Vol:.(1234567890) Maternal and Child Health Journal (2018) 22:932–940 https://doi.org/10.1007/s10995-018-2469-2 1 3 Challenges Faced by Family Physicians Providing Advanced Maternity Care Aimee R. Eden 1  · Lars E. Peterson 1,2 Published online: 6 February 2018 © Springer Science+Business Media, LLC, part of Springer Nature 2018 Abstract Introduction Maldistribution of maternity care (MC) providers in the U.S. limits access to full spectrum MC services. Obstetricians are concentrated in urban areas with many rural areas reliant on family physicians (FP) to provide MC, yet fewer FPs are providing MC. The objective of this study was to understand the challenges FPs face in gaining skills in and providing advanced MC. Methods We conducted qualitative semi-structured interviews with 51 purposively sampled key stakeholders in family medicine MC (21 family medicine-OB fellowship directors, 19 past fellows, and 10 family medicine residency directors of programs with advanced MC training). Interviews were recorded, transcribed, and analyzed using an inductive approach to qualitative content analysis. Results Three primary challenges for FPs providing advanced MC emerged from the interviews. Training: most family medicine residency programs do not provide sufcient surgical OB training, so fellowship training is an important alternative for FPs to acquire such skills. Credentialing: obtaining hospital privileges to perform cesarean sections is unpredictable and highly variable by institution. Professional relationships: “turf battles” with other MC providers can limit FPs’ ability to provide care commensurate with their level of training. Discus- sion As the predominant provider of MC in rural and underserved areas, FPs need to be supported to provide advanced MC services. Possible strategies to accomplish this include: enhanced family medicine training in MC; policy changes to address credentialing inconsistencies; and improved team-based care for pregnant women to ensure that every woman has access to high quality MC. Keywords Maternity care workforce · Family medicine · Qualitative methods Signifcance Family physicians are the de facto provider of MC services in many rural and some underserved areas due to the concen- tration of obstetricians in urban areas. However, fewer family physicians are providing MC with lifestyle, fnancial, and liability concerns often cited. Our study found that among family physicians who want to continue to provide MC, they face barriers along a spectrum from training, credentialing, and professional support that may further this decline at the peril of maternal and child health. Introduction Maternity care (MC) has long been an integral part of family medicine (Mehl et al. 1976), particularly in rural and urban underserved areas. The American Academy of Family Physi- cians (AAFP) recognizes maternal and child care as a core discipline within family medicine, and advocates that com- petency in basic MC be part of all family medicine residency training while training in advanced MC be available for fam- ily physicians (FP) who provide MC as part of their practice (AAFP 2012). MC training and provision in family medicine has been shown to be valuable for FPs, their practices, their patients, and for the specialty. FPs who provide MC maintain a younger patient population (Bredfeldt et al. 1988; Koppula et al. 2012; McCaleb and Wheat 2013), have higher job sat- isfaction (Larimore and Sapolsky 1995; Young et al. 2008), and provide more continuity of care to their patients (Boss et al. 2001; Mehl et al. 1976). FPs are less interventionist in their approach to MC than obstetricians (Abenhaim et al. * Aimee R. Eden aeden@theabfm.org 1 American Board of Family Medicine, 1648 McGrathiana Blvd, Lexington, KY, USA 2 Department of Family and Community Medicine, American Board of Family Medicine, University of Kentucky, Lexington, KY, USA