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Background: Patient‐centered care is the best practice in the care of pregnant and postpartum patients. The COVID‐19 pandemic prompted changes in perinatal care policies, which were often reactive, resulting in unintended consequences, many of which made the delivery of patient‐centered care more difficult. This study aimed to understand the impact of the COVID‐19 pandemic on perinatal health care delivery from the perspective of family physicians in the United States. Methods: From October 5 to November 4, 2020, we surveyed mid‐ to late‐career family physicians who provide perinatal care. We conducted descriptive analyses to measure the impact of COVID‐19 on prenatal care, labor and delivery, postpartum care, patient experience, and patient volume. An immersion‐crystallization approach was used to analyze qualitative data provided as open‐text comments. Results: Of the 1518 survey respondents, 1062 (69.8%) stated that they currently attend births; 595 of those elaborated about the impact of COVID‐19 on perinatal care in free‐text comments. Eight themes emerged related to the impact of COVID‐19 on perinatal care: visitation, patient decisions, testing, personal protective equipment, care continuity, changes in care delivery, reassignment, and volume. The greatest perceived impact of COVID‐19 was on patient experience. Conclusions: Family physicians who provided perinatal care during the COVID‐19 pandemic noted a considerable impact on patient experience, which particularly affected the ability to deliver patient‐centered and family‐centered care. Continued research is needed to understand the long‐term impact of policies affecting the delivery of patient‐centered perinatal care and to inform more evidence‐based, proactive policies to be implemented in future pandemic or disaster situations. [ABSTRACT FROM AUTHOR]

Background: Little is known about how physicians experience preparing for board recertification examinations. As women make up a growing proportion of the primary care physician workforce, we aimed to explore how primary care physicians experience the personal and professional impacts of recertification examination preparation activities, and whether these impacts differ by gender. Materials and Methods: We conducted exploratory qualitative semistructured interviews with 80 primary care physicians, who had recently taken either the American Board of Family Medicine or American Board of Internal Medicine recertification examination and who practice outpatient care. We used an iterative recruitment approach to obtain a representative sample. We applied a team-based constant comparative analytic approach to identify and categorize themes related to how preparing for the recertification examination impacted their personal or professional lives, and then compared these themes by physician gender. Results: We interviewed 41 male and 39 female participants. Physicians most frequently described taking time from personal rather than professional activities to study, but often said this was ''no big deal.'' Physicians described impacts on personal life such as missing out on family or leisure time, conflicts with parenting responsibilities, and an increased reliance on their spouse for domestic and childcare duties. Female physicians more frequently described parenting and leisure time impacts than males did. Conclusions: Recertification examination preparation impacts physicians' personal lives in a variety of ways and are sometimes experienced differently along gendered lines. These findings suggest opportunities for employers, payers, and specialty boards to help physicians ease potential burdens related to maintaining board certification. [ABSTRACT FROM AUTHOR]

Background and Objectives: Family physicians (FPs) are well positioned to increase abortion access given their broad scope and diverse geographic practice regions. Previously published studies focus on physicians who received formal abortion training but do not include the full landscape of FPs performing abortions in the United States. This secondary data analysis presents a unique opportunity to examine characteristics of early-career FPs who provide abortions, including practice locations and if they received abortion training during residency.Methods: We analyzed data from the 2016-2018 Family Medicine National Graduate Survey to generate descriptive statistics about respondents who report providing pregnancy termination, uterine aspiration/dilation and curettage, or both. We evaluated associations between physician and/or practice characteristics and providing pregnancy termination using bivariate statistics.Results: Of the 6,319 survey respondents, 3% reported providing pregnancy termination. Nearly three-quarters of this subset reported graduating residency feeling prepared to provide pregnancy termination. Most respondents completed residency in the West or Northeast US geographic regions, and 3 years later were practicing in the West or South regions. Additional characteristics associated with providing pregnancy termination include female gender, providing continuity care, and practicing in either an academic medical center or a federally qualified health center.Conclusions: FPs are well positioned to address gaps in abortion access, and those who provide pregnancy termination practice in various US geographic regions. This is the first discussion of its kind about the scope of family physicians providing abortion care. Future research should continue to characterize FPs who provide abortions to determine where they train and practice and what type of abortions they provide. [ABSTRACT FROM AUTHOR]

