Tong ST, Makaroff LA, Xierali IM, Parhat P, Puffer JC, Newton WP, Bazemore AW. Proportion of Family Physicians Providing Maternity Care Continues to Decline. Journal of The American Board of Family Medicine 2012;25(3):270-271

The authors analyzed data from ABFM diplomates who completed the continuing certification practice demographic questionnaire from 2000 to 2010 (n = 90, 221). The proportion of US family physicians who report providing maternity care declined from 23.3% in 2000 to 9.7% in 2010. Of the family physicians who do provide maternity care, 10.1% of their time, on average (aggregated over 2000 to 2010), was spent doing so.

Peterson LE, Blackburn B, Phillips RL, Puffer JC. Structure and Characteristics of Family Medicine Maternity Care Fellowships. Family Medicine 2014;46(5):354-359.

Maternity Care Fellowships (MCFs) lack official recognition and certification. The authors surveyed 18 of 29 MCFs to assess their structure and organization. Eighty-eight percent of MCFs were 1 year in length, and the mean number of fellows per year was 1.9. All but one program was associated with a residency training program, and 55.6% were based in community hospitals. All but two programs had a standardized curriculum. Eighty-eight percent of MCFs had obstetricians involved in teaching or clinical supervision. Mean estimated number of deliveries performed by fellows were 80 vaginal and 108 caesarians. Graduates of MCFs were largely able to obtain caesarian privileges after graduation, and many were working in rural and/or underserved areas. Many MCF directors favored formal accreditation and a standardized curriculum across programs.

Rayburn WF, Manning BK, Petterson SM, Dickinson LM, Phillips RL. Trends in Family Physicians Performing Deliveries, 2003-2010. Birth 2014;41(1):26-32.

The authors used data from ABFM diplomates who registered for the ABFM recertification exam from 2003 – 2009 to study associations between demographic and geographic factors and performance of deliveries. Of 49,267 family physicians, the proportion performing any deliveries declined by 40.6 percent, from 17.0 percent (2003) to 10.1 (2009). Most recently, 5.5 percent of all family physicians delivered 1-25 babies per year, whereas 2.8 percent delivered 26-50, and 1.9 percent delivered more than 51. Those who performed deliveries were most likely to be junior members of a partnership or group practice and provided prenatal and newborn care. Deliveries were more common in nonmetropolitan areas.

Barreto T, Peterson LE, Petterson S, Bazemore AW. Family Physicians Practicing High-Volume Obstetric Care Have Recently Dropped by One-Half. American Family Physician 2017;95(12):762.

Previous research has shown a decline in the percent­age of family physicians practicing low (1-25 deliveries per year)- or medium (26-50 per year)-volume obstetrics. Using 13 years of ABFM certification examination registration questionnaire data from 2003 through 2016 (n = 95,750), the researchers found continued declines in low- and medium-volume obstetrics, in addition to a new 50% decrease in family physicians providing high-volume obstetrics (more than 50 per year) to be 1.1%. A 50% decrease in family physicians providing high-volume obstetric care is concerning because it may be more likely to decrease access to obstetric care than the previously observed declines in low- and medium-volume obstetrics.

Barreto TW, Eden AR, Petterson S, Bazemore AW, Peterson LE. Intention Versus Reality: Family Medicine Residency Graduates’ Intention to Practice Obstetrics. Journal of The American Board of Family Medicine 2017;30(4):405-406

Previous studies have shown a decrease in the number of family physicians including obstetric delivery in their scope of practice. The authors used ABFM certification examination questionnaire responses from 2014 – 2016 to compare intentions of graduating residents to include delivery with reported provision of deliveries to by practicing family physicians. Although 23% of new family medicine graduates reported an intention to include obstetric delivery in their scope of practice, only 9% of family physicians currently do so. The reasons for this stark difference must be identified to address potential barriers leading to family medicine graduates ultimately not including obstetric delivery despite intent. These barriers may include malpractice insurance, challenges obtaining hospital privileges, lifestyle concerns, hospital closures, and volume issues.

