— LETTERS TO THE EDITOR —

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

Claire Thomson, MD, MPH | Jessica Taylor Goldstein, MD | Christine Chang Pecci, MD | Fareedat Oluyadi, MD | Sara G. Shields, MD, MS | Narges Farahi, MD

Fam Med. 2022;54(1):69-69.

DOI: 10.22454/FamMed.2022.946530

To the Editor:

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

References

  1. 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
  2. Pregnancy Mortality Surveillance System. Centers for Disease Control and Prevention. Accessed June 4, 2021. https://www.cdc.gov/reproductivehealth/maternal-mortality/pregnancy-mortality-surveillance-system.htm
  3. Birth Equity for All Black Birthing People. National Birth Equity Collaborative. Accessed June 4, 2021. https://birthequity.org/
  4. Young RA. Maternity care services provided by family physicians in rural hospitals. J Am Board Fam Med. 2017;30(1):71-77. doi:10.3122/jabfm.2017.01.160072
  5. Kozhimannil KB, Fontaine P. Care from family physicians reported by pregnant women in the United States. Ann Fam Med. 2013;11(4):350-354. doi:10.1370/afm.1510
  6. Reproductive Justice. Sister Song Women of Color Reproductive Justice Collective. Accessed June 4, 2021. https://www.sistersong.net/reproductive-justice
  7. Magee SR, Eidson-Ton WS, Leeman L, et al. Family medicine maternity care call to action: moving toward national standards for training and competency assessment. Fam Med. 2017;49(3):211-217.
  8. Alavi M, Ho T, Stisher C, et al. Factors that influence student choice in family medicine: a national focus group. Fam Med. 2019;51(2):143-148. doi:10.22454/FamMed.2019.927833
  9. Eden AR, Taylor MK, Morgan ZJ, Barreto T. Racial and ethnic diversity of family physicians delivering maternity care. J Racial Ethn Health Disparities. 2021; Epub ahead of print. doi:10.1007/s40615-021-01055-y
  10. Barreto TW, Eden AR, Hansen ER, Peterson LE. Barriers faced by family medicine graduates interested in performing obstetric deliveries. J Am Board Fam Med. 2018;31(3):332-333. doi:10.3122/jabfm.2018.03.170427
  11. Chen FM. STFM for All. Fam Med. 2019;51(6):535-536. doi:10.22454/FamMed.2019.966678
  12. Cullen, J. AAFP Letter for the Senate Finance Committee RFI on Maternal Health. April 3, 2020. Accessed June 4, 2021. https://www.aafp.org/dam/AAFP/documents/advocacy/prevention/women/LT-SenateFinance-MaternalHealth-040320.pdf

Lead Author

Claire Thomson, MD, MPH

Affiliations: Swedish First Hill Family Medicine Residency

Co-Authors

Jessica Taylor Goldstein, MD - Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM

Christine Chang Pecci, MD - University of California, San Francisco Family Medicine Residency

Fareedat Oluyadi, MD - University of North Carolina Family Medicine Residency

Sara G. Shields, MD, MS - University of Massachusetts Family Medicine Residency

Narges Farahi, MD - University of North Carolina Family Medicine Residency

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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. https://doi.org/10.22454/FamMed.2021.752892

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