“I chose to be a family doctor because I like so many areas of medicine, and family practice gives me the ability to have as broad a scope as I want,” says Linda Prine, MD, a practicing physician at the Institute for Urban Family Health in New York City. But when she had her training more than twenty years ago, Dr. Prine was troubled to find that many family doctors didn’t provide abortions.
“It didn’t seem right that patients would come to me with a pregnancy, and if they wanted to carry to term, I would take care of them, but if they didn’t want to, I’d send them somewhere else. That sends a not-so-subtle message to women.”
While integrating abortion into her practice, Dr. Prine saw potential for family medicine as a specialty to bring reproductive health services to places that need them. Noting that family doctors tend to work in urban and rural areas where doctors are scarce, Dr. Prine explains, “Family physicians are the first line of medical care for many, many women, especially economically disadvantaged women.”
To put her idea to work, Dr. Prine and another physician in New York City started the Access Project in 1999. Now called the Reproductive Health Access Project (RHAP), the nonprofit trains community family doctors in medication abortion, promotes training in early suction abortion for family physicians, and advocates for family doctors to prescribe contraception proactively. Dr. Prine also founded the Group on Abortion Training and Access within the Society of Teachers of Family Medicine, the academic organization for family doctors, in 2000.
Dr. Prine, who is RHAP’s medical director, wants family medicine to “own the responsibility, within our specialty, for providing the full spectrum of reproductive healthcare for women.” Seeing residencies as a key to achieving that goal, she also works as a consultant for the Center for Reproductive Health Education in Family Medicine (known as RHEDI), an organization that funds residency training in abortion. She created and still moderates a Listserv through which more than 500 family doctors, residents, and medical students can share information and advice about contraception and abortion.
In her own practice, Dr. Prine treats abortion and contraception like any other in-house service. And because she sees entire families, she can help those who might not otherwise received gynecological care. “Mothers rarely go to the doctor. They are just too busy taking care of the kids. As a family doctor, I can pull mothers back in: ‘Do you still have birth control? Why don’t I just do a pap while you are here with the kids?’”
Despite her efforts to give Megan birth control, Dr. Prine wasn’t surprised when Megan came in pregnant at 17. After options counseling, Megan arranged to have an abortion with Dr. Prine but was afraid to tell her mother about it. Dr. Prine drew on her long experience with the family: “Because I knew them both so well, I reassured Megan that telling Manuela would be the right thing to do.” It was—Manuela even accompanied her daughter to the appointment, holding Megan’s hand throughout the procedure and stroking her head. “Afterward, as they sat closely together, I felt relieved. They had made it through a difficult situation that could easily have ruptured their tenuous relationship.”
Dr. Prine loves being able to help Manuela, Megan, and the rest of her patients with all of their medical needs: “As a family doctor, you are a trusted member of the family. It’s a wonderful privilege.” She is doing everything she can to give other family physicians and their patients the same experience.
* Patients’ names have been changed.