Eden AR, Peterson LE. Impact of Potential Accreditation and Certification in Family Medicine Maternity Care. Family Medicine 2017;49(1):14-21

This study sought to understand the perceptions and beliefs of key family medicine stakeholders in advanced maternity care regarding the formalization of maternity care training through fellowship accreditation and the creation of a certificate of added qualification. In 2014 and 2015, the authors conducted semi-structured interviews with 51 key stakeholders in family medicine maternity care. Most participants interviewed support formalizing maternity care fellowship training in family medicine through accreditation and a subsequent CAQ, if implemented with attention to minimizing the potential negative consequences such as loss of curricular flexibility.

Barreto TW, Eden AR, Hansen ER, Peterson LE. Barriers Faced by Family Medicine Graduates Interested in Performing Obstetric Deliveries. Journal of The American Board of Family Medicine 2018;31(3):332-333

Leading off from Barreto et al 2017a & 2017b (above), this article examines family medicine graduates who would like to do obstetric deliveries but have difficulty finding a position that supports that scope of practice. Using 2016 responses from the ABFM Family Medicine National Graduate Survey (n=2,108), 87% responded they did not deliver babies, while 60% of people who were interested in doing deliveries (n=865) said that the option to do so was not available to them and/or that lifestyle considerations influence their decision to not.

Eden AR, Peterson LE. Challenges Faced by Family Physicians Providing Advanced Maternity Care. Maternal and Child Health Journal 2018;22(6):932-940

The objective of this study was to understand the challenges family physicians (FPs) face in gaining skills in and providing advanced maternity care (MC). The authors conducted qualitative semi-structured interviews with 51 purposively sampled key stakeholders in family medicine MC. Three primary challenges for FPs were identified: training (most residency programs do not provide sufficient surgical OB training), credentialing (obtaining hospital privileges to perform cesarean sections is unpredictable), and professional relationships (“turf battles” with other MC providers). FPs need support to provide advanced MC. Possible avenues are enhanced family medicine training, policy changes to address credentialing, and improved team-based care for pregnant women.

Tong ST, Hochheimer CJ, Barr WB, Leveroni-Calvi M, Lefevre NM, Wallenborn JT, Peterson LE. Characteristics of Graduating Family Medicine Residents Who Intend to Practice Maternity Care. Family Medicine 2018;50(5):345-52

Cross-sectional data on 2014 to 2016 graduating residents were obtained from the ABFM. Of 9,541 graduating residents, 22.7% intended to provide deliveries and 51.2% intended to provide prenatal care. Individual characteristics associated with a higher likelihood of providing deliveries included female gender, graduation from an allopathic medical school, and participation in a loan repayment program. Residency characteristics included geographic location in the Midwest or West regions, training at a federally qualified health center (FQHC)-based clinic, funding as a teaching health center (THC), more months of required maternity care rotations, larger residency class size, and maternity care fellowship at residency.

Barreto TW, Eden AR, Hansen ER, Peterson LE. Opportunities and Barriers for Family Physician Contribution to the Maternity Care Workforce. Family Medicine 2019;51(5):383-388

The study’s objective was to understand barriers to providing obstetrical care faced by recent family medicine residency graduates who intended to provide it at graduation. Email surveys were sent to graduating family medicine residents who indicated intention to include obstetrics in their practice on the 2014 – 2016 ABFM Certification Examination Registration Survey (response rate of 48.4 percent; n = 1,016). Those currently including obstetrics were more likely to practice in a small rural or isolated community (15.4% vs 5.2% and 4.6% vs 1.7%, P<0.001) and reported credentialing was easy (85.2% and 26.5%, respectively, P<0.001). Physicians not currently including obstetrics in their practice reported “found a job without OB” and “lifestyle concerns” as the most significant barriers. Respondents living in the Middle Atlantic and West, South, and Central regions were least likely to provide obstetric deliveries, with fewer than 50% doing so.

Eden AR, Barreto T, Hansen ER. Experiences of New Family Physicians Finding Jobs with Obstetrical Care in the USA. Family Medicine and Community Health 2019;7(2):e000063

This mixed methods study of 2014-2016 ABFM Certification Examination Registration Questionnaire consisted of a survey (n= 1016) and semi-structured interviews (56) 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. Survey results 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 geographical preferences, family obligations and lifestyle. The shift from physician as practice owner to physician as employee in the USA has implications for job-seeking behaviors of newly graduating medical residents and access to healthcare services by patients.