Objective This study aimed to explore how new family medicine graduates who want to include obstetrics in their scope of practice identify and select jobs and to understand how employment influences scope of practice in family medicine, particularly the ability to provide maternity care and deliver babies. Design Mixed-methods study including a survey and qualitative interviews conducted in 2017. Setting We electronically surveyed US family physicians and followed up with a purposeful subsample of these physicians to conduct in-depth, semistructured telephone interviews. Participants 1016 US family medicine residency graduates 2014-2016 who indicated that they intended to deliver babies in practice completed a survey; 56 of these were interviewed. Main outcome measures The survey measured the reasons for not doing obstetrics as a family physician. To identify themes regarding finding family medicine jobs with obstetrics, we used a team-based, immersion- crystallisation approach to analyse the transcribed qualitative interviews. Results Survey results (49% response rate) showed that not finding a job that included obstetrics was the primary reason newly graduated family physicians who intended to do obstetrics were not doing so. Qualitative interviews revealed that family physicians often find jobs with obstetrics through connections or recruitment efforts and make job decisions based on personal considerations such as included geographical preferences, family obligations and lifestyle. However, job-seeking and job-taking decisions are constrained by employment-related issues such as job structure, practice characteristics and lack of availability of family medicine jobs with obstetrics. Conclusions While personal reasons drove job selection for most physicians, their choices were constrained by multiple factors beyond their control, particularly availability of family medicine jobs allowing obstetrics. The shift from physician as practice owner to physician as employee in the USA has implications for job-seeking behaviours of newly graduating medical residents as well as for access to healthcare services by patients; understanding how employment influences scope of practice in family medicine can provide insight into how to support family physicians to maintain the scope of practice they desire and are trained to provide, thus, ensuring that families have access to care. [ABSTRACT FROM AUTHOR]

To help health care practices transition away from fee-for-service reimbursement and toward value-based payment, the Transforming Clinical Practice Initiative was launched in October 2015. It was designed to provide clinicians support through peer-based Practice Transformation Networks (PTNs). A group of American Board of Family Medicine board-certified family physicians enrolled in PTNs described their expectations of and experiences with PTN participation; we analyzed open-text comments. Physicians expected and experienced PTN support in informatics and data, team building, and workflow and care coordination; however, expectations regarding patient care and engagement, costs and payment reform, and population and panel health were described less frequently. [ABSTRACT FROM AUTHOR]

The American Board of Family Medicine routinely surveys its Diplomates in each national graduating cohort 3 years out of training. These data were used to characterize early career family physicians whose services include management of pregnancy and prescribing buprenorphine. A total of 261 (5.1%) respondents both provide maternity care and prescribe buprenorphine. Family physicians who care for pregnant women and also prescribe buprenorphine represented 50.4% of all buprenorphine prescribers. The family physicians in this group were trained in a small number of residency programs, with only 15 programs producing at least 25% of graduates who do this work. [ABSTRACT FROM AUTHOR]

Introduction: This study examines how improving curricular content and technical interface issues could make maintenance of certification activities more meaningful to American Board of Family Medicine diplomates completing Maintenance of Certification for Family Physicians (MC-FP) Program self-assessment modules (SAMs). Methods: We used a sequential exploratory design to analyze quantitative and qualitative data from 320,500 surveys of family physicians who completed a SAM between January 2004 and April 2013. This included numeric rating scales and free text comments. Basic statistical rankings, template-based automated coding, and emergent coding were used to analyze SAM experience and identify thematic content. Results: Across SAMs, numeric ratings were universally high and positive free text comments outnumbered negative comments two to one. When comparing feedback on the knowledge assessment and clinical simulation (CS) activities, SAMs were rated less favorably when the frequency of ideas identified by participants as most prevalent in one activity mismatched those identified as most prevalent in the companion activity. Participants were also critical of navigation issues, technical issues and a lack of realness in the CS activity. Discussion: Whether analyzed through quantitative data, qualitative data, or mixed methods, a large majority of participants rated their experience with SAMs highly. When individual SAMs were rated poorly, it seemed to be due to discordance in ideas emphasized between the knowledge assessment and CS components, or an opinion regarding the SAM topic that existed independent of the SAM process. [ABSTRACT FROM AUTHOR]

