Experiences of new family physicians finding jobs with obstetrical care in the USA

Abstract

ObjectiveThis study aimed to explore how new family medicine graduates who want to include obstetrics in their scope of practice identify and select jobs and to understand how employment influences scope of practice in family medicine, particularly the ability to provide maternity care and deliver babies.DesignMixed-methods study including a survey and qualitative interviews conducted in 2017.SettingWe electronically surveyed US family physicians and followed up with a purposeful subsample of these physicians to conduct in-depth, semistructured telephone interviews.Participants1016 US family medicine residency graduates 2014–2016 who indicated that they intended to deliver babies in practice completed a survey; 56 of these were interviewed.Main outcome measuresThe survey measured the reasons for not doing obstetrics as a family physician. To identify themes regarding finding family medicine jobs with obstetrics, we used a team-based, immersion–crystallisation approach to analyse the transcribed qualitative interviews.ResultsSurvey results (49% response rate) showed that not finding a job that included obstetrics was the primary reason newly graduated family physicians who intended to do obstetrics were not doing so. Qualitative interviews revealed that family physicians often find jobs with obstetrics through connections or recruitment efforts and make job decisions based on personal considerations such as included geographical preferences, family obligations and lifestyle. However, job-seeking and job-taking decisions are constrained by employment-related issues such as job structure, practice characteristics and lack of availability of family medicine jobs with obstetrics.ConclusionsWhile personal reasons drove job selection for most physicians, their choices were constrained by multiple factors beyond their control, particularly availability of family medicine jobs allowing obstetrics. The shift from physician as practice owner to physician as employee in the USA has implications for job-seeking behaviours of newly graduating medical residents as well as for access to healthcare services by patients; understanding how employment influences scope of practice in family medicine can provide insight into how to support family physicians to maintain the scope of practice they desire and are trained to provide, thus, ensuring that families have access to care.

The Impact of Practicing Obstetrics on Burnout Among Early-Career Family Physicians

“…18 While only 8% of current family physicians include OB in their practice, nearly 22% of recent graduates intend to include OB in their practice. 19 While conducting a qualitative study of recent family medicine graduates to better understand the motivating factors and barriers faced by FPs who want to include obstetric deliveries in their practice, 20,21 we found that almost all participants discussed the concept of burnout related to practicing OB. We aimed to explain how and why practicing OB might be associated with lower levels of burnout 13 by examining the ways in which FPs discussed the relationship between practicing OB and burnout.…”

“…As reported in detail elsewhere, 20,21 in 2017, we conducted semistructured telephone interviews with 56 recent family medicine graduates to understand intention to include OB in their practice. We used data from the American Board of Family Medicine (ABFM) to identify and recruit all FPs who graduated from residency between 2014 and 2016 and who, upon registering for their Board certification exam, indicated that they planned to include obstetric deliveries in their practice.…”

Raise the Bar for Family Medicine Residencies

“…Many of today's family medicine residencies exist in compromised settings where the prevailing scope of practice is much narrower than that desired by residency applicants. 3,4 This needs to change. The health of America's small towns, underserved communities, and rural hospitals depends on our choices now.…”

Proportion of Family Physicians in Solo and Small Practices is on the Decline

“…2,3 A growing number of recent family medicine graduates prefer to work in large practices for a better work-life balance and to avoid the administrative burdens and other responsibilities associated with owning a practice. 3,4 It is unclear if these advantages lead to fewer family physicians (FPs) in small and solo practices.…”