CHAPTER 9 TEACHING POINTS: BECOMING A PROVIDER
- In which setting(s) do you visualize your future participation in reproductive health or abortion care? Do you imagine joining a team that already offers services? Or do you picture starting services on a new site? Do you see yourself adding services in a setting where access is currently limited?
- There are multiple settings in which reproductive health and abortion services may be offered: clinics (community, non-profit, for profit, independent, residency program continuity sites), private doctor’s offices, hospitals, and telehealth organizations.
- You could work on expanding services in your current clinical setting to include the full range of contraceptive options, outpatient miscarriage management, medication and / or aspiration abortion.
- There are many ways to get involved: moonlight at a local clinic, join a practice already providing, get involved in teaching other providers, integrate services into your new practice, or provide services through telemedicine.
- How would you connect with other providers in your region?
- Ask faculty mentors to help introduce you to providers in your new area.
- Look online for providers or ask for contacts on one of the listservs.
- Contact one of the organizations listed to help make an introduction, or to become a member.
- Get on mailing lists of state and local pro-choice groups to get involved in local efforts in your community.
- Attend a regional or national conference.
- Utilize community organizations and networks to identify local mentors with shared identities and backgrounds
- How do you frame this discussion with potential employers? How would you ascertain if your potential employer is open to offering abortion services?
- Role-playing a discussion with a potential employer may give you maximal benefit from this exercise, in order to consider your comfort with various approaches and possible responses. Specific questions to ask are discussed in Chapter 9: Strategies for Interviewing section.
- Also note that employment discussions and decisions may be especially fraught in the current legal landscape following Supreme Court decisions. With some states implementing trigger bans, others creating bans at 6 or 15 weeks, the landscape will be in a state of change, which will make it hard to know if abortion care can be ensured as part of a new position.
- If an employer thought that a Title X clinic couldn’t provide abortions, what would you say to them?
- This is not the case. Agencies who receive Title X funding may still perform and self-refer for abortion services. While federally restricted funds can’t be used for abortion services directly or indirectly, your clinic may have other revenue streams that do not restrict the type of services you can provide.
- The cost of abortion services and time must be broken out, in most cases, from other services in order to prove that federal funding is not being used to provide abortions. This may require setting up a separate cost center, which is easy to do. More information is available in Chapter 10: Practice Integration: Reimbursement Issues, and guides to assist with billing are available
- Title X clinics may provide “factual, neutral information about any option including abortion, as they consider warranted by the circumstances, but may not steer or direct clients towards selecting any option in providing options counseling.” 65 Federal Register, Section 41270.
- If your state has laws restricting state funding from going towards abortion care, consult with a state based legal advocacy group to help you navigate.
EXERCISE 9.2 – Employment negotiations
- Preparation is key to successful interviewing and negotiations with a future employer. Examine your practice priorities and rank them by their relative importance. What strategies can you use to ensure that your priorities are met?
- During the interview, highlight your unique contributions to the organization in terms of valuable skills you have as a reproductive health provider.
- Understand your market worth prior to or as a part of the process of these negotiations. How much are you worth elsewhere (the dollar and reputational value of the skills you are bringing in). Don’t leave it up to the employer to tell you your market worth; you should go into the negotiation knowing (and literally having thought about how you are going to express that).
- Understand the priorities of the person you are interviewing with and which priorities are aligned or in conflict with yours (Sarfaty 2007, Herbert 2012).
- After a negotiation, e-mail the other party summarizing the session to be sure you are both on the same page.
- Do not accept an offer until you review the details in writing.
- In academic medicine, terms of employment often are conveyed in a formal letter or contract; the contract supersedes all other agreements.
- Check your contract carefully for clauses that would prevent you from providing abortion services or restrict you from practicing at another site.
- Creating a list of questions prior to your interview will help you prepare. What information would you want to obtain? How will you address parts of the interview process that will be more challenging for you?
- Get advice from mentors and faculty to obtain different perspectives.
- You will want to understand the scope of your duties and responsibilities.
- Understand the chain of command (Sarfaty 2007, Herbert 2012).
- Role-playing with a trusted mentor or peer may help you prepare.
- Utilize the Abortion Clinic Toolkit for generating interview questions.
EXERCISE 9.3-Managing stigma: the decision to disclose
(Adapted from The Providers Share Workshop, Debbink 2012)
- Abortion providers experience additional layers of discrimination given the politicization and polarization of reproductive healthcare which should be acknowledged and addressed (León 2018)
- If, when, and how you decide to disclose that you provide abortions is a deeply personal issue that this exercise will help you consider.
- Engaging in this exercise with other abortion providers can help foster interpersonal connections, and serve as an effective stigma management tool (Harris 2011)
- Reaching out to others in the field can help provide a supportive environment.
- Your ideas on this can and will likely change with time and circumstances.