Is This A Crisis? by Pat Conrad MD


The headline for the 5/15/13 issue of Family Practice News announces “Contraception Training for FP Residents in Limbo!”  Okay, in fairness, I added the exclamation point, just to add to the excitement.  The salient points:

  • A proposal from the Accreditation Council for Graduate Medical Education (ACGME) would “drop the current requirement that all residents be trained in family planning, contraception, options for counseling for unintended pregnancies, and related procedures.”  This would be replaced by residents devoting a set amount of time/patient encounters “to the care of women with gynecologic issues, including well-woman care.”
  • One Dr. Linda Prine worries that “such training could be dropped by institutions with religious affiliations as well as by some individual program directors who may have personal moral objections…You just have no guarantees that we’re going to turn out a family medicine workforce that’s competent in birth control.  She also noted that these are services that women expect from their primary care providers, even more so now that contraception is deemed a mandated, no extra-cost, preventive care service under the Affordable Care Act (then why do men have to pay for their own cheap wine and Barry White CD’s??  But I digress…)  Dr. Prine, relevantly, is the medical director for the Reproductive Health Access Project in New York.
  • Dr. Elaine Kang, a community health FP, agrees, and thinks that the proposed changes would lead to an increase in unintended pregnancies.
  • “The proposal is not a back-door attempt to shut out contraception, said Dr. Peter Carek.” (seriously, who edited this??)  The ACGME chair in charge of this hot potato feels the current requirements were “too detailed” and didn’t allow them to be “innovative.”  The landscape is such that more specific requirements are likely to be reinserted before publication this summer.
Honestly, I don’t know what to make of all this.  I finished FP residency in 1999, and don’t recall routine contraception training being a big deal.  There were the various single-agent pills and combo pills, some good for contraception, some better for dysmennorrhea, some better for one patient and no good in the next.  You do the workup, try to find the best approach, and if unsuccessful, punt to the OB/GYN.  Ditto for the “related procedures.”  The topic didn’t seem to take up an inordinate amount of curricula time, and those female residents who wanted it were afforded the extra elective time in the subject.  And I have no proof whatsoever, but my gut tells me that no FP residency is dropping actual contraceptive competency from its training. No one need accuse Family Practice News of journalistic balance, as a five minute web search shows both Dr’s Prine and Kang to be reproductive and abortion rights activists.  I don’t care whether they push their chosen cause, but why such a sensationalist, and biased approach?  This is the ongoing politicization of medicine:  the issues will lead to the money, which is the real issue, now and always.  In 2012 a stumbling presidential bid was further shackled by a fictitious contraception issue; the ACA has guaranteed reproductive deferment at virtually no cost; the family medicine establishment is sounding cheap alarms over access; and now the Administration is pushing for complete OTC availability for Plan-B.  In Ian Fleming’s “Goldfinger”, the villain famously remarked:  “Mr Bond, they have a saying in Chicago: ‘Once is happenstance. Twice is coincidence. The third time it’s enemy action’.”
36600cookie-checkIs This A Crisis? by Pat Conrad MD