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MSFC Update- May 2005 Barriers to Abortion Practice Opportunities for training and education on abortion represent only one element of the potential barriers physicians face when they aim to include abortion care in their practices. At the Annual Meeting in Philadelphia, a panel of speakers addressed some other barriers such as staffing concerns, legal factors, and medical liability limitations that medical students and residents can mitigate with careful planning and decision-making. Staffing and practice management issues can be among the most complex,
yet also the most surmountable with careful planning. Staffing issues
include the need for more highly qualified nursing and counseling support,
staff resistance to abortion services, and call schedules. Although abortion
is a simple medical procedure, the need for careful counseling and informed
consent along with monitored patient recovery, pre-procedure testing,
and surgical assisting requires planning for appropriately trained staffing
models. The cost and lack of availability of qualified professionals to
fill these roles can be a substantial barrier to practice. Talking with
peers and thinking ahead to how each of these roles will be filled is
important to mitigating these potential barriers. Within an existing staff group, it is also not unusual to encounter a
staff person who refuses to participate in abortion services. Conversations
with the entire staff group about plans to include this service are one
way to ensure that all staff is informed and the physicians are aware
of any existing opposition. Ultimately, it may be necessary to reschedule
or replace those staff members who oppose the service. Facility needs are also factors that can present a significant barrier to incorporating abortion services. Among these are the costs of equipment, the need for additional laboratory space, and state regulations (TRAP laws) that place onerous requirements on the size and set-up of any facility in which abortions are provided. Researching the legal barriers as well as any cost issues can help overcome these barriers (see resources below).
Many physicians have overcome this barrier by working for other organizations
that provide coverage, such as hospitals or Planned Parenthood organizations.
Other organizations, such as the National Abortion Federation (NAF), are
working to provide support to their members. Funding and reimbursement issues can also be complex. While many private
health insurance companies cover abortion, coverage varies widely by employer
group due to specific restrictions employers may put on this coverage.
With abortion, it is important to develop a medical billing system that
confirms coverage for every patient. Most states also do not reimburse
for abortion under their Medicaid programs, except in cases of rape or
incest. Because most low-income patients cannot afford to pay out of pocket
for their abortion, developing relationships with any available abortion
funds is an important element in eliminating this barrier. Lessons learned through the work of women’s health organizations and many dedicated physicians along with thoughtful planning can help physicians anticipate, plan for, and overcome the many barriers along the path to providing abortions. From decisions regarding specialty to practice location and type, knowing in advance what barriers each choice may raise is key to making a plan to overcome those barriers. Resources are widely available to help along this pathway (see resources below). Resources: Lois V. Backus, MPH, is the Executive Director of MSFC.
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