In one of the clinics where we work, a 16-year-old girl came in with a sprained ankle. She left with a prescription for birth control.
This turn of events is not as surprising as it seems: As family physicians, we treat the whole person. A quick update revealed that our 16-year-old patient had recently begun to have unprotected sex—and had no plan to get birth control. One of the reasons we love practicing family medicine is that we get to know our patients over time and provide the preventive care they need at every possible opportunity.
That is why we are dismayed that the Accreditation Council of Graduate Medical Education (ACGME) has proposed changes to the guidelines for family medicine residency programs removing the requirement that residents learn to provide contraception. These changes will go into effect in 2014 unless the ACGME is convinced otherwise, during an open comment period taking place this week.
A majority of U.S. women get their basic health care from a family physician or other primary care provider, and often that includes reproductive health care. Especially in rural and low-income areas, family physicians do it all! They not only provide birth control but also provide prenatal care, deliver babies, manage miscarriages, counsel patients about unintended pregnancies, and, increasingly, offer pregnancy termination so that their patients do not have to travel long distances and see unfamiliar doctors for these services.
ACGME’s motivations are legitimate: It seeks to simplify the rules for the nation’s family medicine residency programs—numbering over 450—and to allow for more creativity and flexibility. In some areas of practice, this makes sense. Many programs will continue to teach contraception; it will depend on the culture of the institution. However, residency programs based in religiously-affiliated hospitals (which operate nearly 20 percent of inpatient community-hospital beds in the U.S.), will most likely drop birth control training immediately.
Because the ACGME currently requires birth control training, religiously-affiliated institutions must figure out a way to comply. Many rotate their residents through external clinics to learn these skills—which are essential since 99 percent of women in the United States who have ever had sexual intercourse have used a method of contraception other than natural family planning at some point in their lives. Without this requirement, residents in religiously-affiliated programs may get no training at all in contraception.
Just last week, we attended a meeting where an assistant residency director expressed satisfaction at the prospect of no longer needing to teach residents how to counsel patients with unintended pregnancies of all of their options. This is our concern: Limiting the training of family medicine residents in birth control will have a disproportionate impact on the millions of low-income and rural women and teens who rely on their family doctors to provide the full-spectrum of reproductive health care. The Affordable Care Act greatly expands access to contraception for millions of women in the United States. But, if clinicians aren’t trained in providing contraception, then that access is meaningless, even if it is covered. We need to make sure all clinicians who provide primary health care for women are trained to provide high-quality contraceptive care.
Our next generation of family physicians must learn and practice more contraception, not less. Otherwise our shamefully high rate of unintended pregnancy (the highest in the developed world) will rise further.
There is time to make a difference. The ACGME is accepting comments on the proposed guidelines until April 25, 2013. Click here to download our suggested version of the official comment form. Fill in your information and email it to [email protected]. The Reproductive Health Access Project has an online campaign for all of us to tell the ACGME that their changes affect our health care.