From Cradle to Grave: Health During Pregnancy and Over a Lifetime

I applaud the authors of “From Cradle to Grave: Health During Pregnancy and Over a Lifetime'' for emphasizing the importance of longitudinal primary care in addressing the ongoing national maternal health crisis. As highlighted in the editorial, the United States will be short 22,000 OB-GYN physicians by 2050. While Family Physicians are a natural fit to help combat this shortage by the scope of their specialty and training paradigm, the percentage of Family Physicians performing deliveries has declined steeply from 25% to 7% [5]. It is now more crucial than ever to cultivate and maintain interest among Family Physicians to pursue obstetrics. But how do we do that?

The Accreditation Council for Graduate Medical Education (ACGME) now requires Family Medicine residents to complete at least 400 hours (or four months) dedicated to training on the Labor and Delivery floor and perform or directly supervise at least 80 deliveries to practice Obstetrics (OB) post-graduation [1]. This aligns with the Council of Academic Family Medicine Educational Research Alliance (CERA) survey findings that residents completing more than 80 deliveries are 270 times more likely to pursue OB following graduation when compared to residents completing 40 or less deliveries [4]. The same survey also highlights that residents from programs where more than 40% of vaginal deliveries are supervised by Family Physicians are 3.2 times more likely to continue OB in their initial job following graduation [4]. Notably, an omnibus survey of Family Medicine Residency Program Directors highlights that 17% residents from programs with an OB track pursue OB post-graduation compared to 5% residents from programs with no OB track (p<0.001) [3].

Besides creating opportunities for more deliveries, Family Medicine residencies can: (1) create an OB track as part of the curriculum, (2) integrate Family Medicine OB faculty into each residency program, and (3) foster a supportive inter-professional relationship with the OB department [3-5].

Family Medicine residency programs should incorporate appropriate quantity and quality of OB experiences so that our residents feel comfortable including OB as a part of their future practice. Exposure, a structured OB track with more Family Medicine OB faculty, and an interdisciplinary approach are the key tenets to address our nation’s maternal health crisis and the impending national shortage of OBGYNs in the future. Measures must be taken to reverse the declining number of Family Physicians practicing Obstetrics.

References:

1. ACGME Program Requirements for Graduate Medical Education in Family Medicine. Accreditation Council for Graduate Medical Education. July 2024, 35-36; https://www.acgme.org/globalassets/pfassets/programrequirements/2024-prs...
2. Pearce CF, Sutter MB. From Cradle to Grave: Health During Pregnancy and Over a Lifetime. The Annals of Family Medicine. Jan 2024, 22(1) 1-2; DOI: 10.1370/afm.3084
3. Roskos SE, Barreto TW, Phillips JP, King VJ, Eidson-Ton WS, Eden AR. Maternity Care Tracks at US Family Medicine Residency Programs. Fam Med. 2021;53(10):857-863. https://doi.org/10.22454/FamMed.2021.237852.
4. Sutter MB, Prasad R, Roberts MB, Magee SR. Teaching Maternity Care in Family Medicine Residencies: What Factors Predict Graduate Continuation of Obstetrics? A 2013 CERA Program Directors Study. Fam Med 2015;47(6):459-465.
5. Taylor MK, Barreto T, Goldstein JT, Dotson A, Eden AR. Providing Obstetric Care: Suggestions From Experienced Family Physicians. Fam Med. 2023;55(9):582-590; DOI: 10.22454/FamMed.2023.966628