Abstract: Background　Adequate family medicine obstetricians are crucial to ensuring that patients can access to the obstetrical services that they need. However，previous research has shown that the number of family doctors with obstetrics included in the scope of practice is declining year by year，with fewer than 10% of the total now delivering babies. Objective　This study 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. Methods　A mixed-methods study including a survey and qualitative interviews was conducted in 2017. We electronically surveyed US family physicians and followed up with a purposeful subsample of these physicians to conduct in-depth，semistructured telephone interviews. The survey measured the reasons for not doing obstetrics as a family physician. To identify themes regarding finding family medicine jobs with obstetrics，we used a team-based，immersion-crystallisation approach to analyse the transcribed qualitative interviews. Of the 2 098 US family medicine residency graduates 2014—2016 who indicated that they intended to deliver babies in practice，1 016（48.43%） completed the survey，and 56 of them were interviewed by telephone. Results　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 included geographical preferences，family obligations and lifestyle. However，job-seeking and job-taking decisions are constrained by employment-related issues such as job structure，practice characteristics and lack of availability of family medicine jobs with obstetrics. Conclusion　While personal reasons drove job selection for most physicians，their choices were constrained by multiple factors beyond their control，particularly availability of family medicine jobs allowing obstetrics. The shift from physician as practice owner to physician as employee in the USA has implications for job-seeking behaviours of newly graduating medical residents as well as for access to healthcare services by patients；understanding how employment influences scope of practice in family medicine can provide insight into how to support family physicians to maintain the scope of practice they desire and are trained to provide，thus，ensuring that families have access to care.

Key words: Mixed methodology, Family doctor, Obstetrical, Graduates, USA

摘要： 背景　足够的产科家庭医生对于确保患者获取必需的产科服务至关重要。然而，既往研究表明执业范围包含产科的家庭医生数量正在逐年减少，如今从事新生儿接生工作的家庭医生不到10%。目的　旨在探究希望将产科纳入其执业范围的新毕业家庭医生如何发现和选择工作，并进一步了解当前就业形势对家庭医生的执业范围，特别是产科、新生儿接生方面的影响。方法　于2017年进行问卷调查和定性访谈的混合方法研究。对美国家庭医生进行电子问卷调查并在目的性子抽样后对这些医生进行深度半结构化电话访谈。问卷调查总结了家庭医生未从事产科工作的原因，为进一步明确选择从事产科工作的家庭医生的具体情况，采用基于群体的沉浸式方法来转译定性访谈的结果。本研究向2 098例毕业于2014—2016年并希望从事新生儿接生工作的美国家庭医学专业实习医生发送调查问卷，回复1 016份，回复率48.43%，其中56例接受了电话访谈。结果　问卷调查结果显示，未能找到工作范围包含产科的工作是希望从事产科工作的家庭医学毕业生未从事该工作的主要原因。定性访谈结果显示，家庭医生通常通过人脉关系或人才招聘的途径找到产科相关工作，并根据地理位置偏好、家庭义务及生活方式要求等个人考虑因素做出选择。同时，求职过程和择业决策也受到工作结构、执业特点及缺乏产科相工作经验等因素的限制。结论　虽然个人意向决定大部分医学生的工作选择，但其选择仍受到多种不可控因素限制，特别是家庭医学工作提供产科相关工作的能力。美国毕业医学生从医院实习生到执业医师的转变同时影响着毕业生的求职选择和医疗机构患者寻求医疗服务的质量。因此，了解就业情况对家庭医生就业范围的影响方式，有助于进一步明确如何协助家庭医生在其希望从事的范围内工作并对其进行相应协助，从而确保每一个家庭可以获得更好的医疗服务。

关键词: 混合方法学, 家庭医生, 产科, 毕业生, 美国