Table 3

Challenges finding family medicine jobs with obstetrics: themes and illustrative quotes

ThemeDefinitionIllustrative quotes
Lack of availabilityLack of availability of FM-OB jobs overall, in a particular geographic area“I ended up meeting up with a physician recruiter and told him that I wanted to do family medicine with obstetrics and he told me that I was an odd-duck and that it was going to be hard to find me anything close to where I wanted to be geographically. We did end up finding one place that was about an hour and a half northeast of where I trained that was three other family practice OB physicians in a small rural 24-bed critical access hospital with labor and delivery.” (Female doing OB in the Midwest)
“I was surprised when I started looking at how many didn't include OB. So, I had to look specifically for jobs that included OB.” (Male doing OB in the West)
“…eventually I ended up moving and I'm practicing rural full spectrum medicine but without OB in this community also. It's just for me the big barrier is finding a group to practice with and a community that does OB because not every community does OB here.” (Male not doing OB in the Midwest)
“I put out a pretty broad search specifically looking for FM-OB physician in this area and was really surprised to find how little was available in the metro area. It was quite a lot if I wanted to live rurally but I couldn’t because of my family situation. I needed to be close to my husband’s parent …. really does not have a strong culture of family medicine doctors providing delivery services and that was really surprising to me.” (Female not doing OB in the West)
Loss of skill or confidenceAt the time of graduation or after working in a job that did not include OB, the real or perceived loss of skill made it difficult to obtain a job including OB“For me it was just the situation I found myself in and now(it’s)an issue of confidence and credentialing.” (Female not doing OB in the West)
“It’s just my discomfort with not having enough backup and enough experience and now it’s been three years since I’ve done a delivery. I feel like jumping back in would be pretty tough.” (Female not doing OB in the Southeast)
“The thing that is really hurting family medicine docs from doing obstetrics is that if you don’t find a job right out of residency, two years goes by, and no one will privilege you anymore. And there's no way for you to like go back, and train to get to the point where you can have obstetric privileges again, or even feel comfortable doing that again.” (Female doing OB in the West)
DiscouragementDiscouragement or resistance by employers or recruiters“I was discouraged when I was speaking to recruiters. …(They said things like,)‘Family docs don't do that anymore. There's too much liability; there's too much risk. No one—it will be hard getting privileges. It would be hard finding a practice that will support you. It will be hard finding an OB group to back you up.’ Everything you can find, I was discouraged [by] the recruiters, honestly, because they don't know anything.” (Female doing OB in the Southeast)
“When I signed my contract it stated actually that I’m a family physician without OB training who is sort of agreeing to do family medicine healthcare excluding OB care. So I had to talk to them wherever that had a contract to sign for me saying that I was trained with OB. I have OB skills, this is not correct, you have to exclude that, you have to omit it. And then they agreed. So they just said, I’m a family physician trained in the family medicine and I agreed not to do OB, so it didn’t say that I was trained….” (Female not doing OB in the Southwest)
Bait and switchThought could do OB but after started position, realised could not“…we started talking to them as a group in residency and, yeah, and so we had kind of talked to them as a group, like, hey this is what we want to do, they had said, yes, you can do that with us. … So, my first year out of residency, …we were supposed to start OB at the FQHC clinic. I was with, I mean, it was perfect—my partners and I wanted to do it and then we just—we had buy in with administration but then they really fell through on that and blocked that, in a way.” (Male not doing OB in the Midwest)
PerceptionThe real or perceived perception by employers, recruiters, or consumers that family physicians do not do obstetrics“Because I don’t think that people really understand I’m sufficiently trained, even family medicine can do different kinds of things including delivering babies. A lot of people don’t know that, that’s kind of an interesting thing too. In old days the family docs did everything and then our older generations, they assume that we do everything. But younger generation they think that we’re urgent care people.” (Female not doing OB in the Southwest)
  • OB, obstetrics.