Eden AR, Barreto TW, St. Louis J. Improving treatment of opioid use disorder in pregnancy: first define the workforce. American Journal of Obstetrics and Gynecology. 2019;221(4):371-372.

This letter to the editor addresses the need for enhanced breastfeeding support for women who conceive through assisted reproduction and the complexities of managing opioid use disorder in pregnant women. It points out the absence of evidence connecting conception methods to breastfeeding practices in the UK, suggesting a need for further research. Additionally, it critiques the classification of healthcare providers in treating pregnant women with opioid use disorder, highlighting the crucial roles of family physicians and certified nurse midwives, especially in rural areas, and calls for a more nuanced understanding of the maternity care workforce to improve access to treatment.

Hansen ER, Eden AR, Peterson LE. A Qualitative Study of Trainee Experiences in Family Medicine-Obstetric Fellowships. Birth 2019;46(1):90-96

No accreditation system exists for Family Medicine Obstetrics Fellowships leading to variation in training. The study objective was to understand motivations, training, and overall experiences of these fellows. Semi-structured interviews were conducted with 21 current and past FM-Obstetrics Fellows from 15 programs. 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. The diversity of fellows’ experiences suggests possible avenues of improvement for FM-Obstetrics Fellowships.

St. Louis J, Eden AR, Morgan ZJ, Barreto TW, Peterson LE, Phillips RL. Maternity Care and Buprenorphine Prescribing in New Family Physicians. Annals of Family Medicine. 2020;18(2):156-158. doi:10.1370/afm.2504

Using data from ABFM 2016 – 2018 National Graduate Survey responses, a total of 261 (5.1%) respondents both provided maternity care and prescribed buprenorphine. More than 60% of these physicians were female. Family physicians who care for pregnant women and 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. These residencies were largely on the east and west coasts in urban areas.

Tong S, Eden AR, Morgan ZJ, Bazemore AB, Peterson LE. The Essential Role of Family Physicians in Providing Cesarean Sections in Rural Communities. Journal of American Board of Family Medicine 2021;34(1):10-11

Family physicians are vital in providing cesarean sections in rural areas where obstetric care is limited. Over half of these physicians perform cesarean sections in rural settings, often in counties lacking obstetrician/gynecologists. To address the shortage of obstetric services in these regions, it is crucial to enhance the training and credentialing of family physicians, which could help maintain local obstetric care and reduce perinatal morbidity and mortality. Supporting obstetric fellowship training for family physicians is essential to counter the declining trend of obstetric services in rural areas.

Tong ST, Morgan ZJ, Bazemore AW, Eden AR, Peterson LE. Maternity Access in Rural America: The Role of Family Physicians in Providing Access to Cesarean Sections. Journal of the American Board of Family Medicine 2023;36(4):565-573

The article explores the involvement of family physicians (FPs) in performing cesarean sections, particularly in rural areas where access to obstetric services is limited. It highlights that FPs who perform cesarean sections are often male, work in smaller or rural practices, and are crucial in maintaining obstetric care access in communities lacking obstetricians. The study underscores the importance of training and supporting FPs in obstetric care to improve maternal and infant health outcomes, despite challenges such as a decline in FPs providing maternity care and potential reporting biases in the data.

Taylor MK, Barreto T, Goldstein JT, Dotson A, Eden AR. Providing Obstetric Care: Suggestions from Experienced Family Physicians. Family Medicine. 2023;55(9):582-590.

The study discusses the challenges faced by family physicians (FPs) in providing obstetric care, particularly in rural and underserved areas, and offers strategies to overcome these barriers. Key issues include lifestyle impacts, low delivery volumes, difficult relationships with OB/GYNs, inadequate call coverage, and liability concerns. The document suggests promoting team-based care, improving interprofessional relationships, enhancing practice support, and advocating for better compensation structures. It emphasizes the importance of practice location and the need for systemic changes to encourage FPs to continue offering obstetric services.