Background: There are no consistent data on US primary care clinicians and primary care practices owing to the lack of standard methods to identify them, hampering efforts in primary care improvement., Methods: We develop a pragmatic framework that identifies primary care clinicians and practices in the context of the US healthcare system, and applied the framework to the IQVIA OneKey Healthcare Professional database to identify and profile primary care clinicians and practices in the USA., Results: Our framework prescribes sequential steps to identify primary care clinicians by cross-examining clinician specialties and organizational affiliations, and then identify primary care practices based on organization types and presence of primary care clinicians. Applying this framework to the 2021 IQVIA data, we identified 365,751 physicians with a primary specialty in primary care, and after excluding those who further specialized (24%), served as hospitalists (5%), or worked in non-primary care settings (41%), we determined that 179,369 (49%) of them were actually practicing primary care. We identified 287,506 nurse practitioners and 134,083 physician assistants and determined that 88,574 (31%) and 29,781 (22%), respectively, were delivering primary care. We identified 94,489 primary care practices, and found that 45% of them were with one primary care physician, 15% had two physicians, 12% employed nurse practitioners or physician assistants only, and 19% employed both primary care physicians and specialists., Conclusions: Our approach offers a pragmatic and consistent alternative to the diverse methods currently used to identify and profile primary care workforce and organizations in the USA., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Introduction: As an increasing number of rural hospitals close their maternity care units, many of the approximately 28 million reproductive-age women living in rural America do not have local access to obstetric services. We sought to describe the characteristics and distribution of cesarean section-providing family physicians who may provide critical services in maintaining obstetric access in rural hospitals., Methods: Using a cross-sectional study design, we linked data from the 2017 to 2022 American Board of Family Medicine's Continuting Certification Questionnaire on provision of cesarean sections as primary surgeon and practice characteristics to geographic data. Logistic regression determined associations with provision of cesarean sections., Results: Of 28,526 family physicians, 589 (2.1%) provided cesarean sections as primary surgeon. Those who provided cesarean sections were more likely to be male (odds ratio (OR) = 1.573, 95% confidence limits (CL) 1.246-1.986), and work in rural health clinics (OR = 2.157, CL 1.397-3.330), small rural counties (OR = 4.038, CL 1.887-8.642), and in counties without obstetrician/gynecologists (OR = 2.163, CL 1.440-3.250)., Discussion: Although few in number, family physicians who provide cesarean sections as primary surgeon disproportionately serve rural communities and counties without obstetrician/gynecologists, suggesting that they provide access to obstetric services in these communities. Policies that support family physician training in cesarean sections and facilitate credentialing of trained family physicians could reverse the trend of closing obstetric units in rural communities and reduce disparities in maternal and infant health outcomes., Competing Interests: Conflict of interest: Mr. Morgan, Dr. Bazemore and Dr. Peterson are employees of the American Board of Family Medicine. Dr. Eden was an employee of the American Board of Family Medicine at the time of this paper’s development., (© Copyright by the American Board of Family Medicine.)

Supporting a diverse family physician workforce is an integral component of achieving health equity. This study compared the racial/ethnic composition of Federal family physicians (Military, Veterans Administration/Department of Defense) to the entire cohort of family physicians and stratified by gender. Female family physicians serving at Federal sites were more diverse than the overall population of female family physicians and, also than their male Federal counterparts. This gendered trend among Federal physicians needs further exploration., Competing Interests: Conflicts of interest: None., (© Copyright by the American Board of Family Medicine.)

