Article Figures & Data
Tables
- Table 1.
Characteristics of Family Physicians Who Perform versus Do Not Perform Cesarean Sections as Primary Surgeon from the 2017-2022 ABFM Continuing Certification Questionnaire
FPs Performing Primary C-Sections FPs Doing Obstetric Deliveries but Not Primary C-Sections FPs Not Doing Any Obstetric Deliveries N % N % N % p-Value Total 589 1523 26,414 Individual Characteristics Age Under 40 103 17.5% 311 20.4% 3145 11.9% <0.0001 40 to 49 301 51.1% 656 43.1% 10,640 40.3% 50 to 59 119 20.2% 393 25.8% 7556 28.6% 60 or Older 66 11.2% 163 10.7% 5073 19.2% Gender Women 239 40.6% 897 58.9% 12,142 46.0% <0.0001 Men 349 59.3% 626 41.1% 14,272 54.0% Non-binary 1 0.2% 0 0% 0 0% Degree Type MD 520 88.3% 1358 89.2% 23,364 88.5% 0.6897 DO 69 11.7% 165 10.8% 3050 11.5% IMG Yes 73 12.4% 121 7.9% 6337 24.0% <0.0001 No 516 87.6% 1402 92.1% 20,077 76.0% Race Asian 36 6.1% 89 5.8% 4547 17.2% <0.0001 Black 25 4.2% 47 3.1% 1658 6.3% White 505 85.7% 1305 85.7% 18,228 69.0% Other 23 3.9% 82 5.4% 1981 7.5% Ethnicity Hispanic/Latino 35 5.9% 81 5.3% 2002 7.6% 0.0020 Not Hispanic/Latino 554 94.1% 1442 94.7% 24,412 92.4% Faculty at Medical School or Residency Yes, core/salaried faculty 120 20.4% 645 42.4% 2329 8.8% <0.0001 Yes, volunteer/clinical faculty 237 40.2% 423 27.8% 5388 20.4% No 232 39.4% 455 29.9% 18,697 70.8% Practice Characteristics Site Size Solo practice 30 5.1% 33 2.2% 2978 11.3% <0.0001 2 to 5 Providers 162 27.5% 213 14.0% 9090 34.4% 6 to 20 Providers 261 44.3% 632 41.5% 8099 30.7% >20 Providers 136 23.1% 645 42.4% 6247 23.7% Principal Practice Site Hospital/Health System Owned 184 31.2% 452 29.7% 9407 35.6% <0.0001 Independently Owned 141 23.9% 228 15.0% 8293 31.4% Managed Care/HMO 3 0.5% 32 2.1% 1745 6.6% Academic Health Center/Faculty Practice 81 13.8% 473 31.1% 1600 6.1% FQHC or look-alike 55 9.3% 190 12.5% 1727 6.5% Rural Health Clinic 96 16.3% 51 3.3% 559 2.1% Other 29 4.9% 97 6.4% 3083 11.7% Specialty Mix of Principal Practice Family medicine only 312 53.0% 904 59.4% 12,936 49.0% <0.0001 Primary care specialty mix 134 22.8% 300 19.7% 7610 28.8% Multiple specialties (not only primary care) 143 24.3% 319 20.9% 5868 22.2% Presence of Midwife at Practice Yes 104 17.7% 204 13.4% 1130 4.3% <0.0001 No 485 82.3% 1319 86.6% 25,284 95.7% Geographic Characteristics Rurality of Practice Site* Urban 267 45.3% 1183 77.7% 22,847 86.5% <0.0001 Micropolitan 54 9.2% 119 7.8% 1522 5.8% Large Rural 230 39.0% 205 13.5% 1744 6.6% Small Rural 38 6.5% 16 1.1% 301 1.1% Census Region Northeast 23 3.9% 154 10.1% 3787 14.3% <0.0001 Midwest 212 36.0% 660 43.3% 6197 23.5% South 162 27.5% 191 12.5% 9285 35.2% West 192 32.6% 518 34.0% 7145 27.1% Presence of General OB/GYN in county None 193 32.8% 144 9.5% 1408 5.3% <0.0001 5 or Fewer/10,000 reproductive age females in county 205 34.8% 507 33.3% 8453 32.0% Greater than 5 / 10,000 reproductive age females in county 191 32.4% 872 57.3% 16,553 62.7% Presence of Nurse Midwives None 247 41.9% 248 16.3% 3560 13.5% <0.0001 1 or Fewer / 10,000 reproductive age females in county 122 20.7% 360 23.6% 10,079 38.2% Greater than 1/10,000 reproductive age females in county 220 37.4% 915 60.1% 12,775 48.4% Primary Care HPSA Full/Partial County 520 88.3% 1395 91.6% 24,243 91.8% 0.0103 No 69 11.7% 128 8.4% 2171 8.2% Percent of reproductive age females in county Under 18% 280 47.5% 328 21.5% 5515 20.9% <0.0001 18% to 21% 213 36.2% 719 47.2% 13,400 50.7% More than 21% 96 16.3% 476 31.3% 7499 28.4% Social Deprivation Index** Under 25 201 34.1% 468 30.7% 6902 26.1% <0.0001 25 to 75 305 51.8% 829 54.4% 14,040 53.2% More than 75 83 14.1% 226 14.8% 5472 20.7% Abbreviations: CS, Cesarean Section, FP, Family Physician, FQHC, federally qualified health center, HMO, health maintenance organization, HPSA, health professional shortage area, IMG, International Medical Graduate, OB/GYN, obstetrician/gynecologist.
