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Demographic concordance between patients and clinicians has been associated with better outcomes. The current perinatal care workforce is not adequately diverse to allow for patient-clinician concordance. In this mixed-methods study, we aimed to understand family physicians' perception of the impact of patient-clinician concordance on perinatal care. The predominantly (91%) non-Hispanic White sample of 1,505 family physicians (FPs) perceived gender and language concordance to affect perinatal care more than racial or ethnic concordance. Religious concordance is not perceived to greatly affect perinatal care. Nearly half (721) of the respondents chose to leave a free-text comment on the impact of concordance on perinatal care. Four categories emerged (patients, physicians, the patient-physician relationship, and potential ways to mitigate the impact of discordance). Based on the perceptions of FPs experienced in perinatal care, intentionally supporting continuity of care between patients and clinicians may help to mitigate the negative impact of discordance on perinatal outcomes.

Background and Objectives: The number of family physicians who include obstetric care in their scope of practice is declining, resulting in lower access for patients to obstetric care, especially in rural and underserved communities. In our study, we aimed to understand the experiences of mid- to late-career family physicians and capture suggestions regarding how to maintain obstetric deliveries as part of practice throughout their careers., Methods: We administered a 30-item online survey to mid- to late-career family physicians regarding their obstetrical care practice and their suggestions for family physicians to continue attending deliveries throughout the course of their career. We developed descriptive statistics of individual and practice characteristics and thematically analyzed open-text comments offering suggestions for continuing to provide obstetric care., Results: About 1,500 family physicians agreed to participate in the online survey, 992 of whom responded to an open-text question asking for suggestions for family physicians hoping to continue providing obstetric care throughout their careers (56% response rate). The primary themes included suggestions regarding interprofessional relationships, call coverage/backup, training and education, practice characteristics, practice setting, work-life balance, job seeking, policy, and compensation., Conclusions: The findings revealed individual- and structural-level considerations to improve longevity in obstetric scope of practice. Support from multiple levels is necessary to ensure that competent family physicians continue attending deliveries throughout their careers. Practices and hospital systems can have a sizeable impact by directly helping family physicians provide obstetric primary care within their scope of practice, while national organizations can influence health care system-level changes.

The impact of the declining proportion of family physicians who attend deliveries on the provision of other perinatal care during pregnancy, postpartum, and neonatal periods is unclear. We found a strong association between stopping attending deliveries and stopping providing prenatal and postpartum care among family physicians, suggesting that policies which support family physicians to maintain a full scope of practice including all or some aspects of perinatal care may help alleviate shortages in the perinatal workforce and fill gaps in access to obstetric care., Competing Interests: Conflict of interest: The authors have no conflicts of interest to declare., (© Copyright by the American Board of Family Medicine.)

Family physicians who report their race as "Other" in a single best option question find the existing categories and forced choice of one category to be problematic. Our analysis of open-text responses in the "Other" race category supports a modification in the way these data are collected to provide more accurate and meaningful ways to understand the workforce and move toward more diverse, equitable, and inclusive policies in family medicine., Competing Interests: Conflicts of interest: Drs. Eden, Taylor, and Wang are employees of the American Board of Family Medicine., (© Copyright by the American Board of Family Medicine.)

A race and gender salary gap has been well-documented throughout the U.S. economy, but little described in primary care. Using self-reported data on the most widely distributed primary care physician specialty, we reveal lower incomes and hourly wages among Black/African American and female family physicians. The clear gradient in family physician compensation by race and gender demands further study and action to better understand and address the underlying sources of these differences., Competing Interests: Conflict of interest: AB, MT, ZM, TW, and AE are employed by the ABFM. RHO is employed by the AAFP. AA is an ABFM Board Member., (© Copyright 2022 by the American Board of Family Medicine.)

Using data from 2016 to 2020, we found that family physicians who identify as underrepresented minorities in medicine were more likely to have a larger percentage of vulnerable patients in their panels. Increasing access to care for vulnerable patient populations will require a combination of advocating for policies to diversify the physician pipeline and those that encourage all primary care physicians to care for vulnerable patients., Competing Interests: Conflicts of interest: None., (© Copyright 2022 by the American Board of Family Medicine.)