Challenges Faced by Family Physicians Providing Advanced Maternity Care
Introduction Maldistribution of maternity care (MC) providers in the U.S. limits access to full spectrum MC services. Obstetricians are concentrated in urban areas with many rural areas reliant on family physicians (FP) to provide MC, yet fewer FPs are providing MC. The objective of this study was to understand the challenges FPs face in gaining skills in and providing advanced MC. Methods We conducted qualitative semi-structured interviews with 51 purposively sampled key stakeholders in family medicine MC (21 family medicine-OB fellowship directors, 19 past fellows, and 10 family medicine residency directors of programs with advanced MC training). Interviews were recorded, transcribed, and analyzed using an inductive approach to qualitative content analysis. Results Three primary challenges for FPs providing advanced MC emerged from the interviews. Training: most family medicine residency programs do not provide sufficient surgical OB training, so fellowship training is an important alternative for FPs to acquire such skills. Credentialing: obtaining hospital privileges to perform cesarean sections is unpredictable and highly variable by institution. Professional relationships: “turf battles” with other MC providers can limit FPs’ ability to provide care commensurate with their level of training. Discussion As the predominant provider of MC in rural and underserved areas, FPs need to be supported to provide advanced MC services. Possible strategies to accomplish this include: enhanced family medicine training in MC; policy changes to address credentialing inconsistencies; and improved team-based care for pregnant women to ensure that every woman has access to high quality MC.
KeywordsMaternity care workforce Family medicine Qualitative methods
We would like to thank Anneli Cochrane-Horn (AC) for data analysis assistance and Elizabeth Hansen for managing references and editing. We thank Robert Phillips, MD, for providing feedback on the manuscript and ensuring our interpretations were accurate. We greatly appreciate the time and thoughtful responses of the family physicians who participated in the interviews.
- ACOG. (2014). Committee Opinion No. 586: Health disparities in rural women. Obstetrics and Gynecology, 123, 384–388. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Health-Disparities-in-Rural-Women. Accessed 1 July 2016.
- AAFP. (1987). Family physicians and obstetrics: A professional liability study. Kansas City, Mo.Google Scholar
- AAFP. (2012). Maternal/Child Care (Obstetrics/Perinatal Care). AAFP Policies. http://www.aafp.org/about/policies/all/maternal-child.html. Accessed 1 July 2016.
- AAFP and ACOG. (2014). AAFP-ACOG Joint Statement on Cooperative Practice and Hospital Privileges. AAFP Policies. http://www.aafp.org/about/policies/all/aafp-acog.html. Accessed 1 July 2016.
- Aubrey-Bassler, K., Cullen, R. M., Simms, A., Asghari, S., Crane, J., Wang, P. P., & Godwin, M. (2015). Outcomes of deliveries by family physicians or obstetricians: A population-based cohort study using an instrumental variable. Canadian Medical Association Journal, 187(15), 1125–1132.CrossRefPubMedPubMedCentralGoogle Scholar
- Avery, D., Graettinger, K. R., Waits, S., & Parton, J. M. (2014). Comparison of delivery procedure rates among obstetrician/gynecologists and family physicians practicing obstetrics. American Journal of Clinical Medicine, 10(1), 16–25.Google Scholar
- Avery, D., Marshall, E., Hooper, D. E., & Parton, J. M. (2013). University of alabama family medicine obstetrics fellowship: Results and outcomes, 1986–2011. Journal of Family Medicine Obstetrics, 7(1), 23–31.Google Scholar
- Berman, D. R., Johnson, T. R., Apgar, B. S., & Schwenk, T. L. (2000). Model of family medicine and obstetrics-gynecology collaboration in obstetric care at the University Of Michigan. Obstetrics & Gynecology, 96(2), 308–313.Google Scholar
- Bredfeldt, R., Sutherland, J., & Wesley, R. (1988). Obstetrics in family medicine: Effects on physician work load, income, and age of practice population. Family Medicine, 21(4), 279–282.Google Scholar
- Brown, D. R., Brewster, C. D., Karides, M., & Lukas, L. A. (2011). The phenomenon of collaboration: A phenomenologic study of collaboration between family medicine and obstetrics and gynecology departments at an academic medical center. The Qualitative Report, 16(3), 657.Google Scholar
- Glaser, B. G., & Strauss, A. L. (2009). The discovery of grounded theory: Strategies for qualitative research. Piscataway, NJ: Transaction Publishers.Google Scholar
- Kozhimannil, K., Casey, M., Hung, P., Prasad, S., & Moscovice, I. (2014). The obstetric care workforce in critical access hospitals (CAHs) and Rural Non-CAHs. Minneapolis, MN: University of Minnesota Rural Health Research Center.Google Scholar
- Kruse, J., Phillips, D., & Wesley, R. (1989). A comparison of the attitudes of obstetricians and family physicians toward obstetric practice, training, and hospital privileges of family physicians. Family Medicine, 22(3), 219–225.Google Scholar
- McCaleb, H. S., & Wheat, J. R. (2013). The advantages and disadvantages for a rural family physician practicing obstetrical care. Journal of Family Medicine Obstetrics, 7(1).Google Scholar
- Pecci, C. C., Leeman, L., & Wilkinson, J. (2008). Family medicine obstetrics fellowship graduates: Training and post-fellowship experience. Family Medicine, 40(5), 326.Google Scholar