Success stories from physicians who have incorporated abortion services in a way that works for them.
Private Practice: Jill
Jill is a generalist ob-gyn in multi-specialty group practice who has incorporated abortion provision as a component of her a busy practice. While the total number of abortions she performs each month varies, she has made it a priority to squeeze in patients who need abortion services and provide them with excellent care. Most of the patients Jill sees for abortions are already part of her practice, but she also accepts referrals from high-risk obstetricians for patients with chromosomal abnormalities or from new patients whose first visit is for an abortion but often become regular patients. Because she already has relationships with many of her abortion patients, Jill is able to tailor the counseling to their specific situation which uses her time more efficiently while also providing each woman what she needs.Much like patients with miscarriages, women seeking pregnancy terminations need to receive care as soon as possible. To meet this need, Jill can fit in a consultation for a first-trimester procedure in within a few days. At that first appointment, she will provide counseling, pregnancy dating, and help the patient decide whether to have a surgical or medication abortion. If the latter, the patient can start the process the same day by taking Mifipristone in the office and scheduling appropriate follow-up care. For surgical abortions, Jill will bring the patient back into the office for a simple MUA procedure or will schedule the patient in the OR if they are at a later gestation or require more anesthesia. In-office MUA procedures are quick and simple; by scheduling them at the end of the morning or afternoon scheduling block, they can have plenty of time to recover without inhibiting the flow of patients being seen for routine care.
Private Practice: Wayne
Wayne works in a full service general ob-gyn practice in New England where he has integrated in-office abortion procedures up to 13 weeks for many years. Requests for abortions are treated and scheduled like any other appointment. Patients are counseled about their abortion options over the phone and are scheduled for a visit either with a nurse practitioner for a medication abortion or with Wayne for a surgical abortion. For aspirations, patients are scheduled for a one-hour appointment during which the patient will discuss the procedure and receive counseling from Wayne, she will then have the procedure and recover in an exam room. Wayne can often see another patient during the hour while the patient is prepared for the procedure by his staff.Wayne performs procedures on any patient requesting an abortion including referrals and patients never before seen in his office. He has found that many patients who come to him initially for an abortion will continue to utilize his practice for all their ob-gyn needs. He considers abortion provision to be a great “practice builder” because women who receive excellent, non-judgmental, compassionate care for an abortion become patients for life. Patients learn that they can access abortion in Wayne’s practice through word of mouth, online through the practice website or abortion.com, or by referral.
Private Practice: Stephanie
Stephanie is a generalist in a large multi-specialty group practice in the North East. When she started with this practice after residency, the group had an established pattern of referring out all abortion services. Stephanie developed a system to care for her own patients and accept referrals from women in need of second-trimester terminations within their group system. Typically, when Stephanie receives a referral from one of her partners, she finds a slot in her schedule for a pre-op visit within a few days and an OR slot the day after. Sometimes that means rescheduling a few other patients and doing the pre-op visit at lunch time. Because of a long tradition of terminating pregnancy in the hospital where Stephanie works, she hasn’t had any problems finding OR staff to assist her with these cases; however, she has had some trouble getting ultrasound techs from the Radiology department who are willing to participate.In addition, Stephanie works as part of a pregnancy loss team that performs MUA in the clinic setting for women with missed or incomplete abortions. This clinic is set up to use IV conscious sedation and has affiliated nurses who can care for the women with that level of anesthesia. Up to now, Stephanie has been unable to persuade the other team members to schedule first-trimester elective abortion patients in the pregnancy loss center as well. Instead, all first-trimester terminations are referred out to a free standing clinic. While her physician colleagues are supportive of providing elective terminations, there is resistance among the nursing staff.
Pratima does abortions 2 days per week for patients at a large HMO that refers most patients seeking to terminate pregnancy to a freestanding clinic. Because freestanding clinics are not set up to see medically complicated patients, those patients are treated by Pratima in her hospital-based abortion service. This combination ensures that patients do not have their pregnancy options restricted by medical complications and that they can be seen promptly. Most of the patients that Pratima sees for pregnancy terminations do not come to her for their primary ob-gyn care. But, because of the integrated medical record within the health care system, she is able to access their full health history and provide enhanced continuity of care over a referral to a freestanding clinic.
Andrea works in a small group practice outside of Portland. At present, her partners have decided not to perform elective abortions within the practice. They do care for women with early pregnancy loss in the office setting with MUA. Andrea performs terminations at a free standing clinic 2 days per month. She and her partners refer patients seeking abortion to the same clinic. Over the next few years, she may try to include more elective procedures in her practice. In the meantime, her work at the abortion clinic helps her maintain her skills as an abortion provider.
Academic Practice: Jessica
Jessica is a generalist on faculty at the university where she did her residency training. She performs abortions both for her own patients and helps staff a second-trimester clinic for patients referred from the community and Perinatal center. On average, the weekly D&E clinic takes care of 4-5 patients with fetal anomalies in the OR. For her private patients, Jessica can perform MUA in the office or prescribe medication abortion on the same day. If the patient has medical complications or needs more anesthesia, she can be seen in the OR or at local planned parenthood with whom they maintain a strong cross-referral relationship.When Jessica joined the faculty, residents were already being trained to do abortions via a combination of hospital-based and free-standing clinics. But, the second-trimester service for patients with more medical complications was disorganized. By streamlining the scheduling process and organizing some education sessions for the staff, the clinic is now stable and running smoothly.