Sustainable Family Medicine Obstetrics as a Safety Net for Marginalized Low Resource Communities 2005-2022: The Impact of Expanded Training and Office Redesign

Abstract

Background: This prospective study of all pregnancies explored the impact of infrastructure changes reducing health care disparities over 18 years. Office redesign, hospital privileges, and expanded point of care services allowed family physicians to sustain comprehensive family care including obstetrics.

Research design: Family physicians leased office space in a chronically underserved urban area, with clinical revenue as the primary funding source. The office was redesigned to focus on providing bilingual services in a low resource community. Practicing physicians met weekly to improve policies for the care of uninsured and poorly insured patients. Independence from hospital and university control was essential for the changes that led to a self-sustaining medical group. The office was open access 7 days a week. A call group of family physicians with hospital privileges for higher risk obstetric care was formed to cover deliveries 24/7 365. This was prospectively designed as a longitudinal study 2005 to 2022. Data on family care and obstetrics were collected.All physicians followed the American College of Obstetrics and Gynecology (ACOG) guidelines and were subject to hospital peer review. A subset of consecutive patients from the index group, 2019 to 2022, provided detailed data describing office visits, high-risk patients, office ultrasound, nursery services, and subsequent well-child family care. Coding and collections analysis tabulated revenue associated with these deliveries. External audits measured quality and cost.

Results: Data from 13,926 consecutive family medicine deliveries over eighteen years underscore sustainability. A subset of 2,335 deliveries from Medicos 2019 to 2022 validated quality outcomes of high-risk obstetrics and repeat cesarean sections by family physicians. Expanded point of care services data included the first prenatal visit through postpartum, nursery, and early childcare.

Conclusion: This model provides a framework for retaining obstetric services in low-resource, marginalized communities. Independence from hospital control allowed expansion of service which increased access and quality at lower cost.

Keywords: Cesarean Section; Family Medicine; Fellowships; Health Care Economics; Longitudinal Studies; Obstetrics; Point of Care Ultrasound; Reimbursement Data; Training.