Physician says residency programs must reassess post-Roe training for miscarriage, abortion care

By: - December 27, 2023 8:10 am

Family physicians practicing in places where there are no other medical professionals should be able to provide reproductive health care, says Dr. Christine Dehlendorf. (Getty Images)

Dr. Christine Dehlendorf

More than a year after the U.S. Supreme Court overturned Roe, many have raised concerns about training for obstetrician-gynecologists, particularly in states with civil and criminal penalties for providers if they perform abortions. But researchers from the Person-Centered Reproductive Health Program at the University of California San Francisco have found there is reason to be concerned about training for family physicians in ban states as well.

A study published in the November-December issue of the Annals of Family Medicine found that 29% or 201 of 693 accredited family medicine residency programs in the U.S., are in states with abortion bans or significant restrictions on abortion access. The study used publicly available data from the American Medical Association to conduct the analysis, and found 3,930 residents out of 13,541 were in states where abortion is banned or heavily restricted.

This has implications for family physicians who are often tasked with helping patients manage early pregnancy loss, or miscarriage, the researchers said, as well as patients who self-manage an abortion at home with medication. Any of those patients might need follow-up care from a family physician, the study said.

States Newsroom spoke with one of the lead researchers, Dr. Christine Dehlendorf, about the results of the study. Her responses have been edited for clarity and conciseness.

States Newsroom: Why did you think it was important to conduct this study?

Dr. Christine Dehlendorf: We really just wanted to be descriptive about what the reality was. It was less than what was seen in previous analyses of OB residencies (which showed about 45% were in ban or heavily restricted states), but that was based on the assumptions of what bans would look like post-Dobbs. It 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 already a substantial portion of residents are having their training influenced.

The residents that are in those programs are not going to have access to comprehensive reproductive health training because they’re not experiencing it within their state context. They cannot see abortions, cannot perform them, cannot learn how to care for patients after abortions in the same way they would be able to if they were working in a state where abortion was unrestricted.

SN: What does that mean for those residency programs?

Dehlendorf: What that means is that residency programs need to be very intentional about their curriculum and seek out ways for residents to get experience with reproductive health care, including ways they can get that training out of state.

In typical family medicine residency programs, you have your routine primary care curriculum, and then also specialty rotations (e.g., dermatology or other specialties), where you get more dedicated time with that topic. Having abortion be restricted will influence training in both of those contexts. You won’t see people who recently had an abortion and be able to help manage post-care, like bleeding, and you will not be able to provide abortion medication. You won’t be able to see patients who have abortions in hospital settings.

So residency programs will have to think about how, in the absence of this natural way people would be exposed, how they can substitute and supplement the curriculum to make sure people have that exposure. The experience of residency is a moment in time, and the reality is they will be taking care of these patients regardless of whether they’re in states with abortion restrictions.

SN: What supports can family physicians provide to those experiencing a miscarriage or who are self-managing an abortion?

Dehlendorf: People need to be able to go to their primary care doctors with any questions they have, including about bleeding or other side effects. Early pregnancy loss is a very common experience, and the skill set for caring for that and first trimester abortion are very similar.

SN: How concerned are you that these programs won’t provide this training?

Dehlendorf: I’m very concerned that programs will not pay adequate attention to this newfound gap in their curriculum, and therefore that their residents will not be comprehensively trained, and their future patients will be negatively impacted by that.

Patients are going to receive less patient-centered care. Ideally, primary care providers should be able to take care of people throughout the reproductive health cycle. If we can’t do that, what that means is care will be fragmented in a way it doesn’t have to be. It also means some of those patients won’t receive care at all, and some will receive lower quality care.

SN: Who might be affected the most 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 the safety net for underserved communities, rural or urban, where there is no access to specialty care. Those providers need to be able to provide the full scope practice of family medicine, including the full scope of reproductive health care. Those are the communities that are most likely to be impacted.

SN: What can be done to help support those training opportunities?

Dehlendorf: From an educational lens, people in states with abortion access funding training opportunities for people in states without it is something that is absolutely essential.

SN: What other implications might this have on family medicine?

Dehlendorf: Prior to Dobbs, there was a lack of recognition of the critical role that abortion access played in many aspects of our medical institutions and health care system, and that includes the fact that we prescribe medications that can cause birth defects with the knowledge that abortion could be available to the patient if needed. There have been cases of people being denied those medications because access is not available.

All of those things are affecting our lives and health. It’s multi-faceted, and we’re just beginning to see the impacts that are going to influence the system, and how it will fail to meet people’s needs in places where abortion is restricted.

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