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10:29 pm
Wed April 24, 2013

Family Doctors Consider Dropping Birth Control Training Rule

Originally published on Thu April 25, 2013 9:46 pm

One of the more popular provisions of the federal health law requires that women be given much freer access to prescription methods of birth control. That includes not only the pill, but implants and IUDs as well.

But what happens if there are not enough doctors to prescribe those contraceptives?

That's exactly what worries some reproductive health advocates, as efforts are underway to rewrite rules governing the training of the nation's family doctors.

The proposed new rules, they say, drop existing requirements that family medicine residents be required to undergo training in contraception and counseling women with unintended pregnancies. Several groups are now running letter-writing campaigns to make sure the rules remain.

Revising The Rules

Family physicians are what used to be known as general practitioners, or GPs.

"My youngest patient hasn't been born yet, and the oldest I take care of is 94," says Jeff Cain, president of the American Academy of Family Physicians and a family doctor in Denver.

For the majority of women, particularly outside major cities, it's family doctors, not obstetrician-gynecologists, who provide for their reproductive health needs.

"The main people who staff community health centers, as well as large swaths of rural America, are family doctors," says Linda Prine, a family physician from New York.

To become a family doctor, however, medical residents must complete a wide-ranging and rigorous three-year training program approved by the Accreditation Council on Graduate Medical Education.

Every seven years, the ACGME guidelines for each specialty are revised; it's now time for a rewrite of the family medicine curriculum.

Prine, who is also the medical director of the Reproductive Health Access Project, helped lead a push the last time around to require all family medicine residents to learn to provide all forms of prescription contraceptives, including placing IUDs and implants, and to counsel patients with unintended pregnancies on their options.

"The language was put in so that we would be assured that family doctors were prepared to provide health care for their patients," she says.

But now that requirement appears to be going away.

"The feedback we've gotten over the years is that a lot of the curricular requirements were too specific," says Peter Carek, a professor of family medicine at the Medical University of South Carolina and chairman of the committee that's rewriting the requirements for family medicine residents.

"So in general what we've tried to do as a committee is to at least in as many areas as we could, pull back some of those specific requirements and give them more general requirements to follow," he says.

Criticism

Reproductive health advocates say there's a big problem with leaving contraception training up to each program: Many residency programs these days are run by religious hospitals that don't believe in contraception.

"The way it works right now, the residency is required to at least send the residents off-site to another place, say, a family planning clinic where they can learn how to provide birth control," Prine says. "If these regulations change and there's no wording whatsoever about the need to provide contraception, the residency programs would no longer be obliged to send their residents somewhere where they would get this education."

If you think that religious-based health care isn't becoming the norm, think again.

"We took a look recently and found that of the 25 largest health systems in the United States, 13 were religiously sponsored; that includes 11 Catholic systems," says Lois Uttley, who heads the nonprofit group MergerWatch, which works to protect women's access to reproductive health care when secular hospitals merge with religious ones. "So that means the likelihood of a patient encountering a Catholic restriction on contraception is pretty high and growing."

Draft Document

Family medicine officials, however, say they are aware of the concerns from reproductive health advocates.

"The American Academy of Family Physicians and family medicine educators really remain committed to ensuring that women's health is a core educational part of training family physicians," says Cain, the AAFP president. "That includes family planning and maternity care."

Cain says that while the new program standards may not spell out the contraceptive training requirements the way the current ones do, he expects they will be included in a frequently asked questions part of the document that will still carry the same weight.

In any case, he points out, "the truth is this is a draft document right now. We want to make sure the wording in the document reflects the intended outcome."

Both Cain and Carek say they are taking under serious consideration all the comments they have been hearing about the standards so far.

The last day for the public to comment is Thursday.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.

Transcript

STEVE INSKEEP, HOST:

A high-profile provision of the federal health law aims to make it easier for women to gain access to birth control methods that require a prescription. A new proposal pushes in the opposite direction. It would end the requirement that doctors be trained in providing contraceptives.

RENEE MONTAGNE, HOST:

NPR's Julie Rovner reports.

JULIE ROVNER, BYLINE: Linda Prine is a family physician in New York City. She says the kind of services she provides used to be known as general practice.

DR. LINDA PRINE: We do everything in primary care, more or less. We take care of people, cradle to grave, and care for all of their primary health care needs.

ROVNER: And for the majority of women, particularly outside major cities, it's family doctors, not obstetrician-gynecologists, who provide for their reproductive health needs.

DR. LINDA PRINE: The main people who staff community health centers as well as large swaths of rural America are family doctors.

ROVNER: Prine, who's also the medical director of a group called the Reproductive Health Access Project, helped lead a push several years ago to require all family medicine doctors in training to learn to provide all forms of prescription contraceptives and to counsel patients with unintended pregnancies on their options. That includes things like learning to place an IUD or insert a contraceptive implant.

PRINE: The language was put in so that we would be assured that family doctors were prepared to provide health care for their patients.

ROVNER: But that requirement, along with many others in the rule book used for training family physicians, may be about to disappear.

PETER CAREK: The feedback we've gotten over the years is that a lot of the curricular requirements were too specific.

ROVNER: Peter Carek is a professor of family medicine at the Medical University of South Carolina. He also chairs the committee that's rewriting the requirements for family medicine residents. The new rules are to take effect starting next summer.

CAREK: And so in general what we've tried to do as a committee is to, in at least in as many areas as we could, pull back some of those specific requirements and give them, you know, more general requirements to follow.

ROVNER: But Linda Prine says the big problem with leaving contraception training up to each program is that many residency programs these days are run by religious hospitals that don't believe in contraception.

PRINE: The way it works right now is the residency is required to at least send the residents off-site to another place, say a family planning clinic, where they can learn how to provide birth control. If these regulations change and there's no wording whatsoever about the need to provide contraception, the residency programs would no longer be obliged to send their residents somewhere where they would get this education.

ROVNER: And if you think that religious-based health care isn't becoming the norm, think again. Lois Uttley heads the group MergerWatch, which works to protect women's access to reproductive health care when secular hospitals merge with religious ones.

LOIS UTTLEY: We took a look recently and found that of the 25 largest health systems in the United States, 13 were religiously sponsored; that includes 11 Catholic systems. So that means that the likelihood of a patient encountering a Catholic restriction on contraception is pretty high and growing.

ROVNER: Family medicine officials, however, say they're aware of the concerns from reproductive health advocates. Jeff Cain is the president of the American Academy of Family Physicians.

JEFF CAIN: The important thing is that the American Academy of Family Physicians and family medicine educators really remain committed to ensuring that women's health is a core educational part of training family physicians. That includes family planning and maternity care.

ROVNER: Cain says that while the new program standards may not spell out the requirements the way the current ones do, he expects they will be included in a frequently asked questions part of the document that will still carry the same weight. And in any case, he points out...

CAIN: The truth is, this is a draft document right now. We want to make certain that the wording in the document reflects the intended outcome.

ROVNER: Both Cain and Carek said they'll be taking all the comments they've been getting about the changes under serious consideration. Today is the last day for the public to comment on the proposed standards. Julie Rovner, NPR News. Transcript provided by NPR, Copyright NPR.