Identifying Primary Factors Responsible for the Decline of Obstetric Care by Rural Texas Family Practice Physicians

There is a well-documented decline of family practice physicians (FPs) providing OB, and the known reasons behind the decline are varied and complex. The purpose of this study is to assess which factors are most responsible for the decline in OB provided by FPs, with a specific focus on those in rural Texas communities. Specifically, it seeks to determine: 1.) What rural FPs are currently providing OB services? 2.) What are the primary factors/barriers responsible for the decline of OB services provided by rural FPs? A statewide survey of self-identified rural FPs targeted the degree of OB services currently provided and graded factors/barriers responsible for the decline of obstetric care in their personal practices. Current OB practice characteristics were divided into 3 primary categories: currently performing, previously performed, or never performed. Individual factors/barriers were graded using a scale of 1 through 5 and ranked according to highest arithmetic average. The survey was distributed in both physical and online forms to various professional FP societies in Texas and the data and statistical analysis were recorded in Qualtrics online survey software. 35 FPs volunteered to participate. 2 respondents did not self-identify as rural and were excluded from the analysis. Of the remaining 33, we found that 85% felt as if they had received adequate OB training in residency, yet only 29% were currently performing vaginal deliveries as part of their practice. Another 43% had previously performed vaginal deliveries but were not currently, and 29% had never performed vaginal deliveries as part of their practice. Of those adequately trained in OB, lifestyle (4.36), family (4.00), and sleep issues (3.75) accounted for the top three factors, followed by liability (3.41) and difficulty obtaining back-up coverage (3.14). The lowest ranked factors/barriers were hospital privileges (2.11), concern with skill level (1.96), and credentialing barriers (1.79). This data confirms that qualified FPs are declining to provide OB care. Primary factors responsible include lifestyle/family-related issues, liability, and poor back-up coverage. Factors of least concern were credentialing barriers, concern with skill level, and hospital privileges. This study confirms that non-medical factors are affecting medical care in rural areas, and future solutions must take these factors into account.