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

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

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.

Back to top


Sharp decline in prenatal visits

A study in the Annals of Family Physicians measured 10-year trends in the proportion of prenatal visits provided by family physicians. The researchers examined 6,203 records representing 244 million prenatal visits made between 1995 and 2004.

1995-1996 11.6%
1997-1998 9.2%
1999-2000 8.7%
2001-2002 7.7%
2003-2004 6.1%

Source: "Declining Trends in the Provision of Prenatal Care Visits by Family Physicians," Annals of Family Medicine, March/April (link)

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn