Local doctor casts spotlight on reproductive health guidelines

A local doctor-in-training is questioning plans to change the curriculum requirements for new family doctors, saying the proposal could allow some residency programs to eliminate training in women's reproductive health.

Alison Block, a resident with the Santa Rosa Family Medicine Residency, said the proposed changes could wipe out current requirements to teach family doctors how to prescribe birth control; insert IUDs or contraceptive implants; and provide women with "options counseling" for unplanned pregnancies.

Block brought national attention to the issue last week in a first-person story written for the Los Angeles Times. In a subsequent interview, she said the proposed revisions are troublesome, given the politics of reproductive health issues such as abortion and contraception.

"I think the training of family physicians in reproductive health care is something that needs to be pro-actively protected," Block said.

But Perry Pugno, vice president of medical education for the American Academy of Family Physicians, says it's too early to sound alarms.

The Accreditation Council for Graduate Medical Education, which establishes program requirements for medical residencies of all specialties, is still in the process of revamping the requirements, Pugno said.

He said the specific training guidelines for women's reproductive health will likely be placed in a companion document called "Frequently Asked Questions." That document has not yet been completed.

"The specialty is not eliminating this from the training of family physicians," Pugno said.

That remains to be seen, said Block.

"While it is possible that the new FAQs that accompany the new requirements would include these procedures, I don't know of any guarantee of that," she said in an email this week.

In her article for the Times, Block describes counseling a single mom who was faced with an unintended pregnancy. She discussed various options with her patient, including keeping the child, putting it up for adoption and abortion.

The patient decided to keep the baby. Block wrote that six weeks after delivery, "I placed an IUD, a long-acting intrauterine contraceptive device, so that her next pregnancy could be by choice and not by chance."

She said that's the kind of patient care that could be in jeopardy.

In an interview, Block said she doesn't believe the language related to women's reproductive health was left out as a result of "malicious intent." She said it's more likely "a lack of recognition" of how important it is to protect women's reproductive health rights.

Every seven to 10 years, the Accreditation Council for Graduate Medical Education rewrites program requirements for the various residency programs it accredits. The task is headed by review committees for each specialty.

Dr. Peter Carek, who heads the review committee for the family medicine curriculum, said his group would examine public comments on the changes this week. Carek said the review committee has received concerns about the changes to language related to women's reproductive health, along with comments about other changes.

Linda Prine, medical director of the Reproductive Health Access Project, a New York City-based national advocacy group, also said she does not think the proposed changes were politically motivated. She said it was likely an oversight by the review committee.

But she said the language should be in the final program requirements.

"It's not like if you don't describe the need to put on a cast," she said. "There's nothing controversial about putting on a cast for a fractured bone. This is different. This is political. If you leave out birth control there will be many programs that will absolutely opt out of teaching it."

The final program requirements will be formally approved and released by the accreditation council sometime in the fall.