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interested in women's preventive health esp. sexual health for the underserved

Discussion in 'Family Medicine' started by ghandoc, Mar 22, 2007.

  1. ghandoc

    ghandoc New Member
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    hi there, i'm interested in women's preventive health esp sexual health for the underserved and could see myself working for an NPO like planned parenthood.

    However, i'm not so interested in the ob part so i'm not sure i want to do obgyn.
    do you think that is reason for me to do family practice esp since i'm not so interested in the other parts you have to do during FP residency like critical care/ICU, surgery, etc? and with that are FP residencies flexible enough so you can emphasize certain parts of your training(like an FP program with a focus on gyn? will the training in gyn be adequate enough for me to run some sort of sexual health clinic?

    will i get hired by a NPO like planned parenthood? apart of working at PP what are other physicians with similar interests doing?

    sorry to overwhem with questions ,what can i say, i want to change the world and i have some idea of what i want to do but i'm confused on how i could get there and how it would look like exactly.

    you don't need to be ably to answer all the questions,
    any info will be appreciated...
    i'm MSII.
    THANKS
     
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  3. sophiejane

    sophiejane Exhausted
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    First of all, applause to you! There is a huge need there, and I hope you will find just the job you are looking for (or can create it!).

    I can't speak to whether or not you will get that job, but I've researched a lot of family medicine residencies and looked at how curricula differ. There are programs that are starting to offer a "Women's Health Track" or something similar, where you have built-in rotations in gyn, colposcopy, STD clinic, etc. There are also opporunties at traditional programs to use your electives for your area of interest. The amount of elective rotations does seem to vary a fair amount. The average seems to be between 6-8 months of electives over the 3 years.

    There is also a new program called p4 which has been adopted by several programs nationwide (the only one I'm familiar with is JPS in Ft. WOrth, but there are others in several states). This program allows you to tailor-make a curriculum based on your interests, and gives you an extra year to do it. From what I've seen, it looks like a very promising program for people like you that know their niche already.

    I do think FM will offer you the most flexibility. I don't think traditional OB/Gyn will provide you what you are looking for, nor will IM.

    Best of luck and keep us posted!
     
  4. ramonaquimby

    ramonaquimby I'm a PGY3?! WHAT?!
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    yeah!!!! we have very similar interests. i answered anohter one of your posts :)

    you definitely sound like FP. i plan on tailoring my residency as well and will make it VERY gyn/STD/colpo/derm heavy.

    my future practice will be a treehouse iwht a wooden sign on it saying, "no boys alllowed!" (with a 'backwards' S of course, lol...) :laugh:

    welcome, and good luck in your decision, but FP really does sound right up yoru alley! :thumbup:
     
  5. ghandoc

    ghandoc New Member
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    hi ramonaquimby & sophiejane,
    thanks for the encouragement! it's so refreshing!

    what are you guys' plans? do u want to have your own practice with your tailored interests or r u planning on joining an NPO like PP? and where big city/urban?

    i just like to exchange ideas....
     
  6. sophiejane

    sophiejane Exhausted
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    Smaller group full-scope FM in rural area with OB. Hopefully. ;)
     
  7. sophiejane

    sophiejane Exhausted
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    Tell you what, if you can do something about cracking the issues surrounding family planning, I will personally nominate you for a Nobel Prize!

    I can't understand why children continue to get pregnant, with all of the knowledge and availability of birth control. Maybe there isn't the availability I think there is?

    I also can't understand why poor people continue to have child after child that they cannot care for, putting the whole family in a worse situation.

    I would say maybe it's cultural, but the problem seems to cross cultures pretty well.

    Should we start putting OCPs in the water, perhaps? ;) We may have to, if stuff like this keeps happening...

    http://www.cnn.com/2007/EDUCATION/03/23/colleges.contraceptives.ap/index.html
     
  8. pillion

    pillion Senior Member
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    ...or maybe the solution isn't birth control but rather self-control. Children continue to get pregnant because they are children, which means the are not ready for the responsibilities associated with sex (like having children), and which means the best thing we can do for them is to encourage them to wait instead of dangling it in front of their face with a pill or condom, saying "just in case do, here you go!" Teach them to abstain until marriage and then to be faithful during marriage.
     
