Maternity Care Services Provided by Family Physicians in Rural Hospitals

Abstract

Background: The purpose of this study was to describe how many rural family physicians (FPs) and other types of providers currently provide maternity care services, and the requirements to obtain privileges.Methods: Chief executive officers of rural hospitals were purposively sampled in 15 geographically diverse states with significant rural areas in 2013 to 2014. Questions were asked about the provision of maternity care services, the physicians who perform them, and qualifications required to obtain maternity care privileges. Analysis used descriptive statistics, with comparisons between the states, community rurality, and hospital size.Results: The overall response rate was 51.2% (437/854). Among all identified hospitals, 44.9% provided maternity care services, which varied considerably by state (range, 17-83%; P < .001). In hospitals providing maternity care, a mean of 271 babies were delivered per year, 27% by cesarean delivery. A mean of 7.0 FPs had privileges in these hospitals, of which 2.8 provided maternity care and 1.8 performed cesarean deliveries. The percentage of FPs who provide maternity care (mean, 48%; range, 10 -69%; P < .001), the percentage of FPs who do cesarean deliveries (mean, 66%; range, 0 -100%; P < .001), and the percentage of all physicians who provide maternity care who are FPs (mean, 63%; range, 10 -88%; P < .

Supporting Family Physician Maternity Care Providers

“…12 Despite these trends, FPs often still provide the majority of maternity care in rural areas of the US. 13 The American Academy of Family Physicians (AAFP) and ACOG both acknowledge that FPs sometimes provide all of the obstetric care in rural communities. The ACOG encourages OB/GYNs to partner with FPs to ensure adequate training and consultation in rural areas.…”

Associations Between Program-Level Abortion Training and Graduate Preparation for and Provision of Reproductive Care

“…We hypothesize that because family physicians in rural areas are likely to be the main providers of maternity care, programs with a rural focus consequently emphasize maternity care skills (eg, performing or assisting Csections). [10][11][12] This hypothesis is supported by our multivariate analysis, which attenuated differences in Csection practice when we controlled for programs with rural emphasis. The significant differences in preparation for and practice of colposcopy are harder to explain, though may be related to recent clinical guideline changes that impact the need for colposcopy.…”

Family Medicine and Obstetrics: Let's Stop Pretending

“…Our study of our early P4 graduates who completed a year of extra training in maternity care found they were much more likely to provide maternity care services, plus they were more likely to provide a wide basket of other services including caring for hospitalized adults and children, and performing hospital-based procedures. 9 We have heard similar anecdotes from other programs offering extra training, and there is a literature on the effect of traditional obstetric fellowships on the provision of maternity care in practice, which found that roughly half of their graduates work in rural areas, at least for part of their early career, and roughly half become residency faculty. 10,11 Our profession has had a considerable lively discussion of the role of maternity care in residency education, its requirements, and its impact on graduates' provision of these services.…”

“…19 A survey of family medicine and OB/GYN residents confirmed that family medicine residents were more likely to provide maternity care services to rural areas 20 and other studies have found that family physicians provide a disproportionate share of rural deliveries. 9,21 Greater travel distance to maternity care services is associated with worse perinatal outcomes. 22 But rural hospitals are closing, especially labor and delivery units, a trend that has recently been reported in the lay press.…”