Background: Maternal and birth outcomes represent some of the most profound racial and ethnic disparities in health in the USA, and are, in part, attributed to a lack of diversity in the maternity care workforce. Family physicians are an often-overlooked part of the maternity care workforce, yet frequently provide care to underserved populations. This study aims to characterize the family physician workforce providing obstetric care in terms of race/ethnicity., Methods: In this cross-sectional study, we used data collected via the American Board of Family Medicine Exam Registration Questionnaire from 2017 to 2019. Respondents included family physicians seeking to continue their certification in those years. We conducted bivariate tests and an adjusted analysis using logistic regression to examine associations with providing obstetric deliveries. Variables included race, ethnicity, age, gender, degree type, international medical graduate status, practice site, and rurality., Results: Of 20,820 family physicians in our sample, those identifying as Black/African American (OR 0.55, CI 0.41 to 0.74) and Asian (OR 0.40, CI 0.31 to 0.51) had significantly lower odds of including obstetrics in their practice than those identifying as White. We found no significant difference in practicing obstetrics between Hispanic and non-Hispanic family physicians (OR 0.94, CI 0.73 to 1.20). Asian (OR 0.40, CI 0.31 to 0.51) and Black/African American (OR 0.55, CI 0.41 to 0.74) physicians still have significantly lower odds of providing obstetric care than White physicians after controlling for rurality., Conclusions: Family physicians who identified as Black/African American or Asian are less likely to include obstetrics in their practice. A diverse and racially/ethnically representative maternity care workforce, including family physicians, may help to ameliorate disparities in maternal and birth outcomes. Enhanced efforts to diversify the family physician maternity care workforce should be implemented., (© 2021. W. Montague Cobb-NMA Health Institute.)

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.)

Background: While barriers to care for pregnant patients with opioid use disorder (OUD) have been described, the experiences and challenges of the physicians providing care to these patients are poorly understood., Objectives: To describe the experiences of family physicians providing comprehensive care to pregnant people with OUD and the challenges they face in providing such care., Methods: Qualitative thematic analysis of 17 semistructured interviews conducted from July 2019 to September 2020 with family physicians who possess a Drug Enforcement Administration "X" waiver and provide care to pregnant patients., Results: Seventeen family physicians practicing in the United States who care for pregnant people with OUD were interviewed. They described physician-, patient-, and systems-level barriers to providing and accessing care for this patient population. Of the 12 interrelated themes regarding challenges to delivering and accessing this care, 3 were particularly salient: the pervasive effects of social determinants of health, a lack of adequately trained providers, and social stigma associated with pregnant people with OUD., Conclusion: A comprehensive, multilevel, and multidisciplinary approach is necessary to address these barriers and move towards health equity for this vulnerable patient population., (© The Author(s) 2021. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: COVID-19 pandemic-related health care disruptions necessitated rapid adaptation among family physicians to safely meet patient needs while protecting themselves and their staff. On April 1, 2020, the American Board of Family Medicine (ABFM) introduced a COVID Performance Improvement (PI) activity for physicians to report on and receive Family Medicine certification credit for practice adjustments they made during the early stages of the pandemic. We aimed to understand the types of interventions implemented, and lessons physicians learned from the efforts., Methods: We analyzed data from COVID-PI activities submitted by self-selected family physicians between April 1 and June 30, 2020. We summarized the COVID-related topics chosen for improvement and performed a qualitative content analysis on a random sample of open-text responses about lessons learned., Results: The most common practice changes among 1259 unique COVID-PI activity submissions related to virtualization of patient visits, implementing new workflows, developing screening protocols, and obtaining and preserving personal protective equipment. We identified 12 themes regarding lessons learned, most commonly regarding patient and staff safety, modified practice processes and workflows, positive perceptions of and future plans for virtual visits, access to care, and patient satisfaction. Most submitters noted early successes with their interventions., Conclusion: A PI activity template designed for continuous board certification allowed family physicians to report on how they successfully implemented short term practice changes during the early stages of the COVID-19 pandemic. Reflections from this subset of physicians regarding lessons learned may prove useful in informing future COVID-19 related practice changes., Competing Interests: Conflict of interest: The authors are employees of the ABFM. Dr. Newton is the president of ABFM., (© Copyright 2022 by the American Board of Family Medicine.)

