New York Times 11 June 2002
Newest Skill for Future Ob-Gyns: Abortion Training
By LINDA VILLAROSA
Like just about every fourth-year medical student, Nicole Fanarjian recently made the rounds of hospitals in search of a residency program that would train her for her specialty: obstetrics-gynecology. This spring, she visited 13 programs, and in nearly every interview, she asked this direct, but sometimes eyebrow-raising question: "Do you provide residents with abortion training?"
"I am planning to be an ob-gyn, and I intend to provide the full range of reproductive services, including abortion," said Ms. Fanarjian, 33, who will begin her residency at the University of South Florida in Tampa next month. "I want to be exposed to the procedure, because I strongly believe that if you go into this specialty, you should feel comfortable providing abortions."
Ms. Fanarjian's question may become unnecessary over the next decade. Though only about half the residency programs in the United States teach ob-gyns in training how to perform abortions, more are adding the training to their programs.
Most notably, beginning next month, New York will become the first city to require abortion techniques as a standard part of training for ob-gyn residents at public hospitals. New York trains a large number of doctors; one of seven doctors in the United States does a residency here. Every year 154 residents rotate through the eight public hospitals that offer ob-gyn residency programs. Those residents who object to abortion on religious or moral grounds can be excused from the training.
The National Abortion and Reproductive Rights Action League pressed for the New York City plan, which was endorsed by Mayor Michael R. Bloomberg. The league is looking to duplicate the model in cities in the 17 other states that provide Medicaid financing for abortion. They include California, Massachusetts, New Jersey and Texas.
"We are hoping to extend this project in the face of a looming national shortage of abortion providers," said Kelli Conlin, director of the Institute for Reproductive Health Access at the Naral/NY Foundation.
Outside of New York City, abortion training for residents is also on the rise. In 1996, the Accreditation Council for Graduate Medical Education required ob-gyn residency programs to include family planning and abortion training for its students.
A 2000 survey conducted by the National Abortion Federation, a Washington professional group for those who perform abortions, found that from 1992 to 1998, ob-gyn residency programs reporting routine first trimester abortion training increased almost four-fold, to 46 percent from 12 percent. Routine second trimester abortion training increased even more sharply, to 44 percent in 1998 from 7 percent in 1992.
The investigators of the NAF report, which appeared in the journal Perspectives on Family Planning, admit to the study's limitations. For instance, the 1991-92 study had a response rate of 87 percent, while the 1998 surveys response rate was only 69 percent, a factor that may have skewed the figures, making the difference seem more striking. Nonetheless, experts across the country confirm the increase in residency programs offering abortion training.
"There is no question that many more residents have been trained to provide abortion since the changes in 1996," said Dr. Frank W. Ling, professor and chairman of obstetrics and gynecology at the University of Tennessee College of Medicine in Memphis. "Abortion training is now nationally accepted. It is mainstream where it had previously been marginalized."
Others say they have continued to see increases in abortion training more recently, over the last two years. In 1999, the University of California at San Francisco, created the Kenneth J. Ryan Residency Training Program in Abortion and Family Planning to help encourage abortion instruction. In the last three years 11 programs have added the training for ob-gyns, including hospitals in Michigan, California, Massachusetts and New York, and 20 others are in various stages of development.
Abortion-rights proponents hope that these newly trained doctors will integrate abortion into their practices to reverse a downturn in the number of doctors who perform abortion.
About 84 percent of counties in the nation have no doctors performing abortions, and the figure rises to 94 percent outside metropolitan areas. Many of those who provide abortions will retire in the next decade.
Many younger doctors avoid the practice because of opposition to abortion, including violence against clinics and doctors, or because they have not been trained.
Abortion opponents say abortion training for residents is unnecessary. "There is absolutely no evidence to support the claim that physicians coming out of residency programs were ill-equipped to perform abortions," said Dr. Anthony Levatino, an ob-gyn in Albany who is a board member of the Physicians Life Alliance, which supports medical students opposed to abortion and euthanasia.
"There is no reason to mandate abortion training," he said. "Most abortions are done by suction vacuum D.& C.'s, and residents are exposed to hundreds of them during their training," he said. The procedure, dilation and curettage, involves opening the cervix and removing the contents of the uterus.
But proponents say that in a vast majority of programs, residents learn how to do D.& C.'s using a metal curet, rather than a vacuum. This process is generally used to diagnose problems, including cancer, rather than as an abortion technique.
In New York City, residents learn the two techniques, and they are also trained to provide medical abortion using the drug mifepristone, known as RU-486, and to offer support and counseling. Some also learn to do less common second-trimester abortions.
"Being able to perform abortions is more than just learning to do a D.& C.," said Dr. Wendy Chavkin, a professor of public health and gynecology at Columbia University and chairwoman of Physicians for Reproductive Choice and Health, a doctors' advocacy group.
Opponents also argue that the training is unnecessary because demand for abortions is dropping. The Alan Guttmacher Institute, a reproductive health research organization, estimates that the number of abortions performed each year dropped by 17.4 percent from 1990 to 1997, when its most recent statistics were compiled.
"There are existing abortionists who are competing for a pool of patients that is shrinking," Dr. Levatino said. "The motivation behind this isn't about providing medical care, but about pushing more physicians into doing abortions." Some residents say they plan to refuse the training. "I don't believe in abortions, because life begins at conception," said Noemi Pagan, a fourth-year medical student at the Medical University of South Carolina, who will begin an ob-gyn residency at Riverside Regional Medical Center in Newport News, Va., in July.
"Residencies can't make you learn how to perform an abortion," she said, "and I have no problem saying I don't want to learn it."
Some are getting the training even earlier, in medical school. Marie Soller, a second-year medical student at Stanford University School of Medicine, takes part in an elective program that allows students to follow a doctor who performs abortions. "I plan on going into family practice, and given how common abortion is, patients are going to ask me to perform them," said Ms. Soller, 25, who is a coordinator for the group Medical Students for Choice. "I believe that to be a responsible physician, you should know how to provide an abortion. Period."
<http://www.nytimes.com/2002/06/11/health/womenshealth/11ABOR.html> -- Yoshie
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