Family doctors can do C-sections: Tips for securing privileges

Residency training, fellowships and practice culture matter

As a resident, I sought a residency program with OB training, including C-sections. Then I attended PCC's Perinatal Child Health Fellowship, a yearlong surgical fellowship that included a month of global health experience doing C-sections in Arusha, Tanzania.

(The AAFP’s fellowship directory helps members find programs that offer the training they want, including surgical OB.)

Today I work at a federally qualified health center (FQHC) where family physicians are empowered to practice to the full extent of their training. As at many community FQHCs, we’re encouraged to practice to the full extent of training to best meet the needs of an underserved community that faces many barriers to care.

There’s also a culture of trust in our abilities; leadership has no qualms about family physicians taking on responsibilities that, in other settings, might be limited. My FQHC’s openness to privileging has allowed me to leverage my experience and training to serve patients more fully.

Navigating the privileging process: Be transparent

For me, the privileging process at a new institution was surprisingly straightforward. When the opportunity arose, a senior physician who knew about my fellowship training and privileges at another hospital asked, “Do you want to do sections here?” My answer was an enthusiastic yes.

The whole privileging process took about two or three months. My malpractice insurance is through Federal Tort Claims Act coverage, which provides a big safety net, though the hospital also had to check with its malpractice provider.

Another family physician and I scheduled a meeting with the department chair and hospital privileging committee to discuss my scope of practice and comfort level. I was asked about my experience with emergent C-sections and handling patients with high BMI or multiple previous sections. I was able to say I’d logged more than 100 C-sections, many as an attending physician. I was also clear about my willingness to call for backup if complications arose, and that patient safety came before my ego. Because there was in-house OB/Gyn, I had help readily available if I needed it.

That transparency and support helped build trust and set expectations.

Make the most of your institution’s reputation

When you seek credentials or privileging, your employer’s reputation can be a tremendous asset. It definitely has been for me.

My clinic provides primary care across the lifespan as well as behavioral health, dental and vision services. It was started by a church in the community, and most of the staff and clinicians live locally. When I started here as a new physician who wanted C-section privileges, I benefited right away because I was stepping into an institution with a 40-year legacy. Babies have been delivered here for decades, so our presence in local hospitals was well established.

Our clinic refers our patients for imaging and specialist care at the local hospitals, and our networks are integrated. When I care for patients in one of the hospitals, they’re always our clinic’s patients. That continuity of care builds trust with hospital staff and reinforces the value of privileging family physicians to bring patients to the hospital.

Partner facilities extend FQHCs such as mine a lot of goodwill because they know our mission isn’t prestige or profit. We serve the community, period. That clarity of purpose, coupled with our reputation, helped me gain trust and open doors.

Documentation is important to privileging and proving competence

One lesson I learned early is the importance of documentation. I’ve always recorded every C-section I perform in a personal procedure log. If I ever need to apply for privileges at another hospital, I can show that I’ve done hundreds of the procedures independently.

Numbers matter—they’re tangible proof of competence—but there’s more to competence than just a procedure log. I had vaginal delivery privileges before I got C-section privileges and I earned a reputation by how I manage labor, promote vaginal birth, coach patients and adhere to standard-of-care protocols. And in handling all of these elements of care, I cement important relationships with colleagues who see my work in real time and can vouch for my expertise.

My employer also keeps comprehensive billing records, which is helpful for tracking procedures I don’t always log personally, such as vaginal deliveries or IUD insertions. Having access to those records adds another layer of credibility and transparency when documentation of numbers matters.