The Contribution of Family Physicians in Providing Obstetric Care in Maternity Care Deserts

Context: Due to hospital closures, patients in many counties in the U.S. lack a place to receive maternity care, particularly in rural and urban underserved areas. Further, many of these counties do not have certified nurse midwives (CNM) or obstetrician-gynecologists (OB-GYNs) providing care and have been defined as maternity care deserts. In response, the Health Resources and Services Administration (HRSA) is in the process of developing criteria for identifying maternity care health professional shortage areas (HPSAs) to help improve access to maternity care in these areas. However, Family Physicians (FPs) often provide obstetrical care in maternity care deserts in both rural and urban settings and are an essential component of the obstetrical workforce.

Objective: This project will evaluate the presence of family physicians practicing obstetrical care in counties that do not have certified nurse midwives or OB-GYNs.

Study Design: This project will use the ABFM Certification Exam Questionnaire data from 2010-2020, as well as county level data on maternity care deserts from the Area Health Resource File (AHRF) and the Rural-Urban Commuting Codes to examine the distribution of family physicians practicing obstetrical care in relation to Maternity care deserts in the U.S.

Population Studied: Our analysis included non-Puerto Rico U.S. counties (n=3,142);

Outcome Measures: All counties where FPs practice OB; counties without a CNM or OB-GYN that have FPs practicing OB.

Results: 1,398 counties do not have a CNM or OB-GYN. More than ¾ of these counties (1,071) have at least one family physician practicing; we anticipate that many of these counties will have at least one FP doing OB care.

Conclusions: These results will provide important information about the role of family physicians in providing OB care in counties that have no other obstetric care and will likely demonstrate that family physicians are well- positioned to fill gaps in care. This research will help inform policy makers developing designations for maternal health professional shortage areas (HPSAs).