The Obstetric Care Workforce in Critical Access Hospitals (CAHs) and Rural Non-CAHs


This policy brief describes obstetric staffing patterns in rural hospitals in nine states by Critical Access Hospital (CAH) status. The purpose of this study was to examine current obstetric practice models in rural hospitals, with a goal of providing timely and useful information to rural hospitals with obstetric care units regarding the obstetric workforce and to inform policymakers involved in shaping healthcare about the context in which rural hospitals operate.

Key Findings:

  • In the nine states we studied, almost two-thirds of the 244 rural hospitals (64.3%) had more than one type of clinician providing obstetric care. The most frequent combinations were obstetricians working with certified nurse-midwives (17.2% of hospitals) and obstetricians working with family physicians (15.6%).
  • Critical Access Hospitals (CAHs) were significantly more likely than rural non-CAHs to have family physicians and general surgeons attending deliveries, and significantly less likely to have obstetricians attending deliveries.
  • When asked about the challenges they face staffing rural obstetric units, survey respondents most frequently cited census variability, retention and recruitment, maintenance of skills and competencies, and staffing arrangements (scheduling, taking call, unit coverage, etc.).
University of Minnesota Rural Health Research Center
Katy Kozhimannil, Michelle Casey, Peiyin Hung, Shailendra Prasad, Ira Moscovice