Thursday marks the last day to comment on a new curriculum for training medical professionals proposed by The Family Medicine Committee of the Accreditation Council of Graduate Medical Education (ACGME), a group that most Americans have likely never heard of before. But it’s an obscure issue with huge implications. Thursday’s deadline is important because it marks the next big fight for birth control access: ensuring that doctors know how to prescribe it.
Obamacare took a big step forward in expanding access to affordable contraceptive services by requiring health insurers to offer coverage for birth control without charging a co-pay. But, when it comes to making sure that women can get the contraception they need, it doesn’t end there. Since the United States still uses the outdated practice of tying birth control prescriptions to regular doctor’s visits — despite the fact that most countries around the world make birth control available over the counter — family doctors across the country need to be qualified enough to write a prescription for it.
That’s where the ACGME’s curriculum comes in. Up until now, the ACGME has required family medicine residents undergo training in reproductive care, like providing women with contraception and counseling them about unintended pregnancies. But now, the committee is preparing to drop that requirement.
If that proposed change goes through, it will represent a huge blow to family planning education — particularly for rural and low-income women. The majority of women get their contraceptive care at family practices rather than from more specialized OB-GYNs, and that’s especially true outside of large cities, where there tend to be fewer gynecologists available. And the staff at community health clinics, which provide services for poorer and uninsured women, are usually family doctors.
Linda Prine, a family physician in New York and the medical director of the Reproductive Health Access Project, is helping to lead the push to preserve the birth control requirement in the ACGME curriculum. “The language was put in so that we would be assured that family doctors were prepared to provide health care for their patients,” she explained to NPR.
If the specific language that Prine is referring to ends up being removed, family doctors wouldn’t have to learn basic skills like how to prescribe different birth control options, how to counsel women about addressing or preventing unintended pregnancies, or how to insert IUDs and contraceptive implants, or how to assist with miscarriage or abortion care. Prine’s group points out that these are basic services that all primary care providers should be able to perform.
That’s especially concerning for the doctors who complete their residency programs in religiously-affiliated hospitals. Right now, Catholic hospitals are required to send their doctors to an off-site location, like a family planning clinic, where they can fulfill their reproductive health services requirement. But those programs will likely simply choose to skip any training related to contraception if they have the option, and that could affect a wide range of doctors. The nonprofit group MergerWatch recently found that 13 out the 25 largest health systems in the United States are religiously affiliated, and 11 of them are Catholic.
Family medicine officials say they are fully committed to ensuring high quality reproductive care, and are carefully reviewing the comments they are receiving from women’s health groups.