Understanding and Overcoming Barriers to Rural Training in Family Medicine Obstetrics Fellowships


This study describes characteristics of rurally oriented family medicine (FM) obstetrical (OB) fellowships and challenges these programs face in providing OB training. Researchers identified and surveyed 21 rurally oriented FM OB fellowships that either (1) served a predominately rural catchment area, (2) mentioned requiring rural training, (3) specified training physicians for rural practice in their mission, or (4) prioritized applicants who intended future rural practice. None of these programs were rurally located according to Rural-Urban Commuting Area codes.

Key Findings:

  • All 13 survey respondents (62% response rate) reported a mission to train family physicians for rural practice, yet less than one-third (n=4, 31%) reported their fellowship programs required rural training.
  • Nearly all fellowships reported training graduates to provide prenatal and delivery care, including vaginal deliveries, C-sections, gynecology procedures, and OB ultrasound.
  • The most frequently reported major challenges to providing rural OB training were community factors that included competition with other OB providers (n=4, 31%), declining OB patient populations (n=4, 31%), and lack of community awareness of family physicians' scope of practice (n=3, 23%).
WWAMI Rural Health Research Center
Sara Woolcock, Erin Fredrickson, David Evans, Lisa Garberson, Davis Patterson