Why Does the ACGME Want to Eliminate Contraceptive Training for Family Physicians?


In one of the clinics where we work, a 16-year-old girl came in with a sprained ankle.  She left with a prescription for birth control.

This turn of events is not as surprising as it seems:  As family physicians, we treat the whole person.  A quick update revealed that our 16-year-old patient had recently begun to have unprotected sex—and had no plan to get birth control. One of the reasons we love practicing family medicine is that we get to know our patients over time and provide the preventive care they need at every possible opportunity.

That is why we are dismayed that the Accreditation Council of Graduate Medical Education (ACGME) has proposed changes to the guidelines for family medicine residency programs removing the requirement that residents learn to provide contraception. These changes will go into effect in 2014 unless the ACGME is convinced otherwise, during an open comment period taking place this week.

A majority of U.S. women get their basic health care from a family physician or other primary care provider, and often that includes reproductive health care. Especially in rural and low-income areas, family physicians do it all! They not only provide birth control but also provide prenatal care, deliver babies, manage miscarriages, counsel patients about unintended pregnancies, and, increasingly, offer pregnancy termination so that their patients do not have to travel long distances and see unfamiliar doctors for these services.

ACGME’s motivations are legitimate:  It seeks to simplify the rules for the nation’s family medicine residency programs—numbering over 450—and to allow for more creativity and flexibility. In some areas of practice, this makes sense. Many programs will continue to teach contraception; it will depend on the culture of the institution. However, residency programs based in religiously-affiliated hospitals (which operate nearly 20 percent of inpatient community-hospital beds in the U.S.), will most likely drop birth control training immediately.

Because the ACGME currently requires birth control training, religiously-affiliated institutions must figure out a way to comply. Many rotate their residents through external clinics to learn these skills—which are essential since 99 percent of women in the United States who have ever had sexual intercourse have used a method of contraception other than natural family planning at some point in their lives. Without this requirement, residents in religiously-affiliated programs may get no training at all in contraception.

Just last week, we attended a meeting where an assistant residency director expressed satisfaction at the prospect of no longer needing to teach residents how to counsel patients with unintended pregnancies of all of their options. This is our concern: Limiting the training of family medicine residents in birth control will have a disproportionate impact on the millions of low-income and rural women and teens who rely on their family doctors to provide the full-spectrum of reproductive health care. The Affordable Care Act greatly expands access to contraception for millions of women in the United States. But, if clinicians aren’t trained in providing contraception, then that access is meaningless, even if it is covered. We need to make sure all clinicians who provide primary health care for women are trained to provide high-quality contraceptive care.

Our next generation of family physicians must learn and practice more contraception, not less. Otherwise our shamefully high rate of unintended pregnancy (the highest in the developed world) will rise further.

There is time to make a difference. The ACGME is accepting comments on the proposed guidelines until April 25, 2013. Click here to download our suggested version of the official comment form.  Fill in your information and email it to familymedicine@acgme.org.  The Reproductive Health Access Project has an online campaign for all of us to tell the ACGME that their changes affect our health care.

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  • cjvg

    So women will still be required to obtain a prescription to even be allowed to purchase birth control, but the prescribing doctors do not have to know a thing about it?!

    There goes the whole excuse that birth control can not be over the counter.
    Obviously if the prescribing doctors can be less knowledgeable then the women using it, there is really no legitimate argument that can be made for continuing the “doctor as the gatekeeper of birth control access for safety” model!

    • http://www.facebook.com/NancyRichardColburn Nancy Richard Colburn

      Nice!!

  • L. S.

    As a physician, specifically a family physician who trained at an ACGME certified location, I think it’s unreasonable to allow any program to not train residents/students on reproductive health and pregnancy prevention. It is shameful, really. To think that residents would be at the mercy of their program director’s ideology when it comes to a large part of their training!

    • HeilMary1

      Such anti-choice program directors are guilty of criminal Munchausen by Proxy abuse. Withholding or deliberately misinforming patients about needed care can be as deadly as directly poisoning or suffocating patients.

    • http://www.facebook.com/NancyRichardColburn Nancy Richard Colburn

      Poor med students

  • theprinterlady

    How will women who need contraception for other conditions get adequate care? You can’t just plug “x” pill or treatment into “y” woman without understanding the differences in the medications. 43% of women need these medications and devices for other things… that leaves women open to rotten care.

    • http://www.facebook.com/profile.php?id=9433650 Sarah ES

      Yes, it is institutionalized violence against women.

