The number of family physicians who deliver babies and provide care for pregnant women has declined, a change that coincides with a projected shortage of obstetricians.
A study by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, which was published in American Family Physician, found that the number of family physicians practicing high-volume obstetric care dropped by half between 2009 and 2016.
That’s a concern, given the American Congress of Obstetricians and Gynecologists projection of a shortage of 9,000 obstetricians by 2030.
“This combination of a decrease in family physicians attending deliveries and a shortage of obstetricians leads to concern for reduced access to care for pregnant women, especially those in rural areas,” wrote lead author Tyler Barreto, M.D., a Robert L. Phillips policy fellow at the center, and her fellow researchers.
To encourage more family physicians to provide obstetrical care, the industry must remove obstacles including payment, credentialing and other policies, the authors write. The decline was greatest among family physicians who delivered 25 babies or fewer per year, but it was also seen in family medicine practices that delivered more than 50 babies annually.
Factors that contributed to the decline included insurance payment policies that limit reimbursement for prenatal and obstetrical care to obstetricians and family physician employment status, the study found. Hospitals may also credential only obstetricians for prenatal and delivery services.
“Potential responses to growing shortages of obstetric providers could include changing call schedules, lowering barriers to reimbursement and credentialing and creating other payment or practice incentives to keep family physicians practicing obstetrics,” Barreto said.
The lack of doctors hits rural areas especially hard. Despite a federal law that requires every emergency room in the U.S. to treat women in labor, some women are still turned away at rural facilities or treated at hospitals that lack an obstetrics specialist.
The Robert Graham Center for Policy Studies in Family Medicine and Primary Care is an independent research unit affiliated with the American Academy of Family Physicians.