Strong Obstetric Care Training in Family Medicine Residency: Bolstering the Number of Family Physicians Attending Births

Background and Objectives: Despite being critical to maternity care access, family physicians attending births continue to decrease in number. We aimed to determine the level of obstetric training at family medicine residencies and to use this variable to quantify the impact of residency training on the maternity care workforce.

Methods: We used data from the 2016 to 2023 American Board of Family Medicine National Graduate Survey and the 2018 Council of Academic Family Medicine Educational Research Alliance residency program director survey. Our exposure variable was created from a self-reported number of births attended in residency and tested using bivariate analyses with eight survey items that may indicate strong obstetric training. We then included residency obstetric training in a multilevel multiple logistic regression with attending births in practice as the outcome.

Results: Sixty percent of residencies train all the family physicians who attend births. Of the 11,728 family physicians included, the higher the obstetric training exposure for their residency, the higher the rate of attending births in practice (35.8% for average 81 + births per resident across residency vs 22.6% average 61–80 births per resident vs 10.9% average 41–60 births per resident). After adjusting for multiple other variables, graduating from a residency with higher exposure was significantly associated with attending births in practice.

Conclusions: Independent of other factors, residency obstetric training exposure has a significant impact on whether a family physician attends births in practice. Policies protecting and developing residencies with the highest exposure may improve access to safe maternity care.