• FP Delivers Essential, Full-scope Care for Rural Community

    February 17, 2020 03:00 PM David Mitchell -- At a time when less than 20% of AAFP members are delivering babies, Zita Magloire, M.D., is working to show medical students and residents that they can still practice full-scope family medicine if they choose to.

    "I always knew I wanted to do everything, although I didn't know it was called family medicine until I got to medical school," said Magloire, whose practice includes inpatient and outpatient care for all ages, obstetrics (including cesarean sections), women's health, sports medicine and endoscopy. "Obstetrics is an important part of family medicine. It's essential."

    That's especially true in rural and underserved areas. Magloire's rural hospital in Cairo, Ga., delivers about 270 babies per year. Last year, Magloire delivered 87 of them. She's the CEO of a practice that includes one other full-scope family physician, one full-time obstetrician and a part-time obstetrician. In the fall, the practice will add two family physicians, one of whom will deliver babies, who are completing their training.

    "This is what family medicine really is," said Magloire, who also is chair of the Department of Obstetrics and Pediatrics at her hospital. "I find it easier to care for people when I care for the whole family."

    For example, Magloire delivered twins this winter for a patient who subsequently was seen for a colposcopy. The children, who were recently ill, and their mother all needed to be seen for follow-ups, so Magloire scheduled their visits so they could be seen at the same time.

    Magloire also chairs the AAFP's obstetrics member interest group, which is developing a resource for medical students, residents and fellows who are looking for family medicine mentors like Magloire who have full-scope practices.

    "There are students and residents who want to provide maternity care in family medicine, but they have been told it's not possible," she said. "They want to know, 'Where can I go to train?' or 'Where can I get a job where I can do this?' There are plenty of people doing this and it works well."

    Magloire spoke about maternal health disparities in rural communities Feb. 13 in Washington, D.C., during the Rural Health Disparities Summit, which was hosted by the AAFP, the National Rural Health Association and the American Heart Association. Magloire addressed the nation's high maternal mortality rate -- particularly among minority women -- as well as steps that can be taken to address it.

    For example, in 2006 California launched a Maternal Quality Care Collaborative designed to reduce preventable morbidity, mortality and racial disparities. By 2013, the state had experienced a 55% reduction in maternal mortality.

    "California implemented targeted protocols to deal with things like postpartum hemorrhage and hypertensive disorders," Magloire said, "and now their maternal mortality rate is below the national average."

    Other states have taken note. Magloire's hospital is one of 43 in a Georgia collaborative that has implemented targeted protocols regarding issues such as postpartum hemorrhage and hypertension, as well as continuing education on topics like implicit bias in health care.

    "We're excited," she said. "Being such a small hospital and being part of a statewide initiative is really cool."

    Magloire has lived in the same small town -- population 10,000 -- where she has practiced for more than five years. In addition to her full-scope practice, she precepts medical students, including those from her alma mater, Florida State.

    "When I'm on call, I'm on call for everything -- adult hospital medicine call, obstetrics as well as pediatrics -- depending on the call rotation. "It may not be for everyone, but it certainly works in this setting."

    Magloire found what she was looking for in family medicine less than 40 miles from her hometown, Tallahassee, Fla.

    "I don't have to travel to see my family," she said. "It's a good balance and a good quality of life. It's been wonderful."