DEHLENDORF AND GRUMBACH RESPOND

Abstract

We appreciate the comments made by Johnson, and agree that family physicians have the potential to improve access to abortion services for women. As stated in our article, medical liability insurers are inappropriately limiting the ability of trained and willing providers to offer this important service by both refusing to provide coverage for abortion care and by charging inordinately high premiums for this coverage. Medical professional organizations, state legislators and regulators, and the medical liability industry itself all have a role to play in eliminating this barrier to the provision of abortion care. Several factors, in addition to liability insurance coverage, which impede the ability of family physicians to integrate first trimester terminations into their routine primary care practices also deserve consideration. Few family medicine residency programs currently provide training in abortion as a routine part of their curriculum1; it is essential that the availability of training be dramatically expanded. Further, the decisions of credentialing bodies of hospital systems and health care insurers are crucial, as these institutions have the potential to inappropriately limit the scope of practice of primary care providers. Finally, the willingness and availability of obstetricians and gynecologists to provide surgical back-up to family physicians and other primary care clinicians providing abortions needs to be considered. While complications associated with first trimester abortions are rare, having arrangements with surgical providers for assistance in the case of difficulties can ensure that primary care clinicians feel supported in their provision of this controversial service. Attention to these issues, in addition to the availability of liability insurance, will ensure that family physicians and other primary care clinicians who wish to provide abortions are in fact able to, facilitating the transformation of the model of abortion care which Johnson envisions. An additional point made by Johnson merits attention. She notes that the provision of abortion care in the primary care setting may be preferable not only with respect to expanding access to care, but also from the perspective of continuity of care and interpersonal relationships between patients and providers. We concur with this opinion, with an important caveat: while many women would prefer to obtain all reproductive health services, including abortion, in the primary care setting, some women prefer the anonymity of a specialty setting.2,3 Both specialty abortion providers and primary care providers have a critical role to play in ensuring that women have access to abortion services in the setting of their choice.