A family physician can complete residency fully prepared to care for low-risk pregnancies and deliveries, only to discover that the hospital where they practice will not grant obstetric privileges, their employment contract does not include deliveries, or the demands of call are unsustainable. The consequences extend beyond an individual physician’s career. In rural communities, it means the loss of a clinician who can provide maternity care close to home.
The rural maternity-care crisis is often framed as a shortage of OB/GYN physicians. Expanding the obstetrician-gynecologist workforce in rural communities is essential. They provide the medical and surgical expertise required for high-risk pregnancies, obstetric emergencies, and comprehensive reproductive health care, and their role cannot be replaced. However, recruitment is only part of the solution. The challenge is not simply training more family physicians to provide obstetric care. It is ensuring that those who are trained have the opportunity and support to continue providing that care once they enter practice.
Family physicians have long been an important part of the maternity-care workforce, particularly in rural communities. Some provide prenatal care, perform deliveries, care for newborns, and continue caring for families after discharge. Family physicians who perform cesarean deliveries are disproportionately located in small rural counties and in counties without an OB/GYN. Family medicine obstetrics (FM-OB) is not a substitute for OB/GYN care. Rather, it is one way to preserve appropriate local maternity care within an OB/GYN-supported regional system. Patients with high-risk pregnancies require timely access to maternal-fetal medicine, surgical expertise, neonatal care, and reliable transfer pathways. At the same time, many patients with uncomplicated pregnancies benefit from having a clinician nearby who can provide continuity of care from prenatal visits through delivery and postpartum follow-up.
The challenge is that fewer family physicians are providing obstetric care. Among early-career family physicians, the proportion reporting that they deliver babies declined from 13.1 percent in 2016 to 10.8 percent in 2024. In 2024, 17 percent of second-year family medicine residents reported plans to provide deliveries after graduation, compared with 23 percent of new graduates reporting that intention between 2014 and 2016. These data do not follow the same physicians from residency into practice, so they cannot determine how many physicians who intend to provide obstetric care ultimately leave delivery practice. They do, however, point to a concerning pattern: Training and interest do not consistently translate into sustained obstetric practice. Why? The answer is not simply inadequate training. Among recent family medicine graduates who wanted to provide deliveries but did not, fewer than 12 percent identified training as their primary barrier. More commonly, they reported that available positions did not include obstetric care or that the demands of call and lifestyle made continuing delivery practice difficult to sustain.
Real physician voices, twice a week
Free, and one click to unsubscribe.
Other barriers further limit the ability of trained family physicians to provide obstetric care. A physician may complete residency fully prepared to perform deliveries yet be unable to obtain or maintain hospital privileges. A low-volume hospital may not offer enough clinical experience to sustain procedural skills. Malpractice costs can be prohibitive, and the demands of frequent call with limited backup may make continued obstetric practice difficult to sustain. These challenges reflect the realities of the systems in which physicians practice, not simply individual career choices. The result is a maternity-care pipeline that loses valuable capacity after training.
To better understand this workforce challenge, we should look beyond the number of clinicians entering training programs. Rural hospitals, residency programs, and policymakers should also examine how many physicians who complete obstetric training obtain hospital privileges, enter positions that include deliveries, and remain in delivery practice three to five years later. Reporting these measures, particularly among rural health systems receiving public support for maternity services, would provide a clearer picture of where the pipeline is breaking down. It could help distinguish whether the greatest barriers are related to privileging, employment opportunities, practice structure, or the sustainability of call coverage. Without these data, efforts to strengthen the rural maternity-care workforce may overlook opportunities to retain clinicians who are already trained and willing to provide care.
Addressing these barriers requires practical, system-level solutions. Hospitals can support qualified family physicians by creating positions that include maternity care rather than limiting them to outpatient primary care. Decisions regarding obstetric privileges should be based on documented competency, current skills, clinical outcomes, and ongoing assessment. Shared call arrangements, collaboration with OB/GYN colleagues, and well-defined referral pathways can help create practice environments that are both safe for patients and sustainable for clinicians.
Maintaining obstetric skills is equally important. The American College of Obstetricians and Gynecologists (ACOG) recommends multidisciplinary simulation, regular drills, experience at higher-volume facilities, regional consultation, and established transport agreements for rural and low-volume obstetric settings. These resources should be viewed as essential components of a safe and sustainable rural maternity-care system.
Rural maternity care depends on OB/GYN leadership, skilled nursing and midwifery, regional referral networks, and policies that preserve access to labor and delivery services. It also depends on health systems that support family physicians who are trained, qualified, and committed to providing appropriate obstetric care. Training family physicians to provide obstetric care is only the beginning. Rural families also need health systems that enable qualified clinicians to continue providing safe, local maternity care throughout their careers.
This essay is cited in the KevinMD record on primary care.
Frista Gradica is an osteopathic medical student.
