Background and Goal: This study explores the geographic distribution of family physicians providing maternity care and identifies opportunities for family physicians to expand access to maternity care.
Study Approach: The study merged county-level counts of OB-GYNs, certified nurse-midwives, and hospitals offering obstetric services from the 2021–2022 HRSA Area Health Resource File with 2013–2021 American Board of Family Medicine data on family physicians who reported delivering babies.
Researchers used a mapping approach to identify three types of vulnerable counties based on the following: family physicians as the only clinician provider of maternity care along with at least one hospital providing obstetric care ('family physicians with hospitals'); family physicians as the only clinician provider of maternity care with no hospital providing obstetric care ('family physicians only'); and no clinician providers of maternity care but county has at least one hospital providing obstetric services ('only hospital').
Main Results:
The majority of the 325 vulnerable counties across the three types are rural and concentrated in the central U.S., the upper Midwest, and in Mississippi. More than one-third of these counties are found in just four states: Texas, Iowa, Nebraska, and Kansas.
'Only hospital' counties are located primarily in a few states, including Mississippi, Missouri, Oklahoma, and Texas, have significantly higher percentages of Black populations, and have higher rates of social deprivation.
'Family physicians with hospital' and 'family physician only' counties have significantly lower rates of preterm births, low birth weight, and infant mortality when compared to 'only hospital' counties.
Why It Matters: While family physicians are providing maternity care in rural areas across the U.S., opportunities exist to expand their reach. The study findings highlight the importance of supporting rural training tracks, obstetric fellowship programs, and obstetric-focused family medicine residency programs in filling high-need area deficits.
Michael Topmiller, PhD, et al
The Robert Graham Center for Policy Studios in Family Medicine, American Academy of Family Physicians, Washington, DC
