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Doctors urge funding, clearer rules to expand maternal care training and reduce county-level care deserts
Summary
A family physician who runs an OB fellowship for family medicine told the committee that Idaho has many counties with no obstetricians, urged support for fellowships and hospital teaching reimbursements, and recommended clarifying legal protections so clinicians feel safe providing maternal care.
A family physician and fellowship director urged the Joint Legislative Sessions to support training programs and clearer guidance for clinicians to expand access to maternal care across Idaho.
Dr. Jennifer Cook, who directs an OB fellowship associated with a family medicine residency, told the committee the state has 28 counties with no medically trained obstetricians and that many counties qualify as maternal-care deserts. She described the long development path for a fellowship: it can take several years to build residency ties, secure sufficient clinical volume and fund fellow salaries and malpractice coverage.
Cook said a fellowship typically requires hospital and clinical volume sufficient for trainees to meet competency thresholds; for example she noted fellows must participate in a high number of deliveries and cesarean sections to develop surgical competency. She said the state-supported fellowship she runs has graduated 11 fellows, with about half remaining to practice in Idaho.
Cook recommended several legislative actions: provide ongoing fellowship funding (she cited an indicative cost of roughly $200,000 per fellow per year for salary, malpractice and related expenses), fund teaching reimbursements for clinicians who supervise fellows or residents, and consider loan-repayment incentives for family-medicine-obstetric practitioners to recruit them to rural communities. She also urged lawmakers to clarify legal language that governs clinicians’ judgment about care to reduce uncertainty among practitioners.
Legislators pressed for details about midwife roles and cash-flow and reimbursement differences for hospitals; Cook said midwives play an essential role but cannot perform surgical interventions such as cesarean deliveries, and she encouraged supports that reduce rural hospital closures and keep maternal services available. She identified Medicaid reimbursement rates and the high cost of malpractice coverage as additional barriers.
Cook told the committee that expanding fellowship training coherently with hospital support and clearer statutory guidance could increase the number of clinicians providing obstetric and maternal care across the state.
