— LETTERS TO THE EDITOR —

In Response to “Women Deserve Comprehensive Primary Care”

Courtney L. Goettel, MD

Fam Med. 2022;54(4):318-319.

DOI: 10.22454/FamMed.2022.871015

To the Editor:

I applaud Dr Barr’s efforts toward reviving maternity care training in family medicine residencies. I agree that maternity care composes a unique feature of the specialty and challenges us to grow to meet the needs of our society.1 To ensure our position as comprehensive care providers, family physicians need to increase access to maternity care and serve as mentors for trainees.

Family physicians can help expand coverage areas for obstetric services to reduce maternal mortality. The need for an enhanced network of maternity care providers is evidenced by increasing maternal mortality in the United States.2 Even without the incorporation of deliveries into practice, family physicians can help ease the burden of obtaining appropriate care with outreach clinics or shared care models where family physicians perform the majority of prenatal visits for patients that intend to deliver elsewhere. Various strategies exist to promote the incorporation of family physicians into maternity care, including developing interdisciplinary programs, supporting work-life balance, broadening training opportunities, and caring for the mother-child dyad.3

Many factors influence whether family medicine residents continue to provide maternity care, including time spent in maternity care rotations.4 However, mentorship by family physicians during these rotations is equally important. A shortage of mentors incorporating maternity care into their careers will perpetuate a cycle of excluding these services from family medicine. The proportion of deliveries attended by family physicians has decreased since the change in ACGME Family Medicine Requirements in 2014.5 The lack of available mentorship for maternity care is more dire in underrepresented minority family physicians. Family physicians who identify as Black/African American and Asian are less likely to provide obstetric care than those who identify as White, even when controlling for setting (rural vs urban).6 Without diversification of the maternity care workforce, the disparities experienced by minority populations will only continue to grow.

Maternity care is woven into the fabric that is family medicine. By increasing access and providing mentorship, family physicians can help to meet the needs and challenges of obstetric care in America

References

  1. Barr WB. Women deserve comprehensive primary care: the case for maternity care training in family medicine. Fam Med. 2021;53(7):524-527. doi:10.22454/FamMed.2021.451637
  2. Hoyert DL. Maternal mortality rates in the United States. NCHS Health E-Stats. 2019;2021. doi:10.15620/cdc:103855
  3. Goldstein JT, Hartman SG, Meunier MR, et al. Supporting family physician maternity care providers. Fam Med. 2018;50(9):662-671. doi:10.22454/FamMed.2018.325322
  4. Tong ST, Hochheimer CJ, Barr WB, et al. Characteristics of graduating family medicine residents who intend to practice maternity care. Fam Med. 2018;50(5):345-352. doi:10.22454/FamMed.2018.631796
  5. Fashner J, Cavanagh C, Eden A. Comparison of maternity care training in family medicine residencies 2013 and 2019: a CERA program directors study. Fam Med. 2021;53(5):331-337. doi:10.22454/FamMed.2021.752892
  6. Eden AR, Taylor MK, Morgan ZJ, Barreto T. Racial and ethnic diversity of family physicians delivering maternity care. J Racial Ethn Health Disparities. 2021;•••. doi:10.1007/s40615-021-01055-y

Lead Author

Courtney L. Goettel, MD

Affiliations: University of Pittsburgh Medical Center (UPMC) St Margaret, Pittsburgh, PA

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Barr WB. Women deserve comprehensive primary care: the case for maternity care training in family medicine. Fam Med. 2021;53(7):524-527. doi:10.22454/FamMed.2021.451637

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