There are many ways to become involved in Health Care Advocacy. Below is one example of a letter to an editor of a peer-reviewed journal:
In the October issue of Family Medicine, Dr. Coonrod and colleagues introduce a 3- level system for maternity care training in the article, “Tiered Maternity Care Training in Family Medicine.” According to the article, tier 1 requires at least 20 vaginal deliveries, tier 2 at least 50 deliveries, and tier 3, at least 50 primary cesarean sections, in addition to 50 vaginal deliveries. Although I agree that our residents should be doing more deliveries as proposed in the authors’ tiers 2 and 3, they are ignoring the inadequacy of tier 1. Since tier 1 is the current proposed minimum by the Family Medicine Residency Review Committee for all family medicine residents, this has the potential to decrease the competency of many residents in training and potentially exacerbate health disparities for access to adequate maternity care in this country.
Have you ever met a family medicine resident who never delivered a baby in medical school? As a current Maternal Child Health Fellow, I have met several. Just recently, I worked with an intern who had limited experience in medical school during her obstetrics rotation. She was very excited to deliver babies on her first maternal child health rotation and this experience obviously caused her to rethink her position on whether or not she wanted to practice obstetrics later in her career. More and more, our residents are starting residency with less and less hands-on experience from medical school, especially in the area of obstetrics.
Also, have you ever met a resident who ended up loving their obstetrical rotation in residency and decided to deliver babies after graduation? I know several family docs in this category too. One of my colleagues in residency came to our program with no intention of doing deliveries when he finished residency. But after he had a favorable experience during his residency, he is now FM faculty teaching residents on our Maternal Child Health service.
If these residents had initially selected a tier 1 program, they would have missed out on the opportunity to become competently trained as maternity care providers and potential teachers in maternal child health. When the new Family Medicine OB revisions are implemented , residents may graduate from residency with only “exposure” to obstetrics; the same “exposure” they should have had in medical school but did not; now they will not get sufficient experience in residency either. We are taking away a key portion of family medicine if we remove maternity care from our skill set. Furthermore, the residents who graduate from a tier 1 program with only 20 deliveries will have very limited opportunities to gain sufficient training if they decide they want to practice obstetrics. We are limiting their future career potential.
Some rural and urban under-served areas depend on family physicians to provide the majority of obstetrical care. If we reduce the number of family physicians who graduate with competency in obstetrics, will we experience a shortage of maternity care providers in these under-served areas? Some family medicine programs are already having difficulty recruiting skilled FP faculty to provide maternity care training. By creating less family medicine graduates who are competent to practice obstetrics, we are also creating less potential FP teachers for all family medicine residents, no matter what ‘tier’ of training they have.
If the RRC revisions occur, some existing programs may avoid citations, but this will occur at the expense of the future of maternity care in our specialty. More importantly, we will worsen the access and quality of obstetrical care for our under-served patients and their families.
Sincerely,
Kristine Carpenter, MD
PCC Maternal Child Health Fellow
Cook County-Loyola-Provident Family Medicine Faculty Development Fellow