Nisen MB, Peterson LE, Cochrane A, Rubin SE. US Family Physicians’ Intrauterine and Implantable Contraception Provision: Results from a National Survey. Contraception 2016;93(5):432-437

Data was used from 2329 family physicians recertifying with the ABFM in 2014. Overall, 19.7% of respondents regularly inserted IUDs, and 11.3% regularly inserted and/or removed implants in a wide range of clinical settings. In multivariate analysis, the scope of practice characteristics showed the strongest association with both IUD and implant provision. For IUDs, this included providing prenatal care with or without delivery, performance of endometrial biopsies, and implant insertion and removal. For implants, it was providing prenatal care and delivery, office skin procedures, endometrial biopsies, and IUD insertion. Individual and clinical site characteristics were not largely predictive of provision. This notes family physicians’ potential to increase IUD and implant access in various settings.

Chelvakumar M, Japparpour Y, Coffman M, Jetty A, Shaw JG. Long-acting Reversible Contraception (LARC) Provision by Family Physicians: Low but on the Rise. Journal of The American Board of Family Medicine 2019;32(1):10-12

Data from the 2014 to 2017 ABFM demographic surveys were used to identify the percentage of family physicians (FPs) who regularly provide LARC services. From 2014 to 2017 the percentage of FPs regularly providing IUDs, implants, and both IUDs and implants each saw an absolute increase of 3% across the 3 years to 21.5%, 13.6%, and 11.4%, respectively by 2017. Total percentage of FPs providing LARCs is still low, at less than 25%. Although, in 2017 survey data, 82% of FPs reported they provided “women’s health services,” suggesting that LARCs are not considered part of the routine primary care offerings by most of the FP workforce. Some reasons for this discrepancy may include variability in residency training, complex reimbursement schemes, and clinical environments not equipped for gynecological procedures.

Bazemore AW, Petterson S, Johnson N, Xierali IM, Phillips RL, Rinaldo J, Puffer JC, Green LA. What Services Do Family Physicians Provide in a Time of Primary Care Transition? Journal of The American Board of Family Medicine 2011;24(6):635-636

Three years (2006-2008) of responses were analyzed from ABFM’s Maintenance of Certification examination registration questionnaire to examine scope of practice. Variation in services provided is considerable, and less than 40% of family physicians reported offering any services in more than half of the areas of scope considered. Family physicians who provided gynecology services was 55.3%, prenatal care was 19.5%, and maternity care and delivery was 14.1% and 13.3% respectively.

Xierali IM, Puffer JC, Tong ST, Bazemore AW, Green LA. The Percentage of Family Physicians Attending to Women’s Gender-Specific Health Needs is Declining. Journal of The American Board of Family Medicine 2012;25(4):406-7

ABFM diplomate demographic data from 2003 to 2009 (n = 62, 331) was used to explore recent trends in the provision of women’s health care by family physicians. The percentage of FPs actually attending to the special needs of women has declined steadily, not only in urban areas, but also in rural and primary care Health Professional Shortage Areas (HPSAs) from a national average of 73% in 2003 to 51% in 2009.

Peterson LE, Phillips RL, Puffer JC, Bazemore A, Petterson S. Most Family Physicians Work Routinely with Nurse Practitioners, Physician Assistants, or Certified Nurse Midwives. Journal of The American Board of Family Medicine 2013;26(3):244-245

Any physician who accessed their online physician portfolio on the ABFM website was asked a survey question about working with physician assistants, certified nurse midwives, and nurse practitioners. In a two-week period 5818 family physicians were surveyed and nearly 60% of respondents reported routinely working with NPs, PAs, and CNMs.

Peterson LE, Blackburn B, Petterson S, Puffer JC, Bazemore A, Phillips RL. Which Family Physicians Work Routinely with Nurse Practitioners, Physician Assistants or Certified Nurse Midwives. Journal of Rural Health 2014;30(3):227-234

The sample consisted of a convenience sample of physicians through the ABFM website in the fall of 2011. Data were linked to characteristics of physician’s Primary Care Service Area level. Of the 3,855 family physicians in the sample, 60% reported routinely working with NPs, PAs, or CNMs. In regression analysis, characteristics positively associated with working with NPs, PAs, or CNMs were providing gynecological care (Odds Ratio = 1.23 [95% confidence interval, 1.06-1.42]), multispecialty group practice, any rural setting, and higher availability of PAs. Restrictive NP scope of practice laws failed to reach significance.

