Obstetric care in family practice residencies: a national survey.

BACKGROUND Supervision of obstetric care by family practice faculty increases the likelihood that family practice residents will choose to practice obstetrics. METHODS A survey instrument was developed to obtain information about practice faculty and the educational setting in which residents learn family physician obstetric care. Questionnaires were sent to all family medicine residency directors and all full-time family physician faculty. RESULTS Two hundred eighty-four program directors and 1396 faculty members responded. The mean percentage of recent graduates estimated to be practicing obstetrics was 30 percent. Factors independently associated with an increased likelihood of resident graduates practicing obstetrics included supervision of resident deliveries by family physicians, increasing number of family practice center deliveries, regional differences, and availability of training to perform Cesarean sections. Sixty-four percent of the responding family physician faculty were currently supervising deliveries, but only 5 percent had Cesarean section privileges. Seven percent of the faculty reported denial of obstetric privileges. Eighty-nine percent of all respondents supported the mandatory inclusion of obstetrics in family medicine residencies. CONCLUSIONS Residency programs in family practice can increase the number of their graduates practicing obstetric care by focusing on the family physician supervision model, faculty development that supports this model, and clinical privileges of faculty.