Family Physicians in Abortion Care

programs that offered robust abortion training, eventually choosing one that participated in the TEACH (Training in Early Abortion for Comprehensive Healthcare) program. At that time the center of TEACH’s mission was to train residents to provide “integrated” abortion care, equipping us to incorporate medication and procedural abortion into our primary care practice.

Integration. The word shares a root with “integrity”: the state of adhering closely to moral and ethical principles, but also a state of being whole, undivided.1 It is a core tenet of what it means to be a family physician—not just a philosophy, but an ethic: understanding and treating each patient as a complete human being, rather than a problem list or a compilation of organ systems. Through our training, the benefits of integrated care become obvious to family doctors, even though the challenges are manifold, particularly in abortion care. Any procedure has the potential to disrupt a busy clinic day, requiring time, staff, medications and equipment. Additionally, stigma surrounding abortion may lead support staff and colleagues to object to primary care doctors offering officebased abortion services.

“How long have you been doing this?” a patient recently asked me. She was shivering on the edge of the exam table, her lower half covered by a paper drape. Unfazed, I answered, “About ten years.” She nodded, then asked another question I hear often: “Do you like it?”

I answered her carefully but honestly, knowing that I could never imagine or intuit the range of her emotions in that moment. “Yes,” I said, “I do.”

As a family doctor, I’ve never taken my abortion training for granted. In medical school I applied only to residency

These barriers meant that even in California, very few residents go on to actually provide integrated abortion care. My TEACH trainers presumably knew this. But they also knew that only clinicians who have been trained to think about abortion as part of the care of a whole person are equipped to provide truly compassionate, competent care for all pregnant patients. A doctor who never performs or even observes an abortion during her training will likely come to see abortion itself as a fragment of something broken—care provided “somewhere else,” by a different type of doctor—rather than a piece of an integrated whole.

Despite my TEACH training (and following national trends), my practice has become increasingly fragmented over the past ten years. I provide first- and second- trimester abortions in a dedicated high volume setting, and primary women’s healthcare in a separate office. Nevertheless, my training in integrated care means that all my patients get the benefits of my empathy and expertise. I can discuss pregnancy options continued on page 24 with any patient, in any setting; and I can seamlessly counsel my abortion patients on a host of primary care concerns, from hypertension to HPV vaccines.

Meanwhile, amidst the dramatic political changes of the past several years, family doctors are helping to rethink the meaning of “integrated” abortion care, and to re-envision our role in it.

We are collectively moving away from the focus on individual choice and toward an emphasis on reproductive justice: the right of all persons to have children or not to have children, and to parent the children we have in safe and sustainable communities. We also recognize that as physicians in California, we have a unique duty to help circumvent barriers to abortion access for all patients. Sometimes this means drastically minimizing our own role. In the “new normal” of abortion care, instead of coming into an office, many pregnant persons will complete a brief health screening, order pills over the internet or by phone, then manage their own abortion at home, with only minimal involvement of a clinician. For some this is the safest, most affordable way to end a pregnancy, and family doctors are working to make it more widely available. This is integrated abortion care, and it belongs squarely in the work of family medicine. It is a commitment to treating all pregnant persons as complete human beings, with their own goals, values, and priorities. It is a commitment to wholeness, to justice, to integrity.

1. I owe this etymologic observation, particularly in the context of clinical practice, to Dr. Lindsay Mazotti’s essay, Integration. JAMA. 2010;303(1):15-16.

2. More information on Reproductive Justice, a movement founded and led by Black women, can be found at sistersong.net.

3. Dr. Michele Gomez, a TEACH faculty member and family doctor, is one of the founders of the MYA (Manage Your Abortion) network, one of a growing number of efforts to empower patients to safely manage their own abortions.

Opportunities exist with Tidelands Health for our health system-owned primary care practices in Horry and Georgetown counties. We cover a growing primary service area of more than 320,000. Inpatient services are provided by system-employed hospitalists; full specialty support for referrals including a relationship with Medical University of South Carolina, Charleston. New providers will be busy from the start in growing practices. Practice locations span from Georgetown to Myrtle Beach. We offer fair market value compensation, production and quality bonuses, relocation assistance and a lucrative benefits package. Our coastal communities offer an endless amount of outdoor recreation and a pleasant lifestyle. Please reach out to Lydia Smith, Provider Recruiter at lsmith@tidelandshealth.org