  9. Tired Pigeon

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    Well, easier said than done. It would be great if there were NEVER a single unwanted pregnancy, ever. But until that day comes, there's this pesky reality thing we have to deal with ....
     
  10. sophiejane

    sophiejane Exhausted
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    Right. All those government sponsored abstinence programs? We have several in Texas. 80% who join and "pledge" abstinence end up having sex by the time the graduate from high school.

    Gotta hit some other angle.
     
  11. pillion

    pillion Senior Member
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    It's not a question of taking a one-time pledge in high school, but rather growing up with a set of mores that encourages a certain kind of behavior. Parents, teachers, coaches, doctors can all have a great impact on such mores...
     
  12. justwondering

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    well abstinence in the US may work as well as prohibition did (not!). i think we as a society need to encourage responsibilty in younger people as a whole so we can stop treating teens as kids. kids dont have sex voluntarily, young adults do. i think it's a relatively new phenomenon for the human race to allow 16-17 yo's to act without any responsibilty. it wasn't that many decades ago that a 15 yo female in this country would be married and competently running a household and taking care of her kids. im not saying 15 yo's should be married today, im just saying this total irresponsibility is due to social changes and are not innate.
    i
    it does take a certain level of responsibility to avoid std's (even if u can get an irresponsible person to avoid pregnancy with a Depo shot). so responsibility is one thing that does have to be acknowledged.
     
  13. sophiejane

    sophiejane Exhausted
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    Well said. There are so many levels, though. It's very complex. Babies are seen as a status symbol to some young girls--or a way to keep their boyfriends. How do we change this? It's so deep culturally...

    In the meantime, I say overwhelm them with opportunities and motivation to prevent pregnancy. Yes, promote abstinence. But young people are going to have sex, no matter how well they are guided. To ignore that is naieve. We have to combine the two approaches.

    I'm all about the depot shot, by the way. ;)
     
  14. Marigold

    Marigold Kid Doctor
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    Yes, we should absolutely promote those sets of morals that will help to instill that sense of responsibility in our young ones...because that is one of the things that is missing.

    But also missing is a comfortable dialogue between us as adults, parents, educators, coaches, etc. and our young people. We should be comfortable discussing with them how the best way for a teen to take responsibility might be to wait until they're old enough...but if they can't or don't want to do that, then making sure they understand that there are other ways to be responsible too.

    Of course, this doesn't address the fact that in some teens' eyes, babies are indeed seen as ways to get attention, to keep your boyfriend, etc....one way to address this is to start EARLY teaching our girls about self esteem, confidence, self-worth, etc.
     
  15. Marigold

    Marigold Kid Doctor
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    I guess, overall, I'm just part of the camp that believes that THEY'RE GONNA DO IT if they want to, for whatever reason, and even though it would be ideal to give them the morals and the understanding so that they won't do it till they're truly ready, it doesn't usually work out that way. So, if that's the case, it would be great if we had more systems in place to get these girls using some sort of birth control and STD control. Ideally, she'd be on the pill or the shot AND they'd be using condoms every time.

    ETA: just realized I didn't even address the OP of this thread. How rude of me! :) Ghandoc, I agree that Family Medicine would be a great place for you to start in making your dream a reality. It would be better for you than OB/GYN, imho...and of course, feel free to hang out in the Family Med forum and keep asking questions to determine if you feel like it's a fit as well! Also, as an MS2, you have plenty of time before residency to explore your options, pursue volunteer opportunities of your interest, etc. Good luck!! :)
     
  16. pillion

    pillion Senior Member
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    I hear what you're saying, but just consider the possibility that encouraging the use of birth control is counterproductive to encouraging healthy mores like waiting untill marriage. When a girl goes on birth control, are we really teaching her to be responsible (ie you could get pregnant and have to raise a child) or are we trying to remove her from the consequences of her actions, in other words, teaching her to be irresponsible.

