MSFC Update - November 2004

Beyond Medical School: How to Take Your Pro-Choice Commitment With You to Residency: My Story
Debra Stulberg, MD

I entered medical school planning to become an obstetrician/gynecologist and an abortion provider. My involvement with MSFC gave me a sense of purpose in medical school, and deepened my commitment to providing abortions. The provider panels at MSFC national conferences introduced me to something I had never before been aware of: family doctors who provide comprehensive women’s health services, including abortion.

By my third year of medical school, I was discovering that I did not enjoy the surgery (or the surgical lifestyle) that many ob/gyns seemed to love. I was also finding that, while I was interested in women’s health and pregnancy care, I really liked taking care of moms and kids together. By the start of my fourth year, I had decided on a future in family medicine.

When I began applying to residency, I knew that my choice of family medicine over ob/gyn would make accessing abortion training a little harder. I decided resolutely that during my residency interviews, I would ask all the program directors about the possibility of receiving abortion training at their residency. I applied to programs across the country, but I ultimately decided that I wanted to go back home to Chicago, where I’d grown up and where my family still lived.

When I interviewed at my current hospital, the residency director was effusively supportive of my interest. She explained that, while no abortions were performed at the hospital, we had the maximum possible number of electives in our curriculum, and the program would fully support me in using this elective time to receive my abortion training.

On my match list, I ranked this hospital first because of the answer she’d given me, and because it has a recognized strength in maternal child health and care of medically underserved patient populations. I was thrilled when I matched into this program.

Overall, I think the result has been positive, but it has not always been easy. I have been very happy with the breadth and depth of obstetrics training I have received, and in my outpatient clinic, the majority of patients I see are women of reproductive age and their children. I feel my training in contraception and the prevention and treatment of sexually transmitted diseases has been excellent. And most importantly, the general culture of my program supports the notion that women should make informed decisions that are best for them and their families, and that all choices should be offered them. This is how the faculty members practice, and it is how we are taught to practice.

As far as abortion training, the good news is that I have managed to get two months of training during my electives, and I have one more half-month elective planned. But I was very much on my own in finding these opportunities, and it was harder than I expected.

Through persistence and by putting my friends and the MSFC network to work, the medical director at Planned Parenthood in Chicago decided to give me a chance. I also put together an elective in New York, training half-time with an ob/gyn residency —an opportunity I fell into by sheer good luck — and half-time with one of the family doctors I had met at MSFC national conferences. All three opportunities provided great training experience, and I am thankful that the providers were willing to jump through hoops to bring me in as an outside trainee.

Accessing training in my program has now gotten even harder: this past March, we were taken over by a Catholic hospital system. Future residents in my program will not have the hands-on experience with contraception and family planning that I have had in the clinic and in the hospital. Residents will still be permitted to do off-site electives, but not at Planned Parenthood or other family planning clinics.

I remain hopeful that I will graduate from residency competent to provide abortions. If this is not possible, I will seek out further training after residency.

Lessons I Have Learned

Choosing a specialty and a residency are among the most important decisions you will make in your career. Like all important turning points in life, you have to weigh multiple priorities and preferences in order to come up with a decision that will ultimately make you happy.

For me, abortion training has always been one of my top priorities. But I also fell in love with family medicine. And I decided I wanted to come home to Chicago. For you, perhaps it will be a partner, or children, or a connection to a specific region of the country that guides your choices.

If you do want to be trained to provide abortions during your residency, it is important to gather all the information you can before picking a specialty and a residency program. There is little doubt that obstetrician/gynecologists provide the majority of abortions in this country, and choosing ob/gyn will make getting trained much easier. But there is a growing movement to integrate reproductive health services into primary care. Family physicians, internists, and pediatricians are among the other fields that can and do provide abortions. In fact, in most states, anyone with a medical license can provide abortions. The challenge is getting trained and then finding a practice setting that will make it possible.

As a general rule, do not be afraid to ask questions and make your interests known. Anecdotally, many programs report that they see MSFC participation as a plus in picking their future residents. Of course, there are applicants who have had the opposite experience — they have found that their MSFC work is held against them. But you have to ask yourself: if this program would not want me because of my interest in reproductive health or my work with MSFC, would I really want to be here?

One trend worth noting is that in both the United States and Canada, primary care specialties are currently having a harder time recruiting medical students than the specialized fields. While this may not be a good thing for patient care, it does mean that applicants to these fields are in greater demand, so you may feel more comfortable making specific requests of the programs you are applying to.

Finally, no matter what field you choose, when you interview for residency, make sure you talk not just to the program director, but to as many faculty members and current residents as you can. These are the people you will be working with every day for the next few years. Official policy may say one thing, but if everyone at the program feels differently, their attitudes and practices will predominate.

We all know that there is a shortage of doctors trained to provide their patients with the full scope of reproductive health care, especially when it comes to abortion. If you are committed to addressing this shortage through your own training, you should feel proud of your goal. Do what research you can before applying to a program. But most importantly, when you get the chance, ask questions, express your interests, and try to envision yourself in each program. Residencies should be stumbling over themselves to recruit you. It is your job to find a program that will support you and your priorities.

Additional resources related to this article.

Debra Stulberg, MD, is a 3rd-year resident in Family Practice, and an MSFC Board Member.