We are grateful for the thoughtful and resonant commentary1 on our recent article2 examining the financial landscape in which family medicine obstetrics fellowships (FMOB) operate. The writer compellingly captured the often-invisible values driving the field—values that are constricted and obscured when viewed solely through the lens of fee-for-service models and budget sheets.
The observation that FMOB exists at the intersection of high social value and low financial margin is especially poignant. After reading this letter, the director of our FMOB fellowship, and coauthor on the article, commented that he felt seen in a way he has not experienced in academic literature, professional interactions, or broader policy frameworks. The letter affirms the quiet reality of his daily work and contributions and underscores the critical point that sustainability of rural maternal care depends not only on funding, but also the morale of those who provide the care.
We wholeheartedly agree that systems literacy should be a core component of FMOB training. We are encouraged that our findings resonated in this way and hope our data will serve as a foundation for an operational shift in training. Fellowship graduates require not only clinical and surgical skills, but also the economic and advocacy understanding necessary to protect and promote the services on which rural and underserved communities rely.
We are grateful to the writer for engaging with our work in a way that broadens the conversation to include how the unique contributions of family medicine physicians are defined and valued.
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