    We should have more faith in young people instead of just assuming they're "gonna do it anyways." It's like teaching a kid to ride a bike. We don't say "although you want to stay on the bike, you probably wont, so here's how to walk beside the bike." Teach them how to do things right, and if they fall, be there to help them up so they can try again.
     
  17. sophiejane

    sophiejane Exhausted
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    I don't agree that providing birth control is encouraging sex, or parenthood for that matter.

    The best case scenario: every young girl and boy is raised in a safe, stable home with two loving, emotionally well-functioning parents who are united in being good role models, and that they all have a supportive community that encourages them to be abstinent. They know the risks and understand why it's best to wait, if not until marriage, at least until they're able to support themselves and a child. At the point at which these fortunate young people believe they are in a committed relationship and want to have sex, fully understanding the risks, they are able to have access to affordable and reliable means of birth control.

    This is a fairytale, however. Time to wake up!
     
  18. justwondering

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    i am all for abstinence until marriage due to my own personal beliefs, however i dont know if teaching it to young ppl in the west would have any effect at all. mainly because most young ppl would ignore these messages because they know that the adults teaching them would likely not abstain until marriage themselves. so if society "allows" older ppl to indulge, then it would be very difficult to persuade young opinionated teens to abstain when they have the same desires as older ppl.

    i think broadening young ppl's views of their own potential would have some effect as far as reducing girls purposely getting pregnant. teach guys/girls that they really can get an education and live a comfortable life and 'make it' in the world if they try.

    yes it's all complicated, and has a lot of cultural implications.
     
  19. Marigold

    Marigold Kid Doctor
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    I also hear what you're saying...I agree that in a perfect world, we could put more faith in young people to make the right decisions on their own. However, this is not that perfect world. All of our kids don't grow up in ideal circumstances, with parents who love and support them, who put in the time and the effort to instill these sets of morals into their children that lead them to make responsible decisions as young adults. It's a nice idea that we should put more faith into our young people, but it just isn't realistic, imho.

    Yes, there are some young people out there who ARE indeed capable of making their own good decisions, but these aren't the ones I'm so worried about. For every one that sticks with his or her decision to wait until marriage or at least until he or she is a responsible adult, there is another who makes that one seemingly small mistake that results in her life being changed forever.

    Ideally, abstinence education alone would do the trick...but it just hasn't.
     
  20. MiesVanDerMom

    MiesVanDerMom D.o. or Die
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    1) Have you ever been on depo? Do you know the side effects? I was put on depo at a PP-type clinic in high school and it was horrendous.

    2) This racist, classist attitude so common among doctors: how can we stop these poor women from having so many babies! If only they were enlightened like us good middle class white liberals! Why, let's just implant birth control into all of them against their will. Then they can be good well-behaved poor people. The problem is not that women are having babies. The problem is a society where this is such a great disparity of wealth, where an enormous number of people live in poverty, suffer racism and classism, recieve inadequate education, etc. etc. The problem is that there is a lack of dignified fairly compensated work. The problem is that people live the violence of poverty and racism and of course play that out in their personal anf family lives. The problem is not the poor people, the problem is the rich people. Until we have an equal society where the upper class stops living off the backs of the poor, there will be a problem. It isn't that women have babies; it's that we don't allow these women to support these babies: financially, emotionally, spiritually. What we need is a radical paradigm shift. What we need is doctors leaving their subdivisions, pulling their kids out of the best schools, and living simply so that they might devote themselves to helping the people who need it. What we need is for middle class liberals to get off their soapboxes and roll up their sleeves. What we need is a whole lotta love... Of course there's always forced abortions. That could work too...

    3) There was an article in "Psychology Today" recently about how adolescence is basically an idea we made up and is causing all kinds of problems. I think the dude's got a point.

    4) Why not teach teenage girls about fertility monitoring? If they understood their bodies, it would be empowering and would help them avoid the side effects of chemical birth control and give them the power (as opposed to relying soly on a guy to use a condom properly). It would also introduce more of a sense of adult responsibilty to the situation since monitoring fertility signs requires a certain amount of thoughtfulness and dedication.
     
