OBSTETRICAL PRACTICE AMONG NEW RURAL FAMILY PHYSICIANS

Background. Fewer family physicians now practice maternity care than a decade ago, a trend that is worsening access to obstetrical care in some rural areas. This study explores the effects of a wide range of factors on the likelihood of newly settled rural family physicians providing maternity care. Methods. Subjects included 782 family physicians who moved to nonmetropolitan areas nationwide during the years 1987 through 1990. Physicians who located in health professional shortage areas were oversampled. Questionnaires were mailed in 1991, with a 72% response rate. The final sample used in the analyses included 338 eligible respondents. Results. A total of 151 (45%) of these rural family physicians performed routine deliveries during the previous year. Family physicians more likely to provide maternity care worked in practices they owned and were not solo practitioners (P less than or equal to.05). Maternity care by family physicians also was more common in counties that were less populated, had fewer obstetricians, and had more family physicians. State-by-state differences in the cost of medical malpractice insurance and Medicaid reimbursement rates for obstetrical care were not among the factors associated with the provision of maternity care for these rural family physicians. Conclusions. These data suggest that features of rural family physicians' practices and communities are the best predictors of whether they provide maternity care. Contrary to what family physicians often claim, we found that malpractice premium costs and Medicaid reimbursement rates were not associated with family physicians' likelihood of providing maternity care.