Training non-OB/GYN physicians for surgical abortion

[Hamhock]

Hello -

A friend was at a presentation directed at physicians promoting the idea of training non-OB/GYN physicians to perform surgical abortions to help fill the void of capable providers in large parts of the country (US).

Although I have many friends who are physicians, I have none who is an OB/Gyn. Consequently, I have the following questions for this form (preferably answered by attendings or at least PGY4+):

1. Are there technical complexities you forsee preventing non-surgeons from performing these procedures? Please assume at least some procedural competence (ie critical care, anesthesiology, emergency medicine, interventional radiology) in the "trainee".

2. How difficult do you think it would be to find an OB/Gyn who would serve as back-up for complications? My biggest concern here is that locations without competent providers of abortion are the exact locations where non-OB/Gyns could help. Do you see a way around this?

3. Is it practical to obtain training for this procedure outside of an academic center or program?

Thank you for your careful consideration.

One final request of readers: please do not derail this thread into a discussion (more likely emotional argument) about abortion. If you have an objection to abortion or are angered by any of these questions, please just move along or create another thread to express those feelings or beliefs.

HH

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[anonperson]

Hello -

A friend was at a presentation directed at physicians promoting the idea of training non-OB/GYN physicians to perform surgical abortions to help fill the void of capable providers in large parts of the country (US).

Although I have many friends who are physicians, I have none who is an OB/Gyn. Consequently, I have the following questions for this form (preferably answered by attendings or at least PGY4+):

1. Are there technical complexities you forsee preventing non-surgeons from performing these procedures? Please assume at least some procedural competence (ie critical care, anesthesiology, emergency medicine, interventional radiology) in the "trainee".

2. How difficult do you think it would be to find an OB/Gyn who would serve as back-up for complications? My biggest concern here is that locations without competent providers of abortion are the exact locations where non-OB/Gyns could help. Do you see a way around this?

3. Is it practical to obtain training for this procedure outside of an academic center or program?

Thank you for your careful consideration.

One final request of readers: please do not derail this thread into a discussion (more likely emotional argument) about abortion. If you have an objection to abortion or are angered by any of these questions, please just move along or create another thread to express those feelings or beliefs.

HH

Attending out in practice
1. The procedure is technically easy to perform. Most early terminations can potentially be managed in the office with a manual vacuum aspirator most likely.
2. Unsure about how easy this would be.
I personally wouldn't serve as a backup. This is completely ignoring the potential moral issues related to it.

Why would I serve as backup for a procedure I didn't do and potentially get called into the ED for a complication? This is low pay and high liability. Not to sound selfish, but that is a headache most physicians aren't interested in undertaking.

Regardless, this isn't an issue for the very fact that EMTALA exists. It is one of my main annoyances with these family planning clinics out there (PP and otherwise). There is a family planning clinic near where I practice that performs terminations etc (medical and surgical). The physician doesn't have hospital privileges. I have had at least 1-2 patients this past year that came into the ED with bleeding or retained products of conception and I got the consultation as I was on ED call that day. This happened where I did residency as well which had a Planned Parenthood nearby. I wouldn't say its a dirty secret, but its something that these clinics don't really talk about (if you have a complication, just go to the ED and someone will take care of you etc).

3. Probably in low access areas. But be prepared to have abortion protesters make your life miserable in more conservative states. Heck, I'm in a pretty liberal state and there are protesters outside of the aforementioned clinic near my practice on a regular basis.

 

[Hamhock]

Attending out in practice
.

Wow. Thanks for the considered response.
I have been annoyed by clinics that just send patients to the ED with any complication before. Contributing to something like this is something I would not want to do.
Thanks again for your response, HH