Complex family Planning: A newly accredited, landmark fellowship

As of July 2020, U.S. Obstetrics and Gynecology training programs can apply for accreditation by the Accreditation Council for Graduate Medical Education (ACGME) in Complex Family Planning (CFP). Formerly known as the Fellowship in Family Planning, first launched 1991 by Dr. Phillip Darney at the University of California in San Francisco, the program subsequently expanded nationally under Dr. Uta Landy’s leadership. The CFP fellowship provides post-graduate obstetrician-gynecologists with additional training in abortion and contraception and opportunities to establish themselves as leaders in clinical care, research, and medical education. A separate fellowship program is available for Family Medicine physicians. As of 2020, 28 Obstetrics and Gynecology departments across the country provide fellowship training in family planning. These programs have graduated 353 fellows who provide clinical care, teach the next generation of physicians, and have made substantial contributions to science.

In the decades since its inception, the CFP fellowship has influenced the culture of obstetrics and gynecology practice. Designed to develop leaders, the fellowship had to confront substantial challenges. A myriad of factors have deterred physicians from providing abortion. Abortion care is stigmatized both for clinicians and patients. Poor reimbursement and variable insurance coverage due to state and federal restrictions further discouraged physicians. In addition, diminished access to abortion resulting from a complex combination of socio-political forces has led to harassment and attacks on providers. Integration into academic medicine provided an approach to legitimize the provision of family planning care, increase the pool of physicians, and provide crucial leadership to the field.

From the fellowship’s beginning, formal recognition as a subspecialty within obstetrics and gynecology was the goal. Approximately ten years after the fellowship’s beginning, a group of fellowship directors, educators, and researchers outlined their vision for an academic subspecialty society. As a result, the Society of Family Planning (the Society) was established in 2005. The founders were joined by other leaders in family planning who recognized the limited financial support for research in abortion and contraception and the lack of forums dedicated to sharing research findings []. Since its formation just 15 years ago, the Society has become home to a multi-disciplinary and diverse community of almost 1000 scholars with the commitment to the Fellowship remaining a key focus. The Society provides significant resources for the field. The annual meeting provides a central space for the community to convene and share science. Clinical practice guidelines, published in Contraception, provide important guidance for the provision of evidence-based family planning care. And lastly, research funded by the Society has resulted in the development of a robust, multidisciplinary, and impactful knowledge base. Graduates of CFP fellowship programs shaped not only the early days of the Society, but are major contributors to all of the Society’s programs. Contraception serves as the official journal of the Society and publishes many research contributions from the Fellowship and the Society.

The accomplishments of graduated fellows, the national growth of the fellowship program, advances in family planning research, and representation by an academic society led to a formal application request to the American Board of Obstetrics and Gynecology (ABOG) as the certifying organization for subspecialty. A fellowship advisory board was created to help manage this transition. ABOG established a committee to consider the Fellowship’s request, which culminated in ABOG’s application to the American Board of Medical Specialties (ABMS) in April of 2018 for certification of Complex Family Planning as a subspecialty. The submission received broad support from the Society and many OBGYN specialty and subspecialty societies. In October 2018, the ABMS Board of Directors voted to approve ABOG’s application.

The ABOG CFP Division, like all ABOG divisions, is charged with defining the scope of practice of the subspecialty, setting standards for certification, and developing assessments for future certification. Certifying exams will be offered starting in 2022. With endorsement from ABOG and ABMS, the ACGME began its process of recognizing the subspecialty and building program requirements for fellowship program accreditation. After feedback though public comment, the ACGME approved the program requirements in June 2020. All OBGYN training programs that meet these requirements will be eligible to apply for CFP accreditation.

Benefits of CFP sub specialization include representation within national OBGYN organizations and further legitimization of the