Declining Trends in the Provision of Prenatal Care Visits by Family Physicians

Abstract

PURPOSE We wanted to measure trends in the proportion of prenatal visits provided by family physicians nationally for a 10-year period and determine characteristics of prenatal visits made to family physicians compared with visits made to obstetricians. METHODSWe analyzed the National Ambulatory Medical Care Survey to identify prenatal visits made to family physicians and obstetricians between 1995 and 2004. The primary outcome measure was the trend in proportion of prenatal visits seen by family physicians. Multivariate logistic regression analysis determined characteristics of a prenatal visit occurring with a family physician vs an obstetrician.RESULTS A total of 6,203 records were included in the study, representing 244 million prenatal visits. The percentage of prenatal visits provided by family physicians decreased from 11.6% in 1995-1996 to 6.1% in 2003-2004 (P = .02 for trend). In non-metropolitan statistical areas, family physicians decreased their provision of prenatal visits from 38.6% in 1995-1996 to 12.9% in 2003-2004 (P = .03 for trend). Prenatal visits made to family physicians were associated with location in a non-metropolitan statistical area (OR = 5.56; 95% CI, 3.23-9.62), Medicaid insurance (OR = 1.76; 95% CI, 1.10-2.82), and younger maternal age (aged 30 years and older vs aged less than 24 years: OR = 0.63; 95% CI, 0.41-0.95).CONCLUSIONS Family physicians reduced their provision of prenatal visits by nearly 50% during a 10-year period and at an even greater rate in rural, non-metropolitan statistical areas. These fi ndings should be considered as family medicine considers the role of maternity care and strives to provide accessible prenatal services for all. INTRODUCTIONA ccess to maternity care for women in the United States remains a public health concern. Previous studies have established the contribution of family physicians to maternity care, particularly in rural areas.1-8 A decline in maternity care clinicians in rural communities where physicians may be in short supply has also been associated with poorer perinatal outcomes. 2,9-11A large body of literature from the 1980s and 1990s documented a decline in the provision of maternity care by family physicians. 1,2,[10][11][12][13][14][15][16][17] Even though more recent evidence is sparse, the available evidence suggests that this decline has persisted. Data from the American Academy of Family Physicians indicates that in 1986, 43% of responding family physicians performed deliveries compared with 28% of respondents in 2006, although interpretation of these data are limited by a variable response rate.18 Guirguis-Blake et al showed that family physicians decreased their contribution nationally to prenatal care from 17.3% of total visits (between 1980 and 1992) to 10.2% of visits (between 1993 and 1999

Obstetric Care by Family Physicians and Infant Mortality in Rural Alabama

“…4,5,10 In light of this, the declining number of FPs who are trained in and choose to provide OB services becomes even more concerning. 9,10,23 However, just as FPs benefit the health of the local population when they choose to provide maternity services, a benefit to the physicians themselves has also been documented. Avery and associates 25 documented that FPs practicing OB earn more than those who do not, despite the modest increase in the cost of malpractice insurance.…”

“…5,10 Despite the benefits of FPs providing OB services, the number of FPs incorporating OB into their practices has declined. 6,9,10 The American Academy of Family Physicians reports that in 2016, only 19% of responding FPs performed deliveries, compared with roughly 40% in 1986. 11,12 Likewise, the number of FPs who perform cesarean deliveries has decreased steadily, with only 9.3% performing cesarean deliveries either independently or in consultation with an OB/GYN.…”

“…13 Other studies have attempted to examine the link between improved IMR in rural communities and OB care provided by FPs. 9,20 These have suggested that such care can contribute to a significant reduction in IMR within a given community.…”

Back to the Future: Reflections on the History of the Future of Family Medicine

“…54 For example, the percentage of prenatal visits that were provided by family physicians decreased by 50% from 1995 to 2004, a decline that continued through 2010. 55,56 Family physicians' provision of care to children has similarly declined: One study reported a 33% decrease in the percentage of children's office visits provided by family physicians and general practitioners between 1992 and 2002. 57 Another study reported a decrease in the percentage of family physicians providing children's health care: from 78% to 68% between 2000 and 2009.…”

Proportion of Family Physicians Providing Maternity Care Continues to Decline

“…Several studies over the past decade have reported declining contributions to maternity care by family physicians. 1,2 Seeking to update past findings, we analyzed data from a census of the American Board of Family Medicine diplomates who were applying for the Maintenance of Certification for Family Physicians examination during the years 2000 to 2010 (n ϭ 7436, 8021, 9223, 9241, 9400, 7755, 8216, 9409, 9551, 9536, and 2433, respectively) to determine the mean percentage of practice time spent in maternity care across the study years and the percentage of family physicians who report providing any maternity care in each given year. The proportion of US family physicians who report providing maternity care declined from 23.3% in 2000 to 9.7% in 2010 (Figure 1).…”