faced by general physicians in Loreto, Peru in pursuing residency training; (3) provide baseline information to be used by medical academic institutions to develop specialization programs in Loreto.
  
  
  METHODS
  A survey of 55 questions was created in Spanish encompassing demographics, current medical practice, education, training, and professional goals. Of the total 416 GPs in Loreto, 55 were identified in 2 locations: Iquitos and Requena. The goal was to administer the survey to each of these 55 physicians. Consent was given verbally, and 49 surveys were self-administered. Survey responses were translated into English, data were entered in EpiData and analyzed using SPSS software (SPSS Inc; Chicago, IL, USA).
  
  
  RESULTS
  A total of 49 surveys were completed by GPs in Iquitos and Requena. Of the respondents, 84% were male, the majority were either married or in common-law relationships, with at least one child. Their average age was 37.6 years. Sixty-five percent were born in Loreto and most currently lived in Iquitos. Almost all respondents reported that they intended to pursue further training, the majority (59%) intending to pursue residency. Of those intending to complete a residency in the future, 40% specified a desired specialty from among the basic four, 22% a more specialized residency, and 37% did not specify any. The location of training sites, cost of moving to and living in Lima, and/or personal or family reasons were each identified by approximately 50% of respondents as obstacles to their pursuit of residency. Less common obstacles were: not passing the entrance exam, lack of job stability, and not knowing English. Fifty percent of the respondents only identified one obstacle, while 35% identified two and 15% identified three.
  
  
  CONCLUSIONS
  Cost and location were the most significant factors preventing physicians from pursuing residency; overall, 83% of the physicians surveyed identified one or both of these as a factor that prevented them from pursuing residency. This suggests that there would be interest among the local physician population in residency programs established in Loreto.
authors: Department of Family and Community Medicine, Toronto East General Hospital, Toronto, Ontario, Canada. dana.newman@utoronto.ca
authors: Dana E
authors: DE
authors: Newman
authors: Miriam C
authors: MC
authors: Shapiro
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002321:Career Choice; D005260:Female; D058005:General Practitioners / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D010568:Peru; D012189:Retrospective Studies; D019035:Rural Health Services; D011795:Surveys and Questionnaires; D000078329:Workforce