  21. Blue Dog

    Blue Dog Fides et ratio.
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    Don't forget world peace. ;)

    I believe teen pregnancy was a problem even in the former U.S.S.R., so our capitalist society isn't solely to blame.

    I'm pretty sure that's already covered in health education...you know, that class everyone sleeps through? If teens were universally blessed with "thoughtfulness and dedication," I don't think we'd be having this discussion.

    Meanwhile, I don't think Sophiejane was suggesting that we administer Depo Provera against anyone's will. Depo is actually a perfectly reasonable option for a teenager who desires contraception, but can't or won't use other methods of birth control.
     
  22. sophiejane

    sophiejane Exhausted
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    Yes, Kent has it right--that is what I meant. (and sorry for the misspelled "depot"--we're doing major remodeling right now and Home Depot is on the brain! ;) )

    I think MiesVanDerMom's interpretation of what I was saying takes it to an extreme that I don't personally even believe, much less intended to express here. It appears that the post makes assumptions that I am "racist and classist." If only you all knew how far from the truth that was. (You'd understand if you saw my family pictures, I'll just leave it at that). I have always been a huge advocate for the poor, and have worked for charity and relief organziations for many years. One of the reasons I wanted to do family medicine is because it will give me the greatest breadth of training to allow me to be of service to the medically underserved as part of my practice.

    I believe the kinds of changes Mies is talking about are valid, and I agree with them. But the immediate problem at hand is teen pregnancy, and the biggest problem with teen pregnancy is among the poor. I'm not debating that this isn't fair. Of course it isn't. Wealthier kids' parents have health insurance and they get access to birth control and abortion. To deny that there are differences regarding teen pregnancy among socioeconomic groups is to seriously see the world through rose-colored glasses. I'm not saying anything about race, mind you. I'm talking about income.

    For example, I went to high school in a very poor neighborhood (and by poor, I don't mean smaller houses with no neighborhood pool. I mean crack houses, prostitutes, drive-by shootings, and public housing). I had a number of classmates who knowingly got pregnant in high school because babies were cute, got you attention, and were a way to hold on to your man. These were white, black, and hispanic girls, by the way. There were so many pregnant girls at our school that the stigma literally was not there, and among some groups of kids, it was the opposite of a stigma--it was a kind of status symbol.

    As for teaching fertility awareness, this is pretty labor intensive for a 15 year old who can't always remember to bring her books home every night, much less take basal body temperature at the same time every morning and chart cervical mucus changes. I can just hear it now: "You want me to look at what?? Eeeeewwwww!" Furthermore, many young girls ovulate irregularly for the first few years of their cycles. As an adjunct, yes, but as a primary method of birth control, no way.

    And by the way, "a whole lotta love" is what got most of these young ladies knocked up in the first place. ;)
     
  23. kelaskov

    kelaskov Junior Member
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    That obviously worked in Texas which has the 5th highest teen birthrate in the country.

    Religion and healthcare don't mix and religious health objectives lead to poor health outcomes every time.
     
  24. kelaskov

    kelaskov Junior Member
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    Other than OB and FP..some pediatritions also focuses on adolecent health. They can work at planned parenthood and provide comprehensive reproductive health care, including abortion. You may want to look into doing a Family Planning Fellowship after your residency, ..whatever that may be...especially if you want to do academic medicine..

    I also know an Emergency Med doc who provides part-time abortion/repro health care and works at a local clinic.
     
  25. kelaskov

    kelaskov Junior Member
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    What are you saying here..that we don't make it accesible to teens? SE affect people differently. One person's horrendous depo shot is another woman's perfect solution for preventing unplanned pregnancy.

    Unfortunately, many times it's poor teens who don't have the access, education, guidance to prevent unplanned preg. Look at the stat's. This is true for a number of other factors aswell, ie. Obesity. Poor people, who are ofter the unhealthiest, ofter get poorest care..and the cycle continues.