Background and Objectives: Racial/ethnic score disparities on standardized tests are well documented. Such differences on the American Board of Family Medicine (ABFM) certification examination have not been previously reported. If such differences exist, it could be due to differences in knowledge at the beginning of residency or due to variations in the rate of knowledge acquisition during residency. Our objective was to examine the residents' mean initial scores and score trajectories using the In-Training Examination (ITE) and certification examination., Methods: A total of 17,275 certification candidates from 2014 to 2019 were included in this study. Annual ITE scores and certification examination scores are reported on the same scale and serve as the outcome. We conducted multilevel longitudinal regression to determine initial knowledge and growth in knowledge acquisition during residency by race/ethnicity categories., Results: The mean postgraduate year 1 (PGY-1) ITE score was 393.3, with minority residents scoring 16.2 to 36.0 points lower compared to White residents. The mean increase per year in exam performance from PGY-1 ITE to the certification exam was 39.9 points (95% CI, 38.7, 41.1) with additional change among race/ethnicity categories per year of -3.2 to 1.9 points., Conclusions: This study found that there were initial score disparities across race/ethnicity groups in PGY-1, and these disparities continued at the same rate throughout residency training, suggesting equality in acquisition of knowledge during family medicine residency training but with a persistent gap throughout training.

Background: Because improved patient outcomes and experiences have been associated with health care workforce diversity, efforts to create a diverse family physician workforce have increased. However, a metric that could properly measure family physician representation in various contexts has seldom been studied., Objective: The goal of this study is to propose a new metric logRQ and use it to examine the diversification progress of American Board of Family Medicine (ABFM) certification candidates relative to national, state, and historic populations, as well as medical school matriculants., Methods: We obtained race/ethnicity for certification candidates from the 2014 to 2020 ABFM Certification Examination Registration questionnaire and examined racial/ethnic representation relative to various populations via logRQs., Results: The total sample comprised 26,368 initial certification candidates and 55,347 continuing certification candidates. Asian, Hispanic, and Black's logRQ increased by 0.51, 0.42, and 0.41, respectively, in initial certification candidates compared with continuing certification candidates. In addition, logRQ standard deviation ranged from 0.19 to 0.87 across States, indicating state-level variation. Although Black and Hispanic remained underrepresented, the degree of underrepresentation had improved substantially across the past 5 decades, with logRQ increasing from -2.12 (Black) and -1.16 (Hispanic) in the 1970s to -0.46 (Black) and -0.68 (Hispanic) in the 2010s. The race/ethnicity logRQs of 2020 initial certification candidates relative to 2013 to 2014 medical school matriculants were all near 0, reflecting equitable representation., Conclusion: We utilized the proposed metric logRQ to quantify the advancement in representation among ABFM certification candidates in different contexts. The proposed logRQ may serve as a useful tool to monitor representation progress systematically., Competing Interests: Conflict of interest: None., (© Copyright 2022 by the American Board of Family Medicine.)

Purpose: Physicians of all specialties are more likely to live and work in urban areas than in rural areas. Physician availability affects the health and economy of rural communities. This study aimed to measure and update the availability of physician specialties in rural counties., Methods: This analysis included all counties with a Rural-Urban Continuum Code (RUCC) between 4 and 9. Geographically identified physician data from the 2019 American Medical Association Masterfile was merged with 2019 County Health Rankings, the Census Bureau's 2010 county-level population data, and 2010 Topologically Integrated Geographic Encoding and Referencing shapefiles. Multivariate logistic regression was performed to assess the availability of physicians by specialty in rural counties., Findings: Of the 1,947 rural counties in our sample, 1,825 had at least 1 physician. Specialties including emergency medicine, cardiology, psychiatry, diagnostic radiology, general surgery, anesthesiology, and OB/GYN were less available than primary care physicians (PCPs) in all rural counties. The probability of a rural county having a PCP was the highest in RUCC 4 (1.0) and lowest in RUCC 8 (0.93). Of all primary care specialties, family medicine was the most evenly distributed across the rural continuum, with a probability of 1.0 in RUCC 4 and 0.88 in RUCC 9., Conclusions: Family medicine is the physician specialty most likely to be present in rural counties. Policy efforts should focus on maintaining the training and scope of practice of family physicians to serve the health care needs of rural communities where other specialties are less likely to practice., (© 2020 National Rural Health Association.)

