I was pretty alarmed to read news today that training in contraception may be made optional for family medicine doctors-in-training:
The proposed new rules, they say, drop existing requirements that family medicine residents be required to undergo training in contraception and counseling women with unintended pregnancies.
Essentially, the board that oversees residency training (required for doctors to become board-certified) concluded that its educational standards needed more flexibility, and identified contraception education as one of those areas where it could lay off a little bit. Religiously-affiliated medical centers appear most likely to take advantage of this flexibility. But let’s be clear: this is a proposed change, not yet final, and it’s about training–not about whether reproductive health services can be provided. It’s also possible that trainees could learn a good deal about contraception through FOAM. So the sky isn’t falling, but I have serious misgivings about the precedent this sets.
A few months ago I offered my thoughts on the birth control debate as a whole:
The national conversation on birth control should look a lot more like ours on aspirin. When we talk about aspirin, we talk about about whether it’s right for you. When we talk about birth control, we get one-size-fits-all generalizations, political chaos, and name-calling. Something is wrong. These are individual, medical questions that demand individual, medical answers. Ethics have a place in medicine; faceless bickering and moralism do not.
I wrote those thoughts amid the debate on insurance coverage for contraception–a question that boils down to whether members of an employer-sponosred insurance plan ought to cross-subsidize people’s birth control expenses. In short, it’s thorny. Today’s question is different: should primary care doctors-in-training be required to learn how to provide services related to reproductive health? Should they be qualified to answer those individual, medical questions? To that, my answer is yes.
Family doctors are patients’ first line of trusted healthcare. In many parts of the country, they’re patients only line; not everyone can go to an ob/gyn for routine concerns like birth control. But we already have evidence that family doctors’ understanding of the research on birth control is inconsistent. Why make it worse? More importantly, though, what makes it okay to privilege certain types of medicine over others? Why is family planning any less a part of primary care than say, heart disease? If in fact it is, why can’t religiously-affiliated programs apply the same segregative logic to patients suffering from addiction or contemplating suicide, just because they disagree with it?
Medical education is about preparation. We go through medical school, residency, and all the rest to make sure that we can handle whatever our patients ask of us (within, of course, one’s specialty). Medical education should not be about judgment, about right or wrong, or about politics. It was one thing when the nation asked whether religiously-affiliated employers should pay for birth control. I believe it’s quite another thing when we ask whether our primary care doctors need to know about it. When authorities accept willful ignorance because of concerns that are at their core political, they attack the heart of a profession built on nonjudgmental service, and the patients who rely on it.
Karan is a first-year student at Robert Wood Johnson Medical School and Duke graduate who previously worked in strategic research for hospital executives.