Reply to “Comparison of Maternity Care Training in Family Medicine Residencies 2013 and 2019: A CERA Program Directors Study”

We applaud Dr Fashner and colleagues for their analysis of the changes in perinatal care* training within family medicine residencies following the 2014 Accreditation Council for Graduate Medical Education (ACGME) requirements update.1 As leaders of the STFM Family Centered Maternity Care Collaborative, we share the authors’ concerns that this decline in perinatal care training will detrimentally affect both our core identity as family physicians and the perinatal care workforce. 

As family physicians, we pride ourselves on adjusting our skill set to meet the needs of our communities. Given the current perinatal health crisis2 and inequities in perinatal care,3 how can we remain faithful to this core value while simultaneously deemphasizing perinatal care training? Family physicians care for those most vulnerable to perinatal morbidity and mortality, including Black, Indigenous, and People of Color (BIPOC), trauma survivors, Medicaid beneficiaries, and rural residents.^4,5 With our training in social justice, comprehensive reproductive care, and care of families, we can help communities meet the goals of reproductive justice.⁶ If we are to truly care for all families, we must make a firm, unequivocal commitment to perinatal training in family medicine residency.

The forces that prompted the 2014 ACGME change, including institutional barriers limiting procedural volume, have not gone away. Despite these constraints, some programs are still able to consistently train residents to competency in perinatal care.¹ It is critical that our governing bodies, including the ACGME, support these programs by protecting their training against further institutional threats. To do this, we must have clear, rigorous national standards for competency,⁷ as well as transparency about the scope of training provided at each program. Many students are drawn to family medicine because of the opportunity to provide full-scope care, including perinatal care⁸; we should not lose these future primary care providers by limiting our scope. We also must support family medicine faculty who teach and model perinatal care, particularly BIPOC faculty, given the lack of racial and ethnic diversity in the family medicine perinatal care workforce.⁹ 

Training residents to provide perinatal care is wasted effort if graduates are unable to practice to the full extent of their abilities.¹⁰ National family medicine organizations must advocate to reenvision health systems with a foundation of full-scope family physicians, especially in rural communities. For too long, advocacy for one specialty has meant competition with others; family medicine should be a leader in interdisciplinary collaboration to improve perinatal care. We must partner with community birth advocates, midwives, and obstetrician/gynecologists to ensure improved experiences for all birthing people and families. 

As we strive to retain perinatal care in family medicine, we cannot forget the big picture. Our health care system perpetuates corporate profits, structural violence, and systemic racism at the expense of the people it purports to serve. Thus it should come as no surprise that providing excellent, comprehensive care to families, and training residents to do the same, often feels like a losing proposition. To truly meet the needs of our communities, including equitable and comprehensive reproductive care, we must continue to fight for health care revolution.^11,12