Family physicians seeing fewer prenatal visits
■ The decline sparks concerns about limits on training opportunities and women's access to care.
By Susan J. Landers — Posted June 22, 2009
There has been a sharp drop during the past decade in prenatal care provided by family physicians, particularly in rural areas, according to a new study.
Although the total number of prenatal visits nationwide remained stable during the period studied, researchers found that visits to family physicians fell from 11.6% in 1995-96 to 6.1% in 2003-04. The decline was more severe when less-populated areas were examined. The drop there was from 38.6% to 12.9% during the same times.
For the study, researchers analyzed 6,203 records on prenatal visits collected by the National Center for Health Statistics for its National Ambulatory Medical Care Survey, which gathers data on patient visits to office-based practices in the nation. The study was published in the March/April Annals of Family Medicine (link).
Researchers were not able to determine from the data if maternity care once provided by family physicians was now more likely to be provided by obstetricians, said lead author Donna Cohen, MD, associate director of Lancaster General Hospital's Family Practice Residency Program in Pennsylvania.
But closings of maternity wards and rural hospitals may have contributed to the decline in services the family physicians provided to women in those settings, they said.
The decline is notable because family physicians had long provided maternity care, especially in rural and underserved communities. In 1986, an American Academy of Family Physicians survey showed that 43% of its members did deliveries. By 2006, that percentage had fallen to 28%.
Family physicians also saw prenatal care decline from 17.3% of total patient visits between 1980 and 1992 to 10.2% of visits between 1993 and 1999, stated data cited by the researchers.
Ongoing trend raises new concerns
Researchers said there are broader implications for their findings. Family medicine should consider how large a role maternity care should play in future physician training.
"As family physicians continue to decrease their provision of maternity care, it may prove challenging to support family medicine-based curriculum, recruit faculty members, identify community role models or develop sustainable models for residency graduates to include maternity care within their own practices, leading to further declines in accessible prenatal care physicians," they wrote.
The exclusion of maternity care in family practices may "ultimately affect women's access to prenatal care in communities across the United States," they concluded. Younger and poorer women likely would be most affected by a continuing drop in care provided by family physicians. The researchers found that women younger than 24 and those enrolled in Medicaid obtained care from family physicians more often than they did from obstetricians.