Abortion Provision Among Recently Graduated Family Physicians

Abstract

Background and Objectives: Family physicians (FPs) are well positioned to increase abortion access given their broad scope and diverse geographic practice regions. Previously published studies focus on physicians who received formal abortion training but do not include the full landscape of FPs performing abortions in the United States. This secondary data analysis presents a unique opportunity to examine characteristics of early-career FPs who provide abortions, including practice locations and if they received abortion training during residency. Methods: We analyzed data from the 2016-2018 Family Medicine National Graduate Survey to generate descriptive statistics about respondents who report providing pregnancy termination, uterine aspiration/dilation and curettage, or both. We evaluated associations between physician and/or practice characteristics and providing pregnancy termination using bivariate statistics. Results: Of the 6,319 survey respondents, 3% reported providing pregnancy termination. Nearly three-quarters of this subset reported graduating residency feeling prepared to provide pregnancy termination. Most respondents completed residency in the West or Northeast US geographic regions, and 3 years later were practicing in the West or South regions. Additional characteristics associated with providing pregnancy termination include female gender, providing continuity care, and practicing in either an academic medical center or a federally qualified health center. Conclusions: FPs are well positioned to address gaps in abortion access, and those who provide pregnancy termination practice in various US geographic regions. This is the first discussion of its kind about the scope of family physicians providing abortion care. Future research should continue to characterize FPs who provide abortions to determine where they train and practice and what type of abortions they provide.

Using the Family Medicine National Graduate Survey to Improve Residency Education by Monitoring Training Outcomes

“…Research studies using data from the Graduate Survey have shown a large gap between practice and preparation 4 with further variation between academic-and community-based programs. 5 Other studies using the data have shown lower odds of burnout with broader scope of practice, 6 state-level variation in burnout, 7 associations between residency training and buprenorphine prescribing, 8 barriers to practicing obstetrics, 9 provision of contraceptive services and abortion care, 10,11 and participation in loan repayment programs. 12 Possible Uses and the Future With multiple years of data, residencies have the capability to identify persistent gaps in their curricula and make changes.…”

Family medicine provision of online medication abortion in three US states during COVID-19

“…Only about 40 of the 471 accredited family medicine residency programs in the US, specifically offer integrated, "opt-out" contraception and abortion training [52] . Thus, unsurprisingly the majority (87%) of family physicians graduate residency indicating they are ill-prepared to offer abortion care [3] . But, the COVID-19 pandemic has ushered in a new age of accessible and comprehensive care through the technology of telemedicine.…”

“…During these visits, family physicians deliver a broad range of acute, chronic, and preventive medical services for patients across all ages and genders, including gynecological, obstetrical, and other reproductive health services. Despite family medicine's commitment to continuity of care, less than 5% offer early abortion services in their primary care practices [3] . This low rate is, in part, due to onerous regulations imposed by the US Food and Drug Administration (FDA) through its mifepristone Risk Evaluation and Mitigation Strategy (REMS) program that requires special certification of medication abortion providers and physical dispensing of the medications from clinics, rather than from regular retail pharmacies [4] .…”

A Mixed-Methods Analysis of Physician Abortion Practice After Residency

“…Our findings were consistent with low rates of family medicine and Ob-Gyn doctors performing abortions after residency. 3,13 Workplace restrictions were the main barrier to practice identified, which indicates the importance of education on addressing systemic barriers, such as incorporating guides like Integrating Abortion into Community Health Centers. 14 At UNMFMR, the two training sites for abortion care provide procedural and medication abortions and perform routine ultrasounds.…”

“…1 Family medicine and Ob-Gyn program graduates who participated in abortion training have low rates of providing abortion care after graduation. [2][3][4] Previous studies analyzed barriers that contribute to low rates of abortion care provision. [5][6][7] This study, conducted at one family medicine residency program in the Southwest United States, was designed to examine the graduates' postresidency practice of abortion care in the context of their intent to provide during residency training.…”