More than a year after the U.S. Supreme Court overturned Roe, many have raised concerns about the training of obstetrician-gynecologists, especially in states that subject providers to civil and criminal penalties for performing abortions. But researchers at the Person-Centered Reproductive Health Program at the University of California San Francisco have found that there is reason to be concerned about the training of family physicians in states with restrictions, too.
A study published in the November–December issue of Annals of Family Medicine found that 29%, or 201, of the 693 accredited family medicine residency programs in the US are in states with abortion restrictions or significant restrictions on abortion access. The study used publicly available data from the American Medical Association to conduct the analysis and found that 3,930 of the 13,541 residents were in states that ban or heavily restrict abortion.
This has implications for family physicians, who are often tasked with helping patients manage early pregnancy loss or miscarriage, as well as patients who manage miscarriages themselves at home with medication, the researchers said. Any of these patients may need follow-up care from a family doctor, the study said.
States Newsroom spoke to Dr. Christine Dahlendorf, one of the lead researchers, about the study’s results. Their responses have been edited for clarity and brevity.
STATE Newsroom: Why did you think it was important to conduct this study?
Dr. Christine Dahlendorf: We really just wanted to describe what reality is. This was lower than what was seen in previous analyzes of OB residencies (which showed that about 45% were in restricted or heavily restricted states), but it was based on an assumption of what restrictions would look like after Dobbs. This is an evolving map, we know the abortion policy landscape is changing on a daily, weekly, monthly basis, so this is a moment in time that tells us that already a large portion of the population is influencing their education. doing.
Residents included in those programs may not have access to comprehensive reproductive health training because they are not experiencing it in the context of their state. They can’t, can’t, don’t see abortions, can’t learn to care for patients after abortion the same way they could if they were working in a state where abortion was unrestricted.
SN: What does this mean for those residency programs?
Dehlendorf: This means that residency programs need to be very intentional about their curriculum and look for ways for residents to gain experience with reproductive health care, including when they can get that training out of state.
In typical family medicine residency programs, you have your regular primary care curriculum, and then there are also specialty rotations (for example, dermatology or other specialties) where you get more dedicated time with that subject matter. Banning abortion would affect training in both those contexts. You won’t see people who have recently had an abortion and you won’t be able to help manage post-care, such as bleeding, and you won’t be able to provide abortion medication. You won’t be able to see abortion patients in the hospital.
So residency programs have to think about how, in the absence of this natural way people will be exposed, how they can replace and supplement the curriculum to make sure people get that experience. The residency experience is a moment in time, and the reality is that they will be caring for these patients, even if they are in states with abortion restrictions.
SN: What support can family physicians provide to those who are experiencing a miscarriage or who are self-managing a miscarriage?
Dehlendorf: People need to be able to go to their primary care doctors with any questions they have, including bleeding or other side effects. Early pregnancy loss is a very common experience, and the skills set for its care and those for first trimester miscarriage are very similar.
SN: How concerned are you that these programs won’t provide this training?
Dehlendorf: I am very concerned that programs will not pay adequate attention to this new difference in their curriculum, and therefore their residents will not be comprehensively trained, and this will have a negative impact on their future patients.
Patients are going to receive less patient-centered care. Ideally, primary care providers should be able to care for people throughout the reproductive health cycle. If we can’t do that, it means that care will be fragmented in a way that it doesn’t need to be. It also means that some of those patients will not receive care at all, and some will receive lower quality care.
SN: Who might be most affected by this lack of training?
Dehlendorf: We know that family physicians provide care in areas where there are no other health care professionals, and they are a safety net for underserved communities, whether rural or urban, that may not have access to specialty care. Those providers must be able to provide the full scope of practice of family medicine, including the full scope of reproductive health care. These are the communities most likely to be impacted.
SN: What can be done to support those training opportunities?
Dehlendorf: From an educational standpoint, it is absolutely essential for people in states with abortion to have access to funded training opportunities for people in states without it.
SN: What other impact might this have on family medicine?
Dehlendorf: Before Dobbs, many aspects of our medical institutions and health care system lacked recognition of the important role played by abortion access, and that includes the fact that we prescribe medications that can cause birth defects. With the knowledge that abortion may occur. Be available to the patient if necessary. There have been cases of people being denied those medicines because access is not available.
All these things are impacting our life and health. It’s multifaceted, and just beginning to see the effects that’s going to have on the system, and how it will fail to meet the needs of people in places where abortion is prohibited.
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