FINDING PRACTICE OPPORTUNITIES

There are many job opportunities available that can include reproductive health care provision. In what setting do you visualize your future participation in reproductive health services?

You may join a setting where reproductive health services are already integrated or are the main focus of the practice. If services are not yet integrated, you can have both the excitement and challenge of pioneering them at a site. It may be possible to offer some services initially, and expand with time. Below are a few ways to begin thinking about the integration of reproductive health into your future work. You can also utilize the Abortion Clinic Toolkit Checklist for further strategies.

STRATEGIES FOR INTERVIEWING

When considering employment opportunities, think about these questions when you interview and evaluate whether reproductive healthcare and abortion provision will be possible in different practice settings.

• What is the current scope of practice specifically regarding reproductive health care? For example, does the site already provide prenatal and obstetric services? What is the patient population being served?
• What is the range of contraceptive services accessible to patients, and are there any barriers to starting or stopping a contraceptive method?
• What is the political atmosphere of the area? Consider talking to other regional reproductive health providers BEFORE approaching a new job site directly.
• How are prenatal care, early pregnancy loss, and / or abortion referrals managed? Ask how they respond to patients who ask for abortion services.
• Consider how your personal identities may reflect the patient population. Talk about the importance of continuity of care to your patients, or the importance of including these topics for trainees.
• Share a success story (with patient permission) from your training—a patient who was able to be seen by their own continuity provider and how comfortable it was receiving their reproductive health services in a familiar setting.
• If appropriate, consider letting them know that you have special training in abortion care, advocacy, and administrative set-up; and that you would be willing to spearhead the effort to bring a broader array of these services to the practice or training program. (See Ch. 10 Practice Integration)
• With contract negotiations, pay close attention to exclusivity clauses or stipulations that would restrict abortion provision. For example, some religiously-affiliated organizations specifically prohibit abortion provision even outside of their setting.

JOINING EXISTING CLINICAL SERVICES

Consider becoming a contract clinician for a high-volume abortion provider either in your community or other parts of the country that lack providers. This can be done as your primary work or to supplement another position. It is a great way to maintain your skills, add variety to your job responsibilities, and become more involved in the reproductive health community. You can work as a contract clinician in your own community or with a telehealth organization. Ask your mentors if they would be willing to provide you phone backup to allow you to feel more comfortable as a new provider. Speak with your mentors and contacts about the regional needs where you are going, and level of experience suggested to apply. National programs, including Clinical Abortion Staffing Solutions (CASS) can match trained clinicians with clinics currently in need of abortion providers.

JOINING FACULTY

One way to build on your skills is to work at a professional training program that needs or already offers reproductive health services. Working alongside more experienced clinicians is a great way for early providers to solidify their experience and confidence. Gaining insight into the steps that your training program took to integrate reproductive health care services can help you be prepared to consider replicating the model in a different setting in the future. RHEDI (Reproductive Health Education in Family Medicine) can connect you with many family medicine residencies around the country. Interested advanced practice clinicians should contact the Primary Care Initiative at UCSF’s ANSIRH Program.

BECOMING A TRAINER

Consider becoming a trainer in your own training program or at another site. This is a great way to advance your own skills while becoming a resource person to others. It will also ensure that you are keeping abreast of the latest research and advances. More detailed information is available in Chapter 11: Becoming a Provider.

STRENGTHENING ENABLERS TO PRACTICE INTEGRATION

Clinical training alone is often not sufficient for providers to overcome the barriers to abortion provision after training. To increase abortion provision and access, organizations and advocates should work to strengthen enablers of provision, such as strong mentorship and support networks (Summit 2020, Goodman 2013). Consider gradually building on the types of reproductive health care you offer in your setting. For example, begin expanding contraceptive services and abortion referrals, followed by integrating miscarriage management. Cultivate relationships with key stakeholders, involve staff early in the process, and find support from mentors and reproductive health organizations. Be patient and persistent, as the process will take some time. Keep returning to your core beliefs about the importance of expanding care for your patients.

EXPANDING CONTRACEPTIVE METHODS IN YOUR PRACTICE

Consider whether your practice environment ensures that patients have easy access to the full range of contraceptive options like IUDs and implants. Insertions and removals are core skills to acquire during training. For privileges to insert and remove the contraceptive implant, it is necessary to take a training class offered directly by the pharmaceutical company. Integrating new methods into your practice can usually be done with minimal effort, equipment, and a bit of research on product ordering and reimbursement (see https://larcprogram.ucsf.edu). Working to minimize barriers to access, by improving logistics or same-visit services, are other areas for productive improvement. For more tools, see http://beyondthepill.ucsf.edu.

INTEGRATING MANAGEMENT OF EARLY PREGNANCY LOSS (EPL)

Expanded options for managing EPL – including expectant, medication, and aspiration management – can be integrated into one’s outpatient clinic setting or into Emergency Department services. The counseling, consent, and follow-up for different management options are addressed in Chapter 8.

• Mifepristone and / or misoprostol can be pre-ordered and available on-site for patients who desire medication management (Prine 2003). Due to a recent modification of the REMS restriction on Mifepristone in which the “in-person dispensing” requirement was removed, Mifepristone will be available by prescription at certified pharmacies. Once the law goes into effect in the states that allow it, pharmacies will need to become certified to dispense the drug.
• Manual vacuum aspiration requires further training of clinic staff in order to ensure safety (See Ch. 10 Practice Integration).

Because EPL does not involve a viable pregnancy, its management is not considered an abortion for funding or malpractice purposes, and can be treated like any other minor surgical procedure that you routinely provide. Integrating EPL management might be a stepping-stone towards integrating abortion care in your practice, as the skills and equipment are similar, but the path may be more readily approachable.

IMPROVING REFERRALS IN YOUR PRACTICE SETTING

Taking an active role in improving referral processes at your practice may be an excellent first step in expanding access to abortion care (Zurek 2015), and especially important as targeted legislation restricting abortion access has resulted in facility closures and greater complexity in obtaining services. Providing referrals and logistical support (see Chapter 2) can help counter misperceptions and can assist with complex social or medical circumstances faced when accessing care. Improving care coordination is especially important in settings with limited access where patients face greater stigma.Familiarize yourself with local and national abortions funds, as they play a crucial role in helping patients get to definitive care.