Second opinion 

Blue Mountain Clinic offers rural doctors a different view

Lynsey Bourke cuts right to the chase when explaining Blue Mountain Clinic's approach to providing primary care in western Montana. In fact, the nonprofit's director of development, outreach and communications tells one story to make her point.

"This is the example I love: The guy sitting next to you who just looks like your Average Joe dude could actually be a transgender man who's there for his abortion because he still has a vagina and he's having gay sex with a male partner with a penis," she says. "We just view it all as the same."

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  • Cathrine L. Walters
  • Blue Mountain Clinic physician Joey Banks is concerned that changing requirements to medical training programs will impact how family doctors handle basic reproductive care. “In rural Montana there are doctors who won’t even prescribe contraception,” she says.

Blue Mountain's patient-centered, choice-based outlook has long established it as a valuable resource in Missoula, and now Bourke believes the clinic is playing a pivotal role in addressing a growing concern across the state.

In rural Montana, a family physician is likely to be the only doctor around, and statistics show the majority of those doctors are reaching retirement age. How dire is the situation? At least 52 of the state's 56 counties have a federally recognized shortage of primary care physicians, according to MHA, an association of Montana Health Care Providers.

To help address this issue, the University of Montana last year launched the Family Medicine Residency of Western Montana program, which aims to train 10 new family physicians per year with the hope that most will continue to practice in the state. The three-year residency covers a broad range of medical disciplines and follows guidelines created by the Accreditation Council for Graduate Medical Education, the group that oversees physician training programs nationwide.

In an effort to create more flexibility in its training programs, ACGME is considering changes with how it covers full-scope reproductive care. The proposed updates would remove existing requirements, such as annual pelvic exams and birth control treatments, and leave it up to the discretion of each residency program. Nothing in ACGME's guidelines—current or proposed—addresses abortion.

The situation causes concern for Blue Mountain staff who worry that basic care will fall by the wayside, but also puts the clinic in position to help educate future family practice doctors with issues they will inevitably face.

"This was sort of prompted because certain aspects of gynecologic care aren't required by national residency standards, so in that way we're filling in a void," Bourke says. "Across the nation it's often family doctors who are providing abortions discreetly to patients they've known for a long time. That's why it's so important to have family doctors trained in those skills."

Bourke specifies that residents don't have to learn about abortion at Blue Mountain Clinic. Overall, she says it's only a small portion of what the clinic does.

"We don't care if people that don't want to give abortions don't give abortions, but for doctors to not even see that as an option ... it's a serious problem," she says. "This is the best kind of feminist health care in the world just sitting here in Missoula, offering great care to our community. But I feel it should be available worldwide."

Joey Banks, a board certified family practice physician at Blue Mountain Clinic, says she's most concerned about ACGME potentially stripping the required reproductive health care training from its residency programs. That would mean family doctors would no longer be required to learn how to prescribe birth control, insert intrauterine devices, or IUDs, or manage miscarriages. Banks says that could have serious implications for women across the state.

"In rural Montana there are doctors who won't even prescribe contraception," she says. "There are very few family doctors who will (prescribe) an IUD or other contraceptive devices. People have to drive four or five hours just to get one of those, let alone four to nine hours for an abortion. I'm worried about the things that aren't happening rurally."

Nerissa Koehn, the associate program director of the Family Medicine Residency of Western Montana, says that even if the ACGME changes its gynecological requirements, the residency program will continue to teach a broad spectrum of women's health.

"It's absolutely essential to provide comprehensive care in family medicine—especially when they'll be working in rural areas," Koehn says.

She also emphasizes that Blue Mountain Clinic's pro-choice philosophy has nothing to do with why it was chosen to participate in the program. Rather, it was picked because of the range of services it offers and Banks' experience in other residency programs. Koehn adds that residents see patients at Partnership Health Center and, as part of their gynecological rotations, spend time at Planned Parenthood and Alpine Physical Therapy, as well as Blue Mountain.

"We're not trying to imprint upon them any particular political or philosophical bent," she says. "We try to maintain as broad of a perspective as we can."

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