Abstract
BACKGROUND: Pregnancy care in the USA is in crisis, particularly in rural areas. Shortages and maldistribution of care are contributing factors. Family medicine (FM) physicians could be crucial to addressing the crisis. OBJECTIVES: This study compared pregnancy and rural practice intentions of FM residents and FM obstetrics (FMOB) fellows, and current practices of FMOB fellowship alumni. METHOD: In this cross-sectional survey study, 25 FM residents, 7 FMOB fellows, and 37 FMOB fellowship alumni completed practice intentions or actual practice surveys. Variables of interest included intention or practice in rural locations and medically underserved areas, and pregnancy-care intentions or practice, including items on delivery types and advanced obstetrics. We used Fisher's exact test to compare residents, fellows, and alumni. RESULTS: Trainee intention and alumni practice were similar in practice characteristics except a higher rate of residents (80%) and fellows (100%) intended to practice in a medically underserved area (MUA) than alumni (29%) who practiced in an MUA (P < .001 and P = .001, respectively). Specific to pregnancy care, fellows and alumni respectively intended and provided low-risk, high-risk, and cesarean deliveries, and advanced obstetrics at higher rates than resident intentions. DISCUSSION: Results suggest FMOB fellows are more likely intend to provide pregnancy-related care compared to FM residents, and alumni provide pregnancy-related care at rates similar to fellow intentions. Few FM residents complete obstetrics fellowships. FMOB fellowships alone cannot sufficiently address care shortages. Expanding and promoting FMOB fellowships would increase the pregnancy -care workforce, but more is needed for FM to realize its potential to resolve the crisis.