Family Medicine and Obstetrics: Let's Stop Pretending

Abstract

It is time to stop pretending that delivering babies is one of the core activities of family medicine. At no time in the history of American family medicine have the majority of the members of the American Academy of Family Physicians (AAFP) delivered babies. A study in 1982 found that approximately 44% of family physicians delivered babies 1 , another study reported 43% in 1986 2 , another 26% in 1993 3 , and the most recent data from the AAFP states the current number is 17.1%. 4 The way forward from these trends should not be to continue business as usual. Barreto et al 5 found that 13% of 2016 family medicine residency graduates deliver babies. Almost half the respondents were not interested at all in obstetrics practice (889/2018). Of those left who did not deliver babies, 60% mentioned lack of availability of jobs where family physicians in practice deliver babies as the reason and 60% mentioned lifestyle considerations, followed by malpractice costs and privileging challenges. These realities have implications for family medicine residency education and the basket of services provided by its graduates.

Re: Family Medicine and Obstetrics: Let's Stop Pretending

“…To the Editor: We thank Avery et al for their response to our commentary. 1 While they state that, "… our conclusions are different," we find that their points more confirm our points than refute them. We agree with all their positive statements about family physicians delivering babies, especially in rural areas.…”

Stewardship

“…3 As a result, some have suggested that it is time for us to admit that obstetric care is no longer a core activity in our discipline. 4 The current study is limited by a relatively low response rate (48.4%) and a response bias that probably underestimates the attrition rate. Nevertheless, the results offer a disturbing look at the sad condition of family-oriented maternity care.…”

“…Maybe it is time to make maternity care a fellowship to be completed after residency. 4 After all, we don't need every family physician to provide maternity care, so why does it matter if we have large numbers of residency programs who cannot provide this training?…”

Maternity Care Tracks at US Family Medicine Residency Programs

“…One solution to the need for additional family physicians who provide maternity care in light of the changed ACGME requirements for family medicine training is the opportunity for enhanced maternity care training for interested residents. 15,22 A recent Council of Academic Family Medicine Educational Research Alliance (CERA) survey of 245 program directors aimed to understand trends in family medicine resident maternity care experiences after the 2014 change in ACGME requirements. This survey found that the majority (62%) of program directors estimate that fewer than 10% of their residents continue to attend vaginal deliveries after graduation.…”