Family Physicians in the Maternity Care Workforce: Factors Influencing Declining Trends
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Family physicians provide access to maternity care for a disproportionate share of rural and urban underserved communities. This paper aims to determine trends in maternity care provision by family physicians and the characteristics of family physicians that provide maternity care. We used American Board of Family Medicine survey data collected from every family physician during application for the Maintenance of Certification Examination to determine the percentage of family physicians that provided maternity care from 2000 to 2010. Using a cross-sectional study design, logistic regression analysis was performed to examine association between maternity care provision and various physician demographic and practice characteristics. Maternity care provision by family physicians declined from 23.3 % in 2000 to 9.7 % in 2010 (p < 0.0001). Family physicians who were female, younger and US medical graduates were more likely to practice maternity care. Practicing in a rural setting (OR = 2.2; 95 % CL 2.1–2.4), an educational setting (OR = 6.4; 95 % CL 5.7–7.1) and in either the Midwest (OR = 2.6; 95 % CL 2.3–2.9) or West (OR = 2.3; 95 % CL 2.1–2.6) were the strongest predictors of higher likelihood of providing maternity care. While family physicians continue to play an important role in providing maternity care in many parts of the United States, the steep decline in the percentage of family physicians providing maternity care is concerning. Formal collaborations with midwives and obstetrician-gynecologists, malpractice reform, payment changes and graduate medical education innovations are potential avenues to explore to ensure access to maternity care.
KeywordsMaternity care workforce Physician workforce Family medicine Geographic distribution Obstetrics-gynecology
Conflict of interest
No conflicting or competing interests among the authors.
- 3.American Academy of Family Physicians. Family Medicine, Definition of. (2010). Available at: http://www.aafp.org/online/en/home/policy/policies/f/fammeddef.html. Accessed Sep 03, 2012.
- 4.American Academy of Family Physicians. Annual Residency Census Survey. (2012). Available at: http://www.aafp.org/online/en/home/aboutus/specialty/facts/20.html. Accessed Sep 03, 2012.
- 5.Accreditation Council for Graduate Medical Education. (2007). Program requirements for graduate medical education in family medicine. Section IV.A.5.b) (3). Last revised July 1, 2007.Google Scholar
- 8.Guirguis-Blake, J., et al. (2002). Family physicians’ declining contribution to prenatal care in the United States. American Family Physician, 66, 2192.Google Scholar
- 9.Nesbitt, T. S. (2002). Obstetrics in family medicine: Can it survive? Journal of the American Board of Family Medicine, 15, 77–79.Google Scholar
- 13.Ruddy, G. R., et al. (2005). The family physician workforce: The special case of rural populations. American Family Physician, 72, 147.Google Scholar
- 15.Rosenblatt, R. A. et al. (2010). The future of family medicine and implications for rural primary care physician supply. Final Report #125. Seattle, WA: WWAMI Rural Health Research Center, University of Washington; 2010.Google Scholar
- 21.American Congress of Obstetricians and Gynecologists. (2011). The obstetrician-gynecologist workforce in the United States. Facts, Figures and Implications. 2011. http://www.acog.org/publications/obgynWorkforce/obgynWorkforce.pdf. Accessed Aug 17, 2011.
- 23.US Census Bureau [home page]. (2011). Available at http://www.census.gov/. Accessed Aug 17, 2011.
- 26.Joint Task Force of the American Academy of Family Physicians and the American College of Obstetricians and Gynecologists. (1998). AAFP-ACOG joint statement on cooperative practice and hospital privileges. American Family Physician, 58, 277–278.Google Scholar
- 28.Brown, D. R., et al. (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, 657–681.Google Scholar
- 29.Funk, C. et al. (2010). Survey of obstetric and gynecologic hospitalists and laborists. American Journal of Obstetrics and GYnecology, 203, 177.e1–177.e4.Google Scholar
- 37.Rodney, W. M., & Hahn, R. G. (2002). Impact of the limited generalist (no hospital, no procedures) model on the viability of family practice training. Journal of the American Board of Family Medicine, 15, 191–200.Google Scholar