The practice of obstetrics by Army family physicians

There has been a dramatic decline nationwide in family physicians practicing obstetrics. This study describes the practice of obstetrics by Army family physicians in an environment relatively free of malpractice liability and other financial concerns.

A questionnaire was mailed to every family physician on active duty in the Army (n = 334) in 1993, with a final response rate of 79 percent (n = 265).

Nearly 73 percent of Army family physicians practice obstetrics. Almost all believed they were adequately prepared to provide routine prenatal care (98 percent) and complicated obstetric care (84 percent). More than 95 percent of those assigned to a teaching facility delivered babies. Obstetric procedures that the majority performed included normal vaginal deliveries (100 percent), repair of third-degree (98 percent) and fourth-degree (93 percent) tears, insertion of fetal scalp electrodes (96 percent) and intrauterine pressure catheters (98 percent), interpretation of nonstress tests (97 percent) and contraction stress tests (83 percent), vacuum extractions (93 percent), pudendal or paracervical blocks (88 percent), first assist in Cesarean sections (80 percent), amnioinfusions (76 percent), and low-forceps deliveries (53 percent). Those who currently practice obstetrics were more satisfied with being a family physician compared with those who did not practice obstetrics (95 percent vs 86 percent, P < 0.02).

The majority of Army family physicians perform a wide spectrum of obstetrics care. Those who practiced obstetrics were generally more satisfied with family practice than were those who did not practice obstetrics.