Trends in maternity care by graduates and the effect of an intervention

Only 24% of family physicians in the United States deliver babies, a figure that declined remarkably during the decade of the 1980s. This study examines the content of practice, with regard to maternity care, of graduates of the University of California, Davis Family Practice Residency Network over the past 20 years, and the effectiveness of residency training intervention designed to increase maternity care activity among graduates.

Using a mailed survey instrument, graduates of the UC Davis Family Practice Residency Network have been periodically surveyed on practice characteristics since 1978. Using data from these surveys, maternity care and other practice characteristics of all graduates were analyzed using descriptive statistics. Data on trends in maternity care of two groups of residents who graduated a decade apart were evaluated. A separate evaluation of the two most recent graduating classes was performed to evaluate an intervention at the Network's university-based program. The program had been designed to increase the number of graduates who provide maternity care.

Survey responses from previous graduates of the six network programs showed that only 31% included maternity care in their practices at the time of the 1991 survey. Sixty-one percent of a cohort of graduates from a 3-year period from 1979 through 1981 included maternity care upon entering practice. The 3-year cohort of residents graduating a decade later, during the years 1988-1990, had an initial participation rate in maternity care of only 37% in 1991. However, only 11% of the graduates from the university-based program in the 1988-1990 cohort made an initial decision to include maternity care in their practice. For the graduates of this program from 1991 and 1992, a period following the specific intervention, participation in maternity care increased to 50%.

This study documents the decrease in interest in providing obstetrical services by recent family practice residency graduates when compared to graduates a decade earlier. Further, it suggests that residency programs, even with very low rates of participation in maternity care, can increase the interest and participation of residents to include these services in their practices after graduation.