RT Journal Article
SR Electronic
T1 Maternity Access in Rural America: The Role of Family Physicians in Providing Access to Cesarean Sections
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP jabfm.2023.230020R1
DO 10.3122/jabfm.2023.230020R1
A1 Tong, Sebastian T.
A1 Morgan, Zachary J.
A1 Bazemore, Andrew W.
A1 Eden, Aimee R.
A1 Peterson, Lars E.
YR 2023
UL http://www.jabfm.org/content/early/2023/06/29/jabfm.2023.230020R1.abstract
AB Introduction: As an increasing number of rural hospitals close their maternity care units, many of the approximately 28 million reproductive-age women living in rural America do not have local access to obstetric services. We sought to describe the characteristics and distribution of cesarean section-providing family physicians who may provide critical services in maintaining obstetric access in rural hospitals.Methods: Using a cross-sectional study design, we linked data from the 2017 to 2022 American Board of Family Medicine’s Continuting Certification Questionnaire on provision of cesarean sections as primary surgeon and practice characteristics to geographic data. Logistic regression determined associations with provision of cesarean sections.Results: Of 28,526 family physicians, 589 (2.1%) provided cesarean sections as primary surgeon. Those who provided cesarean sections were more likely to be male (odds ratio (OR) = 1.573, 95% confidence limits (CL) 1.246–1.986), and work in rural health clinics (OR = 2.157, CL 1.397–3.330), small rural counties (OR = 4.038, CL 1.887–8.642), and in counties without obstetrician/gynecologists (OR = 2.163, CL 1.440–3.250).Discussion: Although few in number, family physicians who provide cesarean sections as primary surgeon disproportionately serve rural communities and counties without obstetrician/gynecologists, suggesting that they provide access to obstetric services in these communities. Policies that support family physician training in cesarean sections and facilitate credentialing of trained family physicians could reverse the trend of closing obstetric units in rural communities and reduce disparities in maternal and infant health outcomes.