In Response to “The Impact of Practicing Obstetrics on Burnout Among Early-Career Family Physicians”

Thanks to Dr Tyler Barreto and colleagues for writing “The Impact of Practicing Obstetrics on Burnout Among Early-Career Family Physicians” in the June 2020 issue of Family Medicine. Their article thoughtfully outlines the family medicine-obstetric paradox wherein delivering babies can simultaneously protect from and contribute to burnout for family physicians. While unpredictable call hours and fear/stress of patient outcomes can contribute to provider stress, conversely, delivering babies brings joy to the practice, diversity in practice, and “keeps the practice young.”¹

As an early-career family physician myself, these are the reasons I choose to incorporate family-centered maternity care in my full scope practice. I believe the positives of delivering babies certainly outweigh the negatives. In the original article, family physicians commented on the lifestyle aspect of delivering babies (unpredictable long hours). Balance can be reestablished with a structured schedule. OB night call followed by an administrative morning, instead of patient care, can be protective for the physician to get a later start to the day if it was a busy night. Fear and stress of complicated patient outcomes can be reduced by having adequate OB backup coverage. A laborist model, as practiced at my hospital, is one example. Having a 24-hour OB laborist available in house to help with obstetric complications helps young family physicians feel less fearful of bad outcomes, leading to less burnout.

Additionally, having more family physicians practicing family-centered maternity care will stage a strong model for residents in training. As noted by Dr Chen, maternity and obstetric care is, and must always be, a central pillar of family medicine training. The pregnancy and birth experience is a foundational element of our scope as family physicians. Maternity care directly grows and supports our pediatric care. It also teaches us procedural skills and familiarity. Most importantly, it ties us to the broad scope of care for women, children, and families. It cannot be diluted or lost.²

From a practical standpoint, obstetrics also ensures young children in the practice. This is essential to meeting ACGME-required pediatric numbers, which can generally be challenging for family medicine residencies. There are aspects of delivering babies and providing family-centered maternity care that can lead to physician burnout, however with schedule modification and having adequate OB backup coverage, we can take better care of ourselves, while offering a full-scope practice.