The Ontario Family Medicine Residents Cohort Study: factors affecting residents' decisions to practise obstetrics.

Background: The number of family physicians practising obstetrics in Canada is declining. On the assumption that factors related to the obstetrics training of family medicine residents may be influencing this trend, we conducted a cohort study of residents' stated intentions with regard to practising obstetrics, their educational experiences and their subsequent obstetric practice.

Methods: We followed a cohort consisting of all residents who enrolled in family medicine residency programs in Ontario in 1994 and 1995. The data, collected by mail-in survey at entry to, during and 2 years after completion of the 2-year training programs, consisted of residents' characteristics, stated plans during residency to practise obstetrics, obstetric experiences during training, attitudes and opinions related to obstetrics, and actual practice 2 years after completion of residency. We used logistic regression to determine the factors influencing whether a family physician practises obstetrics after graduation.

Results: Of the 498 residents who started programs in 1994 and 1995, 480 were eligible for inclusion, although not all of those eligible responded to the various surveys. At entry into the residency programs, 216 (52%; 95% confidence interval [CI] 47-57%) of the 411 respondents expressed an intention to practise obstetrics. By the end of residency, the proportion intending to practise obstetrics had fallen to 17% (95% CI 13-22%; 46 of 274 respondents), and only 16% (95% CI 12% to 20%) were actually practising intrapartum obstetrics (i.e., delivering babies) 2 years later. The proportions of residents in the 7 Ontario family medicine programs who were actually practising obstetrics 2 years later ranged from 2% of those from the University of Western Ontario to 38% of those from Thunder Bay. Three factors were independently associated with practising intrapartum obstetrics 2 years after completing residency: intention at the end of residency to practise intrapartum obstetrics (odds ratio [OR] 11.7, 95% CI 3.1-44.7, p = 0.001), not having the opinion that intrapartum care is too disruptive of personal life (OR 9.1, 95% CI 1.5-55.5, p = 0.02) and practising in a community of 15 000 or fewer people (OR 6.0, 95% CI 1.8-19.4, p = 0.003).

Interpretation: Residents who have positive attitudes toward obstetrics at the end of their training and who intend at that time to perform deliveries are more likely to be doing so 2 years later, especially if they practise in communities of 15,000 or fewer people.