Maternity care access in the United States is in crisis. The American Congress of Obstetrics and Gynecology projects that by 2030 there will be a nationwide shortage of 9,000 obstetrician-gynecologists (OB/GYNs). Midwives and OB/GYNs have been called upon to address this crisis, yet in underserved areas, family physicians are often providing a majority of this care. Family medicine maternity care, a natural fit for the discipline, has been on sharp decline in recent years for many reasons including difficulties cultivating interdisciplinary relationships, navigating privileging, developing and maintaining adequate volume/competency, and preventing burnout. In 2016 and 2017, workshops were held among family medicine educators with resultant recommendations for essential strategies to support family physician maternity care providers. This article summarizes these strategies, provides guidance, and highlights the role family physicians have in addressing maternity care access for the underserved as well as presenting innovative ideas to train and retain rural family physician maternity care providers. (Fam Med. 2018;50(9):662-71.)

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Context: The number of family physicians (FPs) providing obstetric care has progressively decreased over time. The FPs who provide this care often do so for rural and underserved patients filling access to care gaps. Finding ways to retain FPs in the obstetric workforce is critical especially for the health of underserved communities. Objective: To identify modifiable differences between FPs who stay in the obstetric workforce and those who stop providing obstetric care. Study Design and Analysis: Survey. Descriptive statistics and logistic regression. Setting: Online survey. Population Studied: Mid to late career FPs who reported that they attend deliveries as part of their practice during their American Board of Family Medicine Continuing Certification exam registration questionnaire. Outcome Measures: Dichotomous response to question if the FP continues to attend deliveries as part of their practice. Descriptive data on individual and practice characteristics. Results: 1,505 FPs were included in this study; 450 of those FPs had stopped attending deliveries as part of their practice after doing so for an average of 20.53 years. Of those, 162 (36%) continue to provide prenatal care and 172 (38.22%) continue to provide postpartum care. We found no differences between FPs who stopped attending deliveries and those who continued based on individual factors including age, gender, race, rurality, or practice setting. However, compensation per delivery or through a fee-for-service model was associated with a decreased likelihood of continuing to attend deliveries compared to FPs paid a salary that included attending deliveries (OR 0.71 95% CI 0.51 to 0.97). Receiving extra compensation in addition to their salary (through a stipend, pay per call, or per hour) compared to being paid a salary that includes attending deliveries (i.e., no additional payment for deliveries) was associated with an increased likelihood of continuing to attend deliveries (OR 2.53, 95% CI 1.10 to 5.85). Conclusions: Experienced FPs who stop delivering babies do not seem to be systematically doing so because of individual or practice setting characteristics. Differences in compensation models between those who have stopped and those who continue to attend deliveries suggest that shifting to a compensation model that provides additional time-based compensation to a salary could help to maintain the workforce of experienced FPs and continue to fill gaps in access to obstetric care.

Background Patient‐centered care is the best practice in the care of pregnant and postpartum patients. The COVID‐19 pandemic prompted changes in perinatal care policies, which were often reactive, resulting in unintended consequences, many of which made the delivery of patient‐centered care more difficult. This study aimed to understand the impact of the COVID‐19 pandemic on perinatal health care delivery from the perspective of family physicians in the United States. Methods From October 5 to November 4, 2020, we surveyed mid‐ to late‐career family physicians who provide perinatal care. We conducted descriptive analyses to measure the impact of COVID‐19 on prenatal care, labor and delivery, postpartum care, patient experience, and patient volume. An immersion‐crystallization approach was used to analyze qualitative data provided as open‐text comments. Results Of the 1518 survey respondents, 1062 (69.8%) stated that they currently attend births; 595 of those elaborated about the impact of COVID‐19 on perinatal care in free‐text comments. Eight themes emerged related to the impact of COVID‐19 on perinatal care: visitation, patient decisions, testing, personal protective equipment, care continuity, changes in care delivery, reassignment, and volume. The greatest perceived impact of COVID‐19 was on patient experience. Conclusions Family physicians who provided perinatal care during the COVID‐19 pandemic noted a considerable impact on patient experience, which particularly affected the ability to deliver patient‐centered and family‐centered care. Continued research is needed to understand the long‐term impact of policies affecting the delivery of patient‐centered perinatal care and to inform more evidence‐based, proactive policies to be implemented in future pandemic or disaster situations.

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