Coutinho AJ, Cochrane A, Stelter K, Phillips RL, Peterson LE. Comparison of Intended Scope of Practice for Family Medicine Residents with Reported Scope of Practice Among Practicing Family Physicians. JAMA 2015;314(22):2364-2372

This study compared intended scope of practice for ABFM initial certifiers at residency completion with self-reported actual scope of practice recertifying family physicians using 2014 Maintenance of Certification examination questionnaire (n = 13,884). Mean scope score was significantly higher for initial certifier intended practice compared with recertifying physicians reported actual practices (17.7 vs 15.5; difference, 2.2 [95% CI, 2.1-2.3). Compared with recertifiers, initial certifiers were more likely to report intending to provide all clinical services asked except pain management; this included obstetric care (23.7% vs 7.7%; difference, 16.0% [95% CI, 14.4%-17.6%]), and prenatal care (50.2% vs 9.9%; difference, 40.3 [95% CI, 38.5%-42.2%]). This pattern suggests that these differences are not generational, but whether they are due to limited practice support, employer constraints, or other causes remains to be determined.

Peterson LE, Blackburn B, Peabody M, O’Neill TR. Family Physicians’ Scope of Practice and American Board of Family Medicine Recertification Examination Performance. Journal of The American Board of Family Medicine 2015;28(2):265-270

This was a cross-sectional study of family physicians taking the ABFM MC-FP examination in 2013. Examination results were linked with the Scope of Practice for Primary Care (SP4PC) scale. Among 10,978 examinees, rural physicians had a higher passing rate (90.7% vs 86.8%, P <.05) and higher SP4PC score (16.1 vs 14.3 P < .05) compared with urban physicians. Regression models without SP4PC score confirmed that urban physicians were less likely to pass (OR = 0.73; 95% CI, 0.62– 0.87) and scored lower, -15.6 points, compared with rural physicians. A broader scope of practice rather than rural or urban practice location, was associated with increased likelihood of passing the MC-FP examination. For Women’s Health, FPs in rural areas had a higher percentage of scope of practice (74.2%) compared to urban practicing FPs (68.3%).

Eiff MP, Hollander-Rodriguez J, Skariah J, Young R, Waller E, Dexter E, O’Neill TR, Peabody MR, Green LA, Carney PA. Scope of Practice Among Recent Family Medicine Residency Graduates. Family Medicine 2017;49(8):607-617

This article surveyed graduates of the 14 family medicine residencies associated with the Preparing the Personal Physician for Practice (P4) project. Graduates 18 months after residency between 2008 and 2014 were surveyed, to measure self-reported practice characteristics, scope of practice, and career satisfaction. Scope using individual practice components (25 clinical activities, 30 procedures) and a scaled score (P4-SOP) that measured breadth of practice scope was assessed. No significant differences were found in mean P4-SOP scores between the Pre and Full P4 groups. Compared to national data, P4 graduates reported higher rates for vaginal deliveries (19.3% vs 9.2%), adult inpatient care, and nursing home care in practice. Graduates exposed to innovations that lengthened training, compared to standard training length, were more likely to include adult hospital care, adult ICU care, and newborn resuscitation (25.6% vs 14%) in their practice and performed 19/30 procedures at higher rates.

Peterson LE, Fang B. Rural Family Physicians Have a Broader Scope of Practice than Urban Family Physicians. UKnowledge – Rural & Underserved Health Research Center Publications. 2018;5

Using data from 18,846 family physicians from ABFM Certification Exam questionnaire data, variations in the provision of 21 clinical services (e.g., inpatient care, home visits, and obstetrics) and 18 procedural services (e.g., prenatal ultrasound, endoscopy, and office skin procedures) across metropolitan, large rural, small rural, and frontier areas were examined. Results showed that the percentage of family physicians providing each type of clinical and procedural service rises with increasing rurality. Rural FPs were more likely to provide obstetrical deliveries and newborn care.

Peterson LE, Fang B, Puffer JC, Bazemore AW. Wide Gap Between Preparation and Scope of Practice of Early Career Family Physicians. Journal of The American Board of Family Medicine 2018;31(2):181-182

Data from the 2016 National Graduate Survey, which was sent to ABFM Diplomates who completed residency in 2013 was used to ask about intention on scope of practice. Out of 1617 eligible respondents who met the inclusion criteria, practice exceeded preparation only for behavioral health care. For specific services, the largest gaps between preparation and practice were for neonatal circumcision, maternity care, and pediatric hospital care.

