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Obstetric Privileges For Family Physicians: A National Study

Background: We surveyed family physicians in the US to determine how many include obstetric services in their practices and to compare trends over time. Methods: In the 1993 Practice Profile Survey, the American Academy of Family Physicians (AAFP) surveyed a random sample of active members whose mailing address was in one of the 50 states or the District of Columbia. The sample was stratified by nine census divisions; after two mailings 2460 responses were received from the 4400 physicians in the sample (56 percent response). Results: Eighty-seven percent of active members had hospital admission privileges. Although there were regional disparities in the proportion of family physicians with various hospital privileges, overall 94 percent perceived that the privileges afforded them were appropriate. Approximately 26 percent of AAFP active members in 1993, compared with 29 percent in 1988, included routine obstetric care in their hospital practices. A higher proportion of family physicians in the West North Central census division had privileges at various levels of obstetric care than did family physicians in other census divisions; for example, while 57 percent of family physicians in the West North Central census division had privileges in routine obstetric care, only 9 percent of family physicians in the East South Central division had these privileges. For those family physicians who did not have privileges for any obstetric care, most indicated that they chose not to include obstetric care in their hospital practices. Family physicians most likely to have had obstetric privileges included those who practiced in nonmetropolitan areas (39 percent of family physicians had privileges in routine obstetric care compared with 21 percent in an urban setting) and those who completed a family practice residency program (33 percent with routine obstetric privileges compared with 13 percent who did not complete a 3-year residency in family practice).

Profile of Family Physicians in the United States

The production of fully trained family physicians in the United States began in 1969 with 15 pilot family practice residency programs.1 There were 1754 residents in training in 164 approved programs by 1973,2 and these numbers passed 7000 in 386 programs only eight years later in 1981. The number of residents in family practice residency programs surpassed 10,000 in 1996 with a total of 10,102 in 452 programs.3 By 1996 each state, the District of Columbia, and the Commonwealth of Puerto Rico had at least one family practice residency.4 The number of family practice residencies and residents peaked in 1998 at 475 programs of 10,687 residents.3 By July 2001, 63,930 physicians had completed family practice residency programs since 1970.5