Of family physicians who perform cesarean sections, more than half do so in rural communities and 38.6% provide cesarean sections in counties without any obstetrician/gynecologists. As policymakers in the United States struggle with a widening landscape of 'obstetrical deserts,' efforts to adequately train a family physician workforce prepared to provide cesarean sections could help maintain access to local obstetric services in rural communities and reduce perinatal morbidity and mortality., Competing Interests: Conflict of interests: STT is employed by the Agency for Healthcare Research and Quality but contributed to this article in his personal capacity. The opinions expressed are the author’s own and do not reflect the view of the Agency for Healthcare Research and Quality, the Department of Health and Human Services or the Federal government. ARE, ZJM, AWB, and LEP are employed by the American Board of Family Medicine., (© Copyright 2021 by the American Board of Family Medicine.)

The American Board of Family Medicine routinely surveys its Diplomates in each national graduating cohort 3 years out of training. These data were used to characterize early career family physicians whose services include management of pregnancy and prescribing buprenorphine. A total of 261 (5.1%) respondents both provide maternity care and prescribe buprenorphine. Family physicians who care for pregnant women and also prescribe buprenorphine represented 50.4% of all buprenorphine prescribers. The family physicians in this group were trained in a small number of residency programs, with only 15 programs producing at least 25% of graduates who do this work., (© 2020 Annals of Family Medicine, Inc.)

Purpose: Little is known about how board-certified physicians prepare for their periodic maintenance of certification (MOC) examinations. This qualitative study explores how physicians experience MOC exam preparation: how they prepare for the exams and decide what to study and how exam preparation compares with what they normally do to keep their medical knowledge current., Method: Between September 2016 and March 2017, the authors interviewed 80 primary care physicians who had recently taken either the American Board of Family Medicine or American Board of Internal Medicine MOC exam. They analyzed transcripts and notes from these interviews looking for patterns and emergent themes, using the constant comparative method and a social practice theory perspective., Results: Most interviewees studied for their MOC exams by varying from their routines for staying current with medical knowledge, both by engaging with a different scope of information and by adopting different study methods. Physicians described exam preparation as returning to a student/testing mindset, which some welcomed and others experienced negatively or with ambivalence., Conclusions: What physicians choose to study bounds what they can learn from the MOC exam process and, therefore, also bounds potential improvements to their patient care. Knowing how physicians actually prepare, and how these activities compare with what they do when not preparing for an exam, can inform debates over the value of requiring such exams, as well as conversations about how certification boards and other key stakeholders in physicians' continuing professional development could improve the MOC process.

Background: A professional association journal should reflect the needs of its organization, its readers, and the field it represents. Evaluating the needs that the Journal of Human Lactation has met, and those it has not, is essential if it is to remain relevant to its readers., Aims: (1) Describe the characteristics of articles published from 1985 through 2018. (2) Describe content intended to educate lactation support providers and clinicians. (3) Explore the ways the content has illustrated the growth and development of lactation knowledge, and (4) identify the reoccurring content threads consistent throughout the 34 years., Methods: A prospective mixed methods approach incorporating a quantitative content analysis and a qualitative thematic analysis was used. Frequency distributions were done on all the variables extracted from published articles ( N = 1586). The second level of analysis identified themes using an iterative and consensus approach., Results: Mirroring the growth in the lactation field, the volume of research articles published each year has increased along with the percent of research articles per issue. Research methods have become more diverse. The international scope and relevance, while always present, has been steadily increasing. Threads identified were; striving for international scope, advancing lactation education, developing a body of knowledge that informs clinical practice in lactation, and creating a centralized place for multidisciplinary research about lactation., Conclusion: The body of work published in the Journal of Human Lactation parallels the development of the lactation specialty. We have highlighted areas for improvement and possible further study.