Weidner AKH, Phillips RL, Fang B, Peterson LE. Burnout and Scope of Practice in New Family Physicians. Annals of Family Medicine 2018;16(3):200-205

Secondary analysis of the 2016 National Family Medicine Graduate Survey respondents who provided outpatient continuity care (n = 1617) was used to look at associations between scope of practice and burnout for FPs. Forty-two percent of respondents reported feeling burned out from their work once a week or more. High levels of burnout were associated with providing more clinical procedures/clinical content areas, working in multiple settings, specifically in hospitals and in patient homes. In adjusted analysis, practicing inpatient medicine and obstetrics were significantly associated with lower odds of burnout (OR = 0.64; 95% CI, 0.47-0.88; P = .0058).

Nasim U, Morgan ZJ, Peterson LE. The Declining Scope of Practice of Family Physicians is Limited to Urban Areas. Journal of Rural Health 2021;37(4):734-744

The study investigates the declining scope of practice among family physicians (FPs) in urban and rural areas from 2014 to 2016, revealing a significant reduction in urban settings across 15 out of 22 practice areas. While rural FPs maintained a broader scope, urban areas saw a notable decrease, with factors such as faculty status and group practice positively influencing scope scores. The research highlights the importance of rural FPs in providing comprehensive care and suggests that the decline in FP scope is primarily an urban issue, influenced by factors like persistent poverty and the presence of non-physician providers. The study also notes associations with racial identity, international medical graduate status, and county characteristics, emphasizing the need to address healthcare access disparities and the distribution of healthcare professionals.

Davis CS, Roy T, Peterson LE, Bazemore AW. Evaluating the Teaching Health Center Graduate Medical Education model at 10 years: Practice-based Outcomes and Opportunities. Journal of Graduate Medical Education 2022;14(5):599–605

The article explores the impact of the Teaching Health Center Graduate Medical Education (THC GME) program on rural and underserved communities, emphasizing its role in addressing physician shortages and enhancing access to care. THC graduates are noted for their broader scope of practice, including behavioral health and outpatient procedures, and their tendency to work in rural and underserved areas. The study underscores the importance of stable funding for these programs and highlights demographic disparities among graduates, suggesting a need for targeted recruitment of underrepresented minorities. Despite limitations such as a focus on family medicine and self-reported data, the findings advocate for continued support of THC programs to improve healthcare access and outcomes. This can be seen explicitly in the deliveries reported in residency vs. practice.

Killeen D, Jetty A, Peterson LE, Bazemore A, Jabbarpour Y. The Association of Practice Type and the Comprehensiveness of Practice of Family Physicians. Journal of the American Board of Family Medicine 2023;36(1):79-87

This paper highlights that FPs in rural health centers (RHCs) have the broadest scope of practice (SOP), offering more comprehensive services like obstetric care (contraception, deliveries, and women’s health procedures), while those in urgent care and federal clinics have a narrower SOP. The findings suggest that practice consolidation and structural factors in certain settings may limit the SOP, potentially impacting patient care negatively. The document emphasizes the need for policy changes to incentivize a broader SOP and calls for further research to understand these trends.

Pollack S, Andrilla CH, Peterson LE, Morgan Z, Longenecker R, Schmitz D, Evans D, Patterson D. Rural Versus Urban Family Medicine Residency Scope of Training and Practice. Family Medicine 2023;55(3):162-170.

The study investigates the differences between early-career physicians who graduated from rural versus urban residency programs, focusing on demographics, perceived preparedness, and practice patterns. It reveals that rural residency graduates are more likely to practice in rural areas and feel better prepared for certain medical procedures and inpatient care compared to their urban counterparts (including women’s health). The findings emphasize the role of rural residency programs in addressing healthcare disparities and enhancing the scope of practice for family physicians, particularly in underserved areas. The study also notes that later-career rural physicians maintain a broader scope of practice than their urban peers, highlighting the importance of rural training in meeting community healthcare needs.