Proposed revisions to residency training requirements could leave future family doctors ill equipped to provide family planning services.
The proposal from the Accreditation Council for Graduate Medical Education would drop the current requirement that all residents be trained in family planning, contraception, options for counseling for unintended pregnancies, and related procedures.
Dr. Linda Prine
Instead, residents would devote a certain amount of time or patient encounters "to the care of women with gynecologic issues, including well-woman care." They also would be expected to demonstrate competence in endometrial biopsy, pap smear, and wet mount.
Without explicit requirements that residency programs spend time on contraception, such training could be dropped by institutions with religious affiliations as well as by some individual program directors who may have personal moral objections to providing the training, according to Dr. Linda Prine, a family physician who is medical director for the Reproductive Health Access Project, New York. And that’s not a small number of institutions, she added.
"You just have no guarantees that we’re going to turn out a family medicine workforce that’s competent in birth control," she said. "This is something that women definitely expect from their primary care physician and should be able to expect."
The proposed changes are especially ill-timed, now that contraception is deemed a preventive care service under the Affordable Care Act and must be covered by health plans without copayments or other patient cost sharing, Dr. Prine noted.
Dr. Elaine Kang, a family physician who works in a community health center in New York City, said that family planning is an essential part of primary preventive care for her patients. It would be very inconvenient for them to have to see another physician simply for birth control counseling, which might cause them to miss school or work. It also would force them to discuss a potentially sensitive topic with a physician they didn’t know as well.
"It’s really important for patients to be able to go see someone that they trust to have [family planning] counseling," Dr. Kang said.
She predicted that the proposed changes would lead to an increase in unintended pregnancies.
Dr. Elaine Kang
The proposal is not a back-door attempt to shut out contraception, said Dr. Peter J. Carek, chair of the committee that is charged with updating the ACGME’s family medicine requirements. Instead, they reflect feedback from residency program directors that the requirements were "too detailed" and didn’t allow them to be "innovative," he said.
"In general, the review committee took that to heart," said Dr. Carek, vice chair of the department of family medicine at the Medical University of South Carolina, Charleston.
Family medicine residency requirements were last updated in June 2007. In this proposed revision, the review committee tried to reduce as much of the specific, detailed requirements as possible while still maintaining the ability of program directors to provide training on the broad patient population that family physicians treat, Dr. Carek said.
It is a difficult balancing act, and committee members expect that some of the specifics will make it back into the final document after public comments are considered, but he said it’s too early to know which specifics might be restored.
The review committee will spend the summer going over public comments and making final revisions. The document then will be reviewed by the ACGME Committee on Requirements and then the Board of Directors. The revisions are scheduled to go into effect in July 2014.
mschneider@frontlinemedcom.com
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