    • http://www.facebook.com/ingrid.heimark.5 Ingrid Heimark

      You are right! I myself are on Cerazette for cramping, and should I need conytraceptio, I would definitely choose that pill. I have tried several others, but had trouble with weight gain. It was my primary physician who asked another physician at the center for advice. Given that I use my full name, I will be cautious, but my doc, on my request, prescribed the Pill to young women not able to get it on their own, affordable at least.
      Contraception is so important to know about, and if you are a pro-life physician, you should be even more on top of it so that unwanted pregnancy is avoided. There are other circumstances also, knowing which pill is ok for which other condition, the mandatory contraception for women on Roaccutane etc.
      I would not feel all my needs were met had I a physician that knew little or nothing about cotyraception

  • http://twitter.com/MeEloise Kirsten Sherk

    I don’t have kids and I’ve never had an abnormal pap, so I haven’t been to an ob-gyn for years. It means a lot to me that when I talk to my physician about my birth control options, she has the big picture of my health profile in mind. This is the sort of preventive care that we should be making it easier for women to get, not harder.

  • Jan Et

    I’m 53, but at 16 I was marched into my family physician’s office by my older sister, who discovered I’d been sexually active for three months with my first boyfriend ever, and was not using anything. For various reasons, my mother never discussed sex with me. By the grace of whatever is good, I avoided pregnancy before that day. I left with a prescription for birth control pills, which I used sucessfully for 12 years before voluntarily changing methods. Hopefully there are multiple lessons to be learned from my experience, as well as those of millions of other young women.

    • Carolan Ivey

      You have an awesome sister. :)

  • nettwench14

    This continuing intrusion of religious belief into medical care is insanity, and I cannot believe that medical organizations will enable it in any way. Do Catholic and evangelical women not have uteruses? This was not the case 20 years ago – nobody cared about contraception outside of a sermon. Do they think promoting ignorance on the part of physicians is going to be helpful to anyone? How will physicians treat endometriosis or ovarian cysts with no knowledge of birth control. It’s not all about babies it’s about a woman’s health. A uterus is not a detachable part of the body. Physicians have to treat the whole person – birth control is medication not a religious sacrament. It’s highly offensive that these restrictions only apply to women, and women’s health care. Where will it stop? Will physicians trained at religious universities not go out and practice on a population including people of all beliefs? This whole situation is a nightmare and just seems to get worse and worse. And let’s also stop pretending that Catholic and evangelical women don’t use birth control – that is ridiculous and hypocritical that we would base medical care on assumptions like this. It’s SCIENCE, not RELIGION!! What in the hell do they expect the result of having ignorant doctors is going to be? More babies? They want to ban sex without procreation, but that is not happening in the 21st century.

    • HeilMary1

      These same sex police want to return to the good old bad days of husbands getting most of their sex from prostitutes, who will be made of abandoned, homeless, underage men and women, you know — where priests always got their sex!

  • disqus_Sli4aAvjaW

    I assume that doctors who are not trained to counsel patients about contraceptives will gladly accept a lower salary because they will have less training and fewer skills.

    • HeilMary1

      LOL!

    • http://www.facebook.com/profile.php?id=9433650 Sarah ES

      Agreed. And they should have to advertise openly whether they have such training or not.

  • cupcakemuffin

    This makes no sense. EVEN IF one were to accept the proposition that physicians should be able to refuse to provide contraception/learn about contraception on moral grounds (which I DO NOT accept) – but even then, what about all of the MANY other conditions that these medicines are used for? A good friend of mine needed to begin taking birth control pills in order to regulate her period, even though she was not sexually active at the time. I need to use hormonal birth control whether I am sexually active or not because I have a problem with ovarian cysts. How is there any justification for doctors to not treat these issues, which have absolutely NOTHING to do with any religious belief?

    • Arachne646

      Those physicians need to go into ophthalmology, or other specialties where their religious/moral scruples will not be in the way of providing quality professional medical care to women patients.

      • HeilMary1

        That will work until embryo stem cells become cures for major eye diseases, never mind that the Catholic Church never condemns involuntary military defense and big pharma experimentation on orphans and the poor!

  • Cady Stanton

    People should also contact the Association of American Medical Colleges, who co-accredits medical schools with the ACGME.

  • http://www.facebook.com/NancyRichardColburn Nancy Richard Colburn

    Doctors discriminating against women is nothing new, but this takes it to a whole new level. When can I start prescribing meds to myself, so I no longer have to misogynized to get health care? Disgusting!!