Family physicians need to be trained in reproductive health now more than ever

A new report published in the current issue of the Annals of Family Medicine provides the results of an analysis of family medicine residency programs in states where abortion care is banned or severely restricted. The report, called “Implications of Overturning Roe v Wade on Abortion Training in US Family Medicine Residency Programs,” highlights the need for such programs to include abortion care training.

According to the report, there are currently 693 accredited family medicine residency programs in the United States, 201 of which are in states where abortion care is severely restricted. Of the 13,542 family medicine residents in programs as of Aug. 2, 2023, 29% were training in states with abortion bans, and 37.1% were in states with policies that protect abortion care.

“Family physicians are a critical part of the workforce caring for people’s reproductive health needs, including preventing pregnancy, having healthy pregnancies, and ideally ending pregnancies when people do not want to be pregnant anymore,” Dr. Christine Dehlendorf, one of the authors of the report, told the American Independent.

Dehlendorf, a professor of family medicine at the University of California, San Francisco School of Medicine, added that although family medicine training in abortion care has increased over the past few decades, it is still not routine.

“It is something that is increasingly recognized, that family physicians have a vital role to play in meeting people’s reproductive needs across the life course and that it is consistent with family medicine values of care, meeting the community’s needs, and providing patient-centered care that, again, is across the life course to provide the full range of reproductive health care, including abortion in the first trimester, especially,” Dehlendorf said. 

Dr. Kristin Lyerly is a Wisconsin-based obstetrician and gynecologist who practices mainly in Minnesota. She told the American Independent via email that it’s vital for family medicine residents to be trained in not just abortion care, but also maternity care, “especially cesarean deliveries, which is increasingly challenging as our population of pregnant people grows increasingly sicker and less able to access even routine care.”

Lyerly explained that there’s a growing physician shortage across the nation “with no end in sight,” and that her colleagues who provide reproductive health care are already overburdened.

“Taking care of someone who is seeking an abortion is not just about the procedure itself. This isn’t like changing the oil in your car,” Lyerly said. “The listening, counseling, helping your patient find resources, aftercare including contraception and other family planning concerns: These are all components of abortion care that are currently missing in the training of Wisconsin’s new physicians.”

The report noted: “Residency training should also address the fact that abortion restrictions potentiate systemic racism, disproportionately harming communities of color and other marginalized communities.”

Lyerly said that without fully trained family physicians able to offer care in reproductive health, patients living in rural areas will also suffer.

“Barriers, including cost, driving distance, assistance with childcare, and time away from work are one thing, but so is availability of services in the region,” she said. “Without some serious policy changes, including Medicaid expansion and protecting access to reproductive health services, the health care deserts in rural Wisconsin will continue to grow, and without an intact family medicine presence in rural Wisconsin, no one, women, children, our aging population, will have local doctors to care for them when they need it the most.”

Dehlendorf said that the study ultimately concludes that family physicians working in states where abortion is banned or restricted will be less able to meet the reproductive needs of their patients in everything from miscarriage to abortion care, including when a patient is self-managing an abortion with medication.

“We need to take steps to ensure that there are not further gaps in our ability to meet people’s health care needs moving forward,” Dehlendorf said.