Fewer Family Physicians Offering Obstetric Care
The proportion of family medicine residency graduates who include obstetric care in their practices has declined substantially, according to a survey of FPs who completed residencies after 1996.
Researchers at the University of Washington in Seattle sent questionnaires to 640 graduates during two survey periods. Among those who completed residencies between 1997 and 1999 and were surveyed in 2000, 81% of 205 respondents said they were providing obstetric care.
Then came the drop. Of 223 FPs who graduated between 2000 and 2002 and responded in 2002, only 61% were providing obstetric care. The 20% decrease was significant (p<0.05), Frederick M. Chen, M.D., M.PH, reported at the American Academy of Family Physicians meeting here.
The change was particularly apparent in urban areas, with a shift from 76% to 51% in the two study periods. The proportion providing care in rural areas did not change substantially between the two survey groups, with approximately 70% of both cohorts providing regular obstetric care.
There was no significant association with physician gender or with the subjective rating of the physicians’ own training in maternity care.
Obstetrical care is the most common form of prenatal care chosen by women. But how do you know if it’s right for you?
What is an Obstetrician?
An obstetrician is a doctor who specializes in caring for pregnancies, as well as labor and the postpartum period. Many obstetricians have also received training in gynecology, which deals with the health of the female reproductive system. Those doctors who are trained in both fields are referred to as obstetrician/gynecologists or OB/GYN. Obstetricians may also study to become perinatologists who specialize in high-risk pregnancies, testing for high-risks and fetal therapy. If you have a history of previous pregnancy complications, are having a multiple pregnancy or have a chronic medical condition, you should visit a perinatologist.
For more information check : Prenatal Care
The physicians surveyed were graduates of residency programs in the WAMI network, which includes facilities in Washington, Alaska, Montana, and Idaho. “In the past we saw about 63% of family practitioners providing such care, which was higher than national rates,” Dr. Chen said. “Now we are moving in the direction of the national rates.”
Dr. Chen and colleagues speculate that some of the decline may be due to the setting in which urban physicians practice. “They may intend to do maternity care but find that the reality of doing so is prohibitive,” said one of the researchers. Anecdotal evidence from survey respondents indicated that they often practiced in clinic settings where they were actively discouraged from providing obstetric care in favor of providing more regular office hours and seeing a larger number of patients.
The Disadvantages
While many women prefer obstetrical prenatal care, it is important to find the right obstetrician for you. Unfortunately, the majority of obstetricians out there are men. While many of them provide excellent care, there are others who have a hard time seeing things from a woman’s perspective. This could mean that you have difficulty in receiving the level of care you want and may be expected to do as you are told rather than voice your opinion (although the same can be said for some female obstetricians).
“Our results are cause for concern especially in urban underserved areas,” Dr. Chen said. “Who is going to be doing obstetrics care? We should think about policies that end up restricting OB practice.”
Primary source: AAFP presentation: Prepared but not practicing: Declining maternity care among recent family medicine graduates. Chen et al.
Revision date: June 22, 2011
Last revised: by Jorge P. Ribeiro, MD