    Hey..someone's gotta help them. You can be sure these teen girls aren't going to get any help from religious conservatives and the republicans who often advocate for witholding repro health services...policies that will keep 'em barefoot, pregnant and out of power. I don't see many republicans advocating allocating additional resources to pregnant teens. Most pregnant teens drop out..and many end up poor and on welfare.

    Actually, 13 year olds and other teens having babies is a problem for all of us. Are you advocating we support teen pregnancy and after they drop out of school to care for thier children..they should just enter the work force...?? It's pretty hard to move up the ladder without formal education..whether you have a child or not.

    On another note..so many of the "Crisis Pregnancy Centers" provide 2-3 months of support to a women after the've harassed her into giving birth. Then they drop her and her baby on the state welfare roles.

    Actually a number of us are already out there....providing comprehensive reproductive health and pregnancy prevention to teens who need it. Unfortunately, we're also cleaning up after conservative docs who directly contribute to the high teen prg. rate by refusing to provide BC and accurate info., etc.
     
  26. kelaskov

    kelaskov Junior Member
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    :laugh: :laugh: :laugh: :laugh: :laugh: :laugh:
    .. could be the funniest quote of the day....is this a direct quote from the pope?!

    Should we tell them about the 20% failure rate or let them figure that out by themselves?
     
  27. kelaskov

    kelaskov Junior Member
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    Unless you're attending a secret med class at Bob Jones U, you should probably keep your plans for reducing teen pregnancy on the DL next year when you attend med school.. otherwise you just may be laughed right off campus.
     
  28. Blue Dog

    Blue Dog Fides et ratio.
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    Please limit the discussion to the topic, not the poster. Thank you.
     
  29. McDoctor

    McDoctor Over One Billion Cured
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    I hope this isn't straying too far from the original post, but I happen to have a radical opinion on teenage pregnancy:

    It's nothing new and not a huge problem in and of itself. The whole issue is wrought with social hysteria and rabid fear-mongering from both the right and left sides of the political spectrum.


    A few points:

    1.) The teenage birth rate in this country reached its highest levels in the 1950's. The birth rate for teenage pregnancies actually declined by 12% in the 1990's.(1)

    2.) As recently as a century ago the average age of menarche was somewhere around age 16. Nowadays, the average is closer to 12 and can occur as early as age 9.(2) So only lately have women been called upon to wait so long after menarche to have children. Perhaps teenage pregnancies have more to do with a woman's maternal instinct (in other words, her "biologic clock") than rampant hedonism.

    3.) Nonetheless, it remains extremely uncommon for a 13 or 14 year old to have a baby.(2)

    4.) A woman's age in and of itself does not necessarily have a huge influence on how a child will turn out. A history of legal problems or living in poverty or other socioeconomic factors play a much bigger role. (my opinion.)

    5.) These rabid debates about teenage pregnancies never focus on deadbeat dads. Go figure.


    Sources:
    1.Luker, Dubious Conceptions, (pub: Harvard University Press, 1996); also see: Glassner, The Culture of Fear (pub: Basic Books, 1999)
    2. Sally Mcintyre and Sarah Cunningham-Burley, "Teenage Pregnancy as a Social Problem" in The Politics of Pregnancy (pub: Yale University Press, 1993) also, some stats are cited by Glassner, The Culture of Fear (Basic Books, 1999)



    I occasionally see a reckless teen in our FP clinic who had a child before age 15 and continues to undertake high risk sexual behaviors, but although these cases stand out in my mind, I probably see more patients in a given month with lupus or other relatively rare diseases than these mythic "preteen girls gone wild" demonized in the media and these forums.
     
  30. sophiejane

    sophiejane Exhausted
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    Can I ask where your practice is located (i.e. suburban, urban, inner city, rural, etc)?

    Are you working in a medically underserved area?

    Do you have a lot of indigent or Medicaid patients?

    A few months ago, while working at the clinic where I will do my residency, I personally saw 3 pregnant girls under the age of 15, and one in the hospital who delivered (fortunately without incident). This was one medical student for one month, and I only had about 8 half-days in the clinic. I imagine the residents saw many more.

    Again, just because you don't see it in your practice doesn't mean it's not there. It just happens to be concentrated in poor areas.
     
