Family physicians' declining contribution to prenatal care in the United States

There has been a substantial decline in prenatal care by family physicians over the past 20 years in all geographic regions of the country. Even so, during the past two decades, FP/GPs have provided over two million prenatal visits per year. As the field re-explores future scope, it should consider the erosion of the provision of prenatal care, its effect on the U.S. population and the specialty, and possibilities for revitalization of prenatal care in residency curricula and practice.

Guirguis-Blake J, Fryer GE, Deutchman M, Green LA, Dovey SM, and Phillips RL

We analyzed National Ambulatory Medical Care Survey (NAMCS) data spanning 1980-1999 identifying all prenatal visits performed by physicians. In order to create comparison periods consisting of an equal number of annual surveys using all NAMCS data available over the past 20 years, data were aggregated for seven surveys prior to 1993 (early period) and seven surveys after 1992 (later period).

Overall, there were 27.4 million live births in the early period and 27.5 million live births in the later period, yet there was a decrease in total number of prenatal visits performed by all physicians in the country as well as a decrease in number of visits per FP/GP and obstetrician. Total prenatal visits by all medical specialties decreased from 192 million in the early period to 182 million in the later period with the loss of visits seen largely in areas outside of Metropolitan Statistical Areas (non-MSAs). The table below focuses on the two specialties that, together, provide almost all physician-delivered prenatal visits to US women. FP/GPs provided 33.2 million visits (17.3% of all prenatal visits) in the early period; this contribution dropped to 18.6 million visits (10.2%) in the later period. Most strikingly, there was a 50% drop in number of prenatal visits by FP/GPs in non-MSAs. FP/GP visits decreased in all regions, including the Midwest, where there was the greatest drop in number of visits over time. In the Midwest, FP/GPs delivered 15.5 million visits in the early period and 6.1 million visits in the later period.

These results support the general impression that FP/GPs' contribution to prenatal care has declined over time. Plausible explanations for these changes include increases in non-physician providers, changes in specialist workforce, or poor access to prenatal services. Nevertheless, FP/GPs continue to make an important contribution to prenatal care especially in non-MSAs. It is unclear whether rural regions would be adequately served if FPs abdicated prenatal care since evidence suggests that these areas are vulnerable to FP/GP service withdrawal.

 

Guirguis-Blake J, Fryer GE, Deutchman M, Green LA, Dovey SM, Phillips RL. Family physicians' declining contribution to prenatal care in the United States. Am Fam Physician 2002;66:2192.