Reply to “It’s Time For Advocacy”

We are grateful to Dr Williamson for his kind comments1 and for his comprehensive service to his patients and community. We agree that overly restrictive credentialing policies can stack the deck against family physicians in some communities and that this very real problem requires action. Dr Williamson suggests this action should be advocacy. We wonder what that means.

The word advocacy evokes discussions with legislators and large organizations, awaiting action to be taken by others on our behalf. This is certainly vital. However, it may take time, or may be ineffective. What are our patients, communities, and colleagues to do as we wait? Family physicians are also well poised to advocate locally by building self-efficacy.2 For example, four family physicians in Texas leveraged their skill sets and services in a rural community resulting in expanded privileges in not just one hospital, but three.3 Others partner with residency training environments to build robust pipelines4,5 and political capital to ensure continued opportunities for broad scopes of practice and better service to patients. Support can also come from outside our specialty; sometimes sympathetic administrators,5 obstetricians, perinatologists,6 or even patients and the public7 can be key voices in the conversation. With our emphasis on community engagement and equity, family physicians are well poised to lead these changes.

We also should not forget our unique strengths in these conversations. Rather than simply advocating for family physicians to deliver babies, we should also emphasize the unique strengths of family-centered maternity care. Family physicians are the only physicians who can care for a pregnant woman along with her entire family during a vulnerable period. We are highly capable of delivering babies, caring for children as they grow, and maintaining the health of fathers and grandparents—all in the same day! Emphasizing that only family physicians can do this, can be a powerful strategy. If all of the family physicians in a community stand together, we can ask hospitals one powerful question: are you willing to give up the rest of what the family physicians in this community do just to keep them out of the delivery room?

We must use every available strategy to protect our scope of practice in a multitude of settings, but we have little chance of success if maternity providers are forced to stand alone. We should consider not only policy change, but also building grassroots movements, local consensus, and community relationships to keep a broad range of skills and services available to our graduates, colleagues, and patients.