FINDING PRACTICE OPPORTUNITIES

There are many job opportunities that can include reproductive healthcare provision. Some settings include those in which reproductive health services are already integrated or are the main focus of the practice. If services are not yet integrated, there can be 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 future work. Also utilize the Abortion Clinic Toolkit Checklist and review Ch 10: Practice Integration for further strategies.

Interviewing Strategies

When considering employment opportunities, consider these questions 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 healthcare? For example, does the site already provide prenatal and obstetric services? What is the population being served? Which department or specialty provides these services?
• What is the range of contraceptive services available to patients, and are there any barriers to starting or stopping a contraceptive method?
• What is the political atmosphere of the area? Talk 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 people who request abortion services.
• Consider how personal identities may reflect the patient population. Talk about the importance of continuity of care with patients, or the importance of including these topics for trainees.
• Share a success story (with patient consent) from training—a person 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.
• Find opportunities to participate in telehealth abortion care services.
• Ask how referrals and clinic relationships with higher levels of care settings are maintained in case of complications. Consider letting them know about special training in EPL or abortion care, advocacy, and administrative set-up; and any willingness to spearhead the effort to bring a broader array of these services to the practice or training program (See Ch 10 Technical Assistance and Funding).
• Inquire if additional employment or contract work is allowed in the contract.
• With contract negotiations, pay close attention to exclusivity clauses or stipulations restricting abortion provision. For example, some religiously-affiliated organizations specifically prohibit abortion provision outside of their setting.

Joining Existing Clinical Services

Consider becoming a contract clinician for a high-volume abortion provider either locally or in other parts of the country lacking providers, or via telehealth. This can be done as primary work or to supplement another position. It is a great way to maintain skills, add variety to job responsibilities, and become more involved in the reproductive health community. Ask internal or external mentors if they would be willing to provide phone backup to allow feeling more supported as a new provider. Speak with mentors and contacts about regional needs if planning for travel work, 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

Another way to build 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 a training program took to integrate reproductive healthcare services can help providers be prepared to consider replicating the model in a different setting in the future. This also offers an opportunity to train and work alongside students, residents, and fellows. TEACH can connect providers with many family medicine residencies around the country. Interested advanced practice clinicians should contact Clinicians in Abortion Care.

Becoming a Trainer

Consider becoming a trainer at a training program in your region or further away, and advocate for training opportunities as new services are added within the organizations you work. This is a great way to advance skills while becoming a resource to others. It will also help remain abreast of the latest research and advances. More detailed information is available in Ch 11: Becoming a Trainer.

Becoming a Telehealth Shield Provider

Although the legal environment is ever shifting, some providers in supportive states with telehealth shield laws may be interested in joining or initiating telehealth practices for providing medication abortion, including to people in banned states. This decision can be complex, as individual providers with marginalized identities may be at a higher risk of state-based surveillance and criminalization. A telehealth abortion shield law is a state law whose goal is to protect healthcare providers from criminal and civil penalties in other states (See Ch 1: Interstate Shield Laws). Per the Abortion Coalition for Telehealth (ACT) steps involve but are not limited to:

• Have licensure and reside in a Shield Law state (as of 2025 CA, RI, CO, MA, ME, NY, WA, VT).
• Obtain personal umbrella or malpractice insurance (available is through ACT or MA State medical board).
• Obtain legal advice to ensure you understand the limits of your state’s telehealth shield law. The Abortion Defense Network can connect you with free legal advice.
• Either join an entity, or create a business entity and register with Danco or Genbiopro to prescribe mifepristone.
• Purchase, log, and begin sending medication abortion pills. Once your prescriber registration is on file through a certified pharmacy, you can begin to send mifepristone prescriptions.
• Consider avoiding interstate travel and additional security precautions (see Personal Security below) to avoid apprehension in ban states.

Joining Forces to Work toward Practice Integration

Clinical training alone is often not sufficient for graduates to start providing abortion services in their own practice after training. Practice integration is an in depth process that will take significant planning and administrative buy-in (see Ch 10: Practice Integration). 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, Razon 2022). Consider collaborating on new or ongoing efforts to gradually build on the types of reproductive healthcare offered in your setting, and expanding your existing network of providers. For example, begin expanding contraceptive services, followed by integrating medication management of EPL and/or abortion. 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 people.

Expanding Contraceptive Methods in Your Practice

Consider whether the practice environment ensures that people have easy access to the full range of contraceptive options, including emergency contraception. Device placements and removals are core skills to acquire during training. Contraceptive implant privileges are available directly by the pharmaceutical company. Integrating new contraceptive methods into 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 streamlining services, are other areas for productive improvement. For more tools, see http://beyondthepill.ucsf.edu.

Integrating Management of Early Pregnancy Loss (EPL)

Expanding options for managing EPL – to include expectant, medication, and procedural 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 Ch. 8: EPL. See Ch. 10: Technical Assistance and Funding opportunities.

• Mifepristone and/or misoprostol can be pre-ordered and available on-site for patients who desire medication management (MacNaughton 2021). And with recent modification of the FDA REMS restrictions on mifepristone, it is also available by prescription for pick up and by mail at certified pharmacies (see Ch. 4: Dispensing Mifepristone).
• Manual vacuum aspiration requires further training of clinic staff in order to ensure safety and clinic flow optimization (see Ch 10: Practice Integration for step-by-step planning).

EPL does not involve a viable pregnancy, and should be treated like other routine office-based procedures for funding or malpractice purposes. There are no prohibitions on providing EPL management in federally funded sites. Integrating EPL management might be a stepping-stone towards integrating abortion care into practice, as the skills and equipment are similar, but the path may be more readily approachable.

Seeking Medical Advice and Improving Referrals

Knowing resources to seek clinical advice and mentoring are essential during early practice phases. Consider asking trainers if they would mind being contacted in the future with clinical questions, and know about the Reproductive Health Hotline (1 844-REPROHH), a free, in the moment, evidence-based hotline for health care providers to call with questions about medical standards for early pregnancy, abortion, miscarriage, contraception, and other SRH related care (see Provider Support below).

Taking an active role in improving referral processes is an excellent first step in expanding access to abortion care (Zurek 2015), and important as targeted legislation restricting abortion access has resulted in facility closures and greater complexity in obtaining services. Providing referrals and logistical support can help counter misperceptions and can assist with complex social or medical circumstances faced when accessing care. Partnerships with other providers, clinics, abortion funds and practical support networks, along with improving care coordination is important in settings with limited and restricted access where individuals can face greater stigma, misinformation, and fear in accessing care. Familiarize yourself with local and national abortions funds, as they play a crucial role in helping people get care.