Obstetrics and Gynecology in Latin America: A Structurally Different Reality that Enriches the Debate on Its Training Attractiveness
Abstract
To the Editor:
We have read with interest the article by Sánchez-Romero et al. (1), which rigorously documents—using 26 years of data from the MIR system—the stable appeal of Obstetrics and Gynecology (OB-GYN) among Spanish graduates. The study provides solid evidence countering the perception that the specialty is in progressive decline and serves as a valuable methodological reference for health workforce planning.
We wish to complement this discussion by presenting the situation in Ecuador, which is structurally different from that of Spain. Unlike the MIR system, Ecuador lacks a single, centralized process for residency placement; instead, each university organizes its own merit-based competitive selection process. OB-GYN programs are offered by the Universidad Central del Ecuador, the Universidad de Cuenca, the Universidad Católica de Santiago de Guayaquil, and the Pontificia Universidad Católica del Ecuador (PUCE)—the latter with campuses in Quito, Portoviejo, Ambato, Santo Domingo, and Ibarra (totaling 46 slots per cohort) (2). Nationally, only 16 of the 62 accredited universities offer medical specializations, distributed across 36 residency programs (3).
This decentralized supply coexists with a sustained demand for specialists: the Ecuadorian Medical Federation has identified OB-GYN as a specialty facing a critical workforce shortage (4), against a backdrop of persistently high maternal mortality (35.6 per 100,000 live births in 2023, down from 41.2 in 2022) (5).
Similarly, a survey in Colombia found that 97.7% of residents considered personal aptitude a key factor in choosing OB-GYN, whereas only 4.5% prioritized financial gain (6); this reinforces the importance of vocational motivation, a factor also documented in Spain.
We believe that extending the use of objective, standardized indicators—adapted to decentralized systems like those in Latin America—would open up a particularly fruitful avenue for comparative research, and we offer our collaboration for future joint studies.
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References
Referencias
1. Sánchez-Romero J, Alfaro-Martínez JJ, Rovira-Negre R, Cánovas-López L, San Frutos-Llorente LM, Oliva-Sánchez R. Long-Term Trends in the Attractiveness of Obstetrics and Gynecology Among Spanish Medical Graduates: Evidence from the MIR Allocation System (2001–2026). RevEspEduMed. 2026, 6, 726061. https://doi.org/10.6018/edumed.726061
2. Pontificia Universidad Católica del Ecuador. Instructivo del Concurso de Méritos y Oposición – Especialidades Médicas, convocatoria 2023. Quito: PUCE. 2023. https://www.puce.edu.ec/docs/dge/admisiones/inscripcion/202302/esp-medicas/especialidades-medicas_instructivo-concurso-meritos-oposicion_2023-02.pdf
3. Cevallos-Miranda I, Mantilla G, Sisa I. Commentary: From education to exploitation: the high price paid by resident physicians in Ecuador's medical specialization. Front Med. 2025, 12, 1550144. https://doi.org/10.3389/fmed.2025.1550144
4. Federación Médica Ecuatoriana. La paradoja en la salud de Ecuador: exceso de médicos generales frente a una grave escasez de especialistas. Primicias. 2025. https://www.primicias.ec/sociedad/salud-ecuador-exceso-medicos-generales-falta-especialistas-maria-jose-pinto-vicepresidenta-114035/
5. Instituto Nacional de Estadística y Censos (INEC). Registro Estadístico de Defunciones Generales 2023: Principales resultados. Quito: INEC. 2024. https://www.ecuadorencifras.gob.ec/documentos/web-inec/Poblacion_y_Demografia/Defunciones_Generales/2023/Principales_resultados_EDG_2023.pdf
6. González-Mariño MA, Ríos-Rodríguez C. Encuesta sobre variables que influyen en la selección de residencia en ginecología y obstetricia. Rev Med. 2025, 33(2), 21-28. https://doi.org/10.18359/rmed.7577
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