With more training during residency, PCPs could expand reproductive health workforce

Key takeaways:

• Family medicine physicians play an important role in providing reproductive health care.
• Those who graduated from programs that fully integrated family planning were more likely to provide contraception.

Family medicine physicians who received residency training in programs that incorporated community-based care and family planning were more likely to provide reproductive health services than those who did not, recent data show.

Writing in JAMA Network Open, Julia Strasser, DrPH, an assistant research professor of health policy and management at Milken Institute School of Public Health, and colleagues noted that “although some primary care physicians provide the full scope of reproductive health services, many do not.”

“In a recent study of [family medicine (FM)] graduates, more than 20% reported that their residency training did not adequately prepare them for implant or [intrauterine devices (IUD)] insertion, and only 40% reported providing these services,” they wrote. “Just 16% reported adequate training for [uterine aspiration/dilation and curettage (D&C)] with less than 5% reporting providing these services.”

For the study, Strasser and colleagues explored characteristics of family medicine residency programs that were associated with the provision of reproductive health care services. The study included 21,904 FM physicians (56.3% women) who graduated from 410 programs between 2008 and 2018, were active in a clinical practice and treated at least one Medicare beneficiary in 2019.

The researchers found that FM physicians who graduated from a Reproductive Health Education in Family Medicine (RHEFM) program — which integrates contraception and abortion training — had greater odds of providing:

• prescription contraception (OR = 1.23; 95% CI, 1.07-1.42);
• an IUD or implant (OR = 1.79; 95% CI, 1.28-2.48); or
• D&C (OR = 3.61; 95% CI, 2.02-6.44).

Meanwhile, physicians who graduated from a program that used the Teaching Health Center (THC) model — which prioritizes community-based health — had greater odds of providing an IUD or implant (OR = 1.51; 95% CI, 1.19-1.91).

Female physicians had significantly greater odds of offering prescription contraception (OR = 2.15; 95% CI, 2.01-2.29), IUD and implants (OR = 2.37; 95% CI, 2.15-2.63) and D&C (OR = 2.04; 95% CI, 1.33-3.13) compared with male physicians. As the female physician workforce grows in the United States, Strasser and colleagues noted that “the future FM physician workforce may be more inclined to provide reproductive health services and to demand better training.”

Although both the RHEFM and THC programs showed positive associations with reproductive health care, because of the small number of residencies for each nationally and without financial and structural support, “the additional benefit of training in these environments will not be available to the entire field,” Strasser and colleagues wrote.

“To improve access to care, FM physicians should provide the full scope of reproductive health services to all patients seeking them, a scenario that relies on access to adequate training in these services and exposure to underserved populations,” they wrote.