Slide in number of family physicians who deliver babies poses potential access challenge

WASHINGTON, DC — Family physicians could hold the key to addressing the shortage of obstetricians, particularly in underserved areas, but payment, credentialing and other policy changes must first be in place, according to a study by Robert Graham Center researchers.

The study, “Family Physicians Practicing High Volume Obstetric Care Has Recently Dropped by Half,” in the June 15 issue of American Family Physician, confirmed a decline in the overall number of family physicians delivering babies. The decline was greatest among family physicians who delivered 25 babies or fewer per year, but it was also seen in family medicine practices that delivered more than 50 babies annually.

From 2003 to 2009, the proportion of family physicians who were practicing high volume obstetrics had held steady. However, by 2016, Tyler Barreto, MD, a Robert L. Phillips policy fellow at the Robert Graham Center, and her colleagues found “a new, 50 percent decrease in family physicians providing high-volume obstetrics.”

The results are of concern, she said, because the American Congress of Obstetricians and Gynecologists projects a shortage of 9,000 obstetricians by 2030.

“This combination of a decrease in family physicians attending deliveries and a shortage of obstetricians leads to concern for reduced access to care for pregnant women, especially those in rural areas,” Barreto writes.

Other data show that insurers’ payment policies and family physician employment status may be among the likely factors contributing to the decline. Insurance companies’ payment policies may limit reimbursement for prenatal and obstetrical care to obstetricians. Likewise, hospitals may credential only obstetricians for prenatal and delivery services.

“Potential responses to growing shortages of obstetric providers could include changing call schedules, lowering barriers to reimbursement and credentialing, and creating other payment or practice incentives to keep family physicians practicing obstetrics,” she concludes.