ORIGINAL RESEARCH
Mario P. DeMarco, MD, MPH; Jennifer D. Cohn, MD; Melissa Donze, MPH; Peter F. Cronholm, MD, MSCE
Corresponding Author: Mario P. DeMarco, MD, MPH; Department of Family Medicine and Community Health, Perelman School of Medicine, University of Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania.
Email: mario.demarco@pennmedicine.upenn.edu
DOI: 10.3122/jabfm.2026.260059R2
Keywords: Family Medicine, Maternal Health, Maternal Health Services, Obstetrics, Residency, Workforce
Dates: Submitted: 2/6/2026; Revised: 7/3/2026; 9/7/2026; Accepted: 9/14/2026
Status: In Press.
BACKGROUND: Family medicine (FM) physicians have a unique role in providing care for pregnant and postpartum patients in both inpatient and outpatient settings, particularly in shortage areas. However, fewer FM physicians are actively delivering babies or providing essential maternity care.
METHODS: A Council of Academic Family Medicine’s Educational Research Alliance (CERA) survey was distributed to FM residency program directors. The survey included 10 items related to residency structures, training settings, maternity care curriculum, and future practice scope for residency graduates. These exposures were correlated with survey responses regarding percentages of graduates practicing both inpatient and outpatient obstetrics and/or in rural or urban underserved areas.
RESULTS: A total of 63% of programs had some form of obstetrical (OB) training experience including an FMOB (Family Medicine obstetrics) service, OB track or OB fellowship. Nearly half of FM residencies (45.4%) do not offer opportunities for residents to provide perinatal care in Federally Qualified Health Center (FQHC) or rural settings. Competency training was uncommon for perinatal substance use (13.5%), high risk conditions (25.3%) and surgical obstetrics (7.0%). Programs with any of these features were highly correlated with having a higher proportion of graduates practice obstetrical or outpatient maternity care and were more likely to have those graduates practice in underserved settings.
DISCUSSION: Compared to prior estimates, more residency programs have incorporated an obstetrical track into their training program. Program structures including OB tracks or an FMOB service can enhance FM resident likelihood to continue obstetrical and/or maternity care in future practice. Exposure to perinatal care in underserved settings including FQHC or rural clinics during FM residency could enhance the future availability of the maternity care workforce in those settings.