In the United States, according to almost every measure, we do not have enough trained maternity care providers to meet the
need. Family physicians are the logical choice to help provide that care, particularly in underserved settings. Advanced training through family medicine obstetrics fellowship programs has proven successful in preparing physicians to provide the full scope of maternity care. However, clinically-determined health outcomes are a function of the system of care and not simply the competency of an individual physician. It is reasonable to expect that better health outcomes can be achieved with a model that combines performance improvement processes with a community medicine-based approach to maternal and child health. In this paper, we describe an approach to family medicine obstetrics fellowship training that emphasizes this model, using a comprehensive academic curriculum featuring elements of quality improvement, peer review, evidence-based medicine, and resource management.