Family Medicine Obstetrics Fellowship Funding and Characteristics

Maternal care in the United States is in crisis due to obstetrics workforce shortages. Family physicians, with whole-person training and geographical practice distribution, are well-positioned to address this crisis. Family physicians completing a family medicine obstetrics (FMOB) fellowship are trained in surgical skills and high-risk pregnancy management, and often practice in health care shortage areas. This study aimed to update and expand knowledge on FMOB fellowships, focusing on program characteristics and financial sustainability.

We sent an email-based survey examining fellowship structure and financial information to 44 FMOB fellowships. Representatives of 22 fellowships (50%) anonymously completed the online survey. Authors used descriptive statistics, including frequency, mean, and standard deviation, to summarize the data.

Half the fellowships were housed in family medicine residency programs. Fellowships, mostly 1 year long, admitted on average 2.2 fellows annually. Financially, nearly half (45%) the fellowships operated at a budget deficit, with clinical revenue and federal funding being major funding sources. More than 50% of programs reported that fellows spent less than 20% of their time as an independent billing physician.

FMOB fellows are surgically trained and uniquely positioned to help address the current crisis, including filling obstetric care gaps in underserved and rural areas. Given funding challenges FMOB fellowships face, developing strategies for financial viability of FMOB fellowships going forward is crucial. Opportunities include increasing clinical revenue generation and attaining secure funding via pursuit of accreditation status for FMOB fellowship programs from the Accreditation Council for Graduate Medical Education.