It’s often difficult for doctors who received abortion training while in residency to integrate the service once they are in practice.  They face many barriers including resistant staff members, malpractice costs, and the need for additional clinical training. An experienced mentor can be helpful in developing strategies for overcoming these barriers.  Each spring the Reproductive Health Access Project reaches out to graduating family medicine residents trained in abortion care to offer them support and to pair them with seasoned practitioners in their area to serve as mentors.

Last year we identified two well-trained, highly motivated physicians in Arkansas—a state with only one abortion provider–who needed mentors.  But, we had no local mentors available.  RHAP is a “can do” organization, so we analyzed the problem from all angles and came up with a solution.  What if we became the mentor?  What if we worked intensively with these clinicians to help them work through the barriers to providing abortion in a rural, underserved area? Together with ANSIRH (Advancing New Standards in Reproductive Health) we created the GAPS (Graduate Abortion Provider) Fellowship to do just that.  Last year, one of the Arkansas clinicians became our first GAPS Fellow.

Through the GAPS Fellowship our Arkansas clinician was able to attend the annual National Abortion Federation meeting so they could become an active part of the national abortion provider community.  The GAPS Fellow also received funding to help underwrite some of the start-up costs of providing abortion care (such as $1,000 towards the additional malpractice coverage they had to get). The GAPS Fellow also got lots of one-on-one technical support from me, RHAP’s national organizer, and clinical support from RHAP’s medical director, Dr. Linda Prine.   In September 2012, our GAPS Fellow started offering medication abortion in their rural family medicine practice.

It’s hard to say what element of the GAPS Fellowship had the biggest impact on the outcome, but we can’t underestimate the value of the intensive technical assistance.  I dedicated more than 100 hours to working through the issues necessary to set up abortion services in Arkansas.  What exactly did I do?  Here’s a short list:

-Reached out to referral sources throughout the state to help the physician build their practice.
-Reached out to potential allies who would support the physician should they ever face harassment.
-Researched state restrictions on abortion care.
-Created clinical systems and procedures to ensure compliance with state abortion regulations such as the 24-hour waiting period and mandatory parental consent.
-Identified resources for the additional malpractice required for a family physician to provide abortion care.
-Identified resources for low cost IUDs.
-Created medical equipment and supply lists.
-Identified a back-up physician to handle complications.
-Developed a plan for providing adolescents confidential reproductive health care (including resources for minors needing a judicial bypass).
-Strategized how to let patients know that the practice offered comprehensive reproductive healthcare.
-Identified rape crisis centers and other local resources for patients.

I just started working with our 2nd GAPS Fellow, the other clinician in Arkansas who needed a mentor and I can’t wait to replicate our success. If you have suggestions about a future GAPS Fellow, send us suggestions or apply today!