↵*Rurality was defined using Rural-Urban Continuum Codes by county of primary practice site with urban codes 1-3, micropolitan 4-5, large rural 6-7 and small rural 8-9. The U.S. Department of Agriculture’s Economic Research Service, which created this scale, defines urban as codes 1-3 and rural as codes 4-9.
↵**Social Deprivation Index is a composite measure of area level deprivation based on income, education, employment, housing, household characteristics, transportation and demographics and is measured on a score of 0-100 with higher numbers suggesting higher deprivation.
- Table 2.
Odds Ratios of FPs Performing Primary Cesarean Sections versus FPs during Obstetrics Deliveries but Not Primary Cesarean Sections
Characteristic Odds Ratio 95% Wald Confidence Limits Age (ref = 40 to 49) Under 40 0.867 0.639 1.176 50 to 59 0.543 0.405 0.728 60 and over 0.659 0.450 0.965 Gender (ref = women) Men 1.573 1.246 1.986 Degree Type (ref = MD) DO 0.949 0.664 1.355 IMG Yes 1.712 1.145 2.560 Race (ref = white) Asian 1.474 0.900 2.415 Black or African American 1.646 0.886 3.056 Other 0.576 0.324 1.024 Ethnicity Hispanic or Latino 1.536 0.934 2.528 Faculty (ref = no) Yes, core/salaried faculty 0.829 0.551 1.245 Yes, volunteer/clinical faculty 1.286 0.981 1.684 Principal Practice Site Size (ref = > 20 providers) Solo practice 2.020 1.008 4.046 2 to 5 providers 1.477 1.010 2.160 6 to 20 providers 1.042 0.773 1.404 Principal Practice Site Type (ref = hospital/health system owned) Independently Owned 1.314 0.944 1.827 Managed Care/HMO 0.246 0.069 0.882 Academic Health Center/Faculty Practice 0.823 0.523 1.295 FQHC or look-alike 0.813 0.523 1.295 Rural Health Clinic 2.157 1.397 3.330 Other 0.523 0.308 0.888 Specialty Mix of Practice (ref = family medicine only) Primary care specialty mix 1.498 1.103 2.034 Multiple specialties 1.244 0.921 1.682 Presence of midwife at practice Yes 2.087 1.513 2.880 Rurality (ref = urban) Micropolitan 1.468 0.962 2.239 Large Rural 2.308 1.577 3.376 Small Rural 4.038 1.887 8.642 Census Region (ref = Midwest) Northeast 0.844 0.499 1.428 South 4.311 3.030 6.133 West 1.933 1.431 2.612 Number of General OB/GYN in county (ref = >5 per 10,000 reproductive age women) None 2.163 1.440 3.250 5 or fewer OB/GYNs 1.224 0.928 1.616 Percentage of reproductive age females in county (ref = 18 to 21%) Under 18% 1.116 0.802 1.553 More than 21% 0.682 0.501 0.929 Primary Care HPSA No 1.140 0.769 1.690 Social Deprivation Index (ref = 25 to 75) Under 25 0.765 0.575 1.017 More than 75 1.022 0.723 1.445 Abbreviations: FP, Family Physician; HMO, health maintenance organization; OB/GYN, obstetrician/gynecologist; HPSA, health professional shortage area; FQHC, Federally qualified health center.
- Table 3.
Yearly Delivery Volume of FPs Who Provide Cesarean Sections by Geographic Variables
Total FPs Mean Yearly Total Delivery Volume Mean Year C-Section Delivery Volume Deliveries Performed Annually (%) 1 to 25 26 to 50 >50 Rurality of Practice Site Urban 267 93.6 34.6 10.5% 21.0% 68.5% Micropolitan 54 76.5 24.5 13.0% 25.9% 61.1% Large Rural 230 56.4 21.3 11.7% 40.9% 47.4% Small Rural 38 48.2 17.3 28.9% 34.2% 36.8% Number of General OB/GYN in county None 193 54.6 20.6 14.5% 40.4% 45.1% 5 or Fewer/10,000 Reproductive Age Women 205 78.8 28.4 12.7% 25.4% 62.0% Greater than 5/10,000 Reproductive Age Women 191 89.7 33.1 9.9% 24.6% 65.4% Abbreviations: FP, Family Physician; OB/GYN, obstetrician/gynecologist; C-Section, Cesarean Section.
Rurality of Primary Practice Site Faculty at Medical School or Residency Total Yes, Core/Salaried Faculty Yes, Volunteer/Clinical Faculty No Urban 103 (85.8%) 85 (35.9%) 79 (34.1%) 267 (45.3%) Micropolitan 8 (6.7%) 23 (9.7%) 23 (9.9%) 54 (9.2%) Large Rural 9 (7.5%) 103 (43.5%) 118 (50.9%) 230 (39.0%) Small Rural 0 (0.0%) 26 (11.0%) 12 (5.2%) 38 (6.5%) Total 120 237 232 589 Abbreviation: FP, Family Physician.