Background: Family Medicine-Obstetrics fellowships provide family physicians with advanced obstetrics training. No accreditation system exists for these fellowships, which leads to variable training. Variation of fellows' experiences is not well understood. Our objective is to understand the motivations, training, and overall experiences of fellows in Family Medicine-Obstetrics fellowships, which may inform opportunities for improvement in fellowship design and suggest how Family Medicine-Obstetrics fellowship-trained physicians are prepared to practice among other obstetrics providers postgraduation., Methods: We conducted semistructured interviews with current and past Family Medicine-Obstetrics fellows between Spring 2014 and Winter 2015. We used a snowball sampling approach. Interviews were recorded, transcribed, and coded following an inductive approach to content analysis., Results: We contacted 47 and interviewed 21 current and past Family Medicine-Obstetrics fellows from 15 programs from across the country. Fellowships varied in cohort size, length, co-occurring presence of obstetrics and gynecology training programs, and structure and curriculum. Interviewees were motivated to complete a fellowship because of inadequate obstetrics training in residency, or because of an interest in rural or urban underserved practice. Fellowship experiences were shaped by fellowship leadership, program structure and curriculum, and relationships with obstetricians. Some felt prepared to forge collaborative professional relationships with obstetricians., Conclusions: The diversity of fellows' experiences suggests possible avenues of improvement for Family Medicine-Obstetrics fellowships. These fellowships can prepare physicians to provide obstetric services in a variety of settings, including working in multispecialty integrated maternity care systems., (© 2018 Wiley Periodicals, Inc.)

Introduction: Maintenance of Certification (MOC) was implemented to help physicians remain current with evolving medical standards, but has been criticized for being irrelevant to practice. We assessed family physicians' (FPs') opinions about the content of American Board of Family Medicine (ABFM) self-assessment modules (SAMs)., Methods: We used ABFM administrative data from feedback surveys completed after each of the 16 SAMs from 2006 to 2016. FPs rated agreement with 2 statements-1) "Content is appropriate for my practice," and 2) "Content was presented at an appropriate level"-on a scale of 1 (strongly disagree) to 6 (strongly agree). We calculated mean ratings of each statement by year and stratified by Knowledge Assessment (KA) and Clinical Simulation (CS) portions of the SAM. We plotted mean ratings by FPs' age at their first SAM completion and the total number of SAMs completed., Results: SAMs were completed (n = 633,198) from 2006 to 2016 with 448,408 (71%) feedback surveys completed. The annual mean ratings of both statements varied little (less than 0.5) and were above 4.5 for all SAMs. CS ratings were consistently lower than KA ratings. FPs of all ages at first SAM provided similar ratings and agreement with content appropriateness increased with repeated exposure to SAMs., Conclusion: Over 11 years, the content of ABFM SAMs was regarded by FPs as appropriate for practice and presented at an appropriate level. Continued monitoring of feedback is necessary to keep the content of MOC programs relevant for physicians' practice., Competing Interests: Conflict of interest: The authors are employees of the American Board of Family Medicine., (© Copyright 2019 by the American Board of Family Medicine.)

Diversification of the physician workforce has been a goal of Association of American Medical Colleges for several years and could improve access to primary care for under-served populations and address health disparities. We found that family physicians' demographics have become more diverse over time, but still do not reflect the national demographic composition. Increased collaboration with undergraduate universities to expand pipeline programs may help increase the diversity of students accepted to medical schools, which in turn should help diversify the family medicine workforce., Competing Interests: Conflict of interest: MP, AE, and RP are employees of the American Board of Family Medicine., (© Copyright 2018 by the American Board of Family Medicine.)

Introduction Maldistribution of maternity care (MC) providers in the U.S. limits access to full spectrum MC services. Obstetricians are concentrated in urban areas with many rural areas reliant on family physicians (FP) to provide MC, yet fewer FPs are providing MC. The objective of this study was to understand the challenges FPs face in gaining skills in and providing advanced MC. Methods We conducted qualitative semi-structured interviews with 51 purposively sampled key stakeholders in family medicine MC (21 family medicine-OB fellowship directors, 19 past fellows, and 10 family medicine residency directors of programs with advanced MC training). Interviews were recorded, transcribed, and analyzed using an inductive approach to qualitative content analysis. Results Three primary challenges for FPs providing advanced MC emerged from the interviews. Training: most family medicine residency programs do not provide sufficient surgical OB training, so fellowship training is an important alternative for FPs to acquire such skills. Credentialing: obtaining hospital privileges to perform cesarean sections is unpredictable and highly variable by institution. Professional relationships: "turf battles" with other MC providers can limit FPs' ability to provide care commensurate with their level of training. Discussion As the predominant provider of MC in rural and underserved areas, FPs need to be supported to provide advanced MC services. Possible strategies to accomplish this include: enhanced family medicine training in MC; policy changes to address credentialing inconsistencies; and improved team-based care for pregnant women to ensure that every woman has access to high quality MC.