Should family physicians continue to provide obstetric and maternity care?

Family doctors are doing less obstetric care these days.

As reported by MedPage Today, a study shows that the number of prenatal visits seen by family physicians declined from 11.6% to 6.1% from 1994 to 2004, and perhaps of more concern, 38.6% to 12.9% in rural areas.

It’s not a huge surprise, since these days, obstetricians have absorbed most of the maternity cases. One reason is that hospitals are less likely to pay the high malpractice premiums needed for family physicians to provide obstetric care, compounded by the nationwide increase in the closure of maternity wards.

In any case, there is a serious possibility that family medicine will soon drop obstetric training, which will further reduce the access patients have to maternity care, especially in rural areas.

Comments

realityrounds.com
You hit upon a very hot button issue in the OB department where I work. We are one of the very few urban hospitals that allow FP’s to deliver babies. The few attending FP’s that do provide maternity care, tend to serve an immigrant population and do a decent job with their patients. The FP residents on the other hand, that is a different story. Most of them have no desire to learn OB, and do not plan on delivering babies after their residency. The quality of care between the OB residents and the FP’s is very obvious (unfair comparison, I know). One bone of contention I would like to point out in your post is that there is no mention of certified nurse midwives. They essentially have the same OB practice privileges as FP’s. CNM’s have fantastic patient outcomes, extremely low C/S rates, nonexistent rates of episiotomies, and very high patient satisfaction scores. CNM’s would be more than capable for picking up the slack in rural communities where FP’s have abandoned maternity care.
Nicolas Bloch
This touches the general and serious problem of excessive malpractice law suites in medicine here in US . We end up with not enough or even without OB/GYNs, Mammographers e.g. in certain regions,… and at the end proper patient care is disabled by a misunderstood and abused liability concept, which should protect and not harm the patient. I am afraid we have not even hit the cusp of this absurd development.
Carla Kakutani MD
I’ve delivered babies in my family practice for 17 yrs, in a community that also offers traditional OB and midwifery. But the difference is that I take call for my own OB patients 24/7 and deliver my own patients (unless I’ve made special coverage arrangements due to being out of town) The slow erosion of OB in family medicine is due to many things but probably the most crucial is the loss of a critical mass of family docs willing to teach OB, model how to integrate it into one’s life and provide coverage for each other. Doing OB certainly impacts your lifestyle, but the reward is huge. It keeps kids in your practice (if I wanted to only do adult medicine I would have become an internist) and creates a bond with your patients that is hard to describe. I’m lucky to work with a supportive group of OB’s at a supportive hospital with a long history of family docs doing OB. Despite that, we are down to just 3 of us still doing it.
Frank Drackman
So why not teach FPs to do Lap Cholys? Probably as many Gallstones out in the sticks as complicated deliveries… and at least only 1 patient gets screwed if you whack up Aunt Blabbies CBD…and you know why CNM’s have low CS rates, no OB/GYN with a lick of sense will have anything to do with them, and when you get down to it, Childbirths a natural event, that baby comes out fine 99% of the time no matter what you do..try leavin a necrotic gall bag in and see what happens…

Should family physicians continue to provide obstetric and maternity care?

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