  31. McDoctor

    McDoctor Over One Billion Cured
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    Our clinic is in a city of about 55,000. We see about 90-95% medicaid. I'd guess about half of our patients are hispanic. I see alot of mothers with way too many children than they can support. There are alot of socioeconomic factors which contribute to this. Age alone is not one of them. Legal problems, substance abuse problems, significant medical illness like poorly controlled type I diabetes or bipolar disorder or schizophrenia, these are all things which come to mind when I think of parents who need to make better decisions about birth control.

    I'd also argue that just because you saw three patients in a months time in a busy clinic also doesn't mean there is an epidemic. If these cases stand out to you as tragic, I would guess it is probably also because they also had some notable socioeconomic or medical burden attached to them beyond their young age alone.

    I'm also curious if the fathers where present for the deliveries or prenatal care in any or all these cases. If not, why not delve into the problem of deadbeat dads? (aside from the fact that the thread refers to women's health, of course).

    I'm also not arguing that pregnancies in this age group are exceedingly rare, just less common than one would think given the heated emotional debate on the issue. I spend 1.5 days per week in our clinic. I probably saw 2 patients with lupus last month. I maybe saw 2 whom had pregnancies before age 15. My anecdotal experience says pregnancy under age 15 is about as common as lupus. I don't necessarily have the inclination to look at any hard numbers, as I'm just opining on an anonymous forum.

    I think my sources justify my argument that teenage mothers are unfairly stigmatized, and the "epidemic" is overstated in the media and political forums. You should check out the book by Glassner, its a good read and well researched.

    Do you have any sources about teen pregnancy and the poor? I believe its probably more prevalent among lower income families, but I'd like to see some data to back that up.

    I also wonder if you give any credence to the argument that younger age of menarche compels teens to have children at younger age based on maternal instinct. I ask because I assume you are a woman from your screen-name and I'm curious about a woman's take on this.

    Finally, don't get me wrong, I don't advocate for teen pregnancy. I just think teenage moms get a bad rap. Most of them do a good job. This gets ignored by the press. And deadbeat dads often are too easily let off the hook by our society. That's the point I'm trying to make.
     
  32. LMarie_MD2b

    LMarie_MD2b AP/CP/Cytopathologist
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    ...but I am also thinking about returning to my small-town roots with an FP practice, possibly with OB included. Reading through the first few posts was truly inspiring, as I am a family-planning/reproductive rights advocate, and I thought of a question that might be answerable in this particular forum.

    Does the 'typical' OB fellowship train physicians to perform abortions? If you're trained in C-sections and other surgical intervention, I would guess that termination procedures would be included.

    NOTE: Please don't turn this into an abortion debate. ::puts on flame suit, just in case:: :scared:
     
  33. sophiejane

    sophiejane Exhausted
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    I do. A recent article on CNN about 5th graders having group sex in a classroom seems to echo that as well. Those hormones are starting to build at earlier and earlier ages, and society already puts so much pressure on little girls to be little women, complete with bare midriffs and low-cut blouses. Our media and advertising are selling sex hard to kids, and we can't really blame them for buying it at an earlier age than they are ready to own it.

    I agree that many step up and do a good job, but at what cost? I don't have the patience to check sources right now--it's late--maybe tomorrow. But I'd venture a guess that teen moms probably stay poorer for longer than those who wait.
     
  34. sophiejane

    sophiejane Exhausted
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    Not necessarily. The FP fellowship is just for obstetrics, not gyn surgery or other procedures as far as I know. Do enough sections and you can become just as competent as anyone else, but that doesn't make you a surgeon.

    I believe most first trimester terminations are done by suction rather than traditional D&C. Someone correct me if I'm wrong.
     
  35. Tn Family MD

    Tn Family MD Junior Member
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    The OB fellowship I plan on doing gets you trained in C-section, BTL, D and C, D and E, C-Hyst, as well as scrubbing on lots of other gyn surgeries. It's a two year fellowship, though, whereas most OB fellowships are one year. So, you may be able to get more experience there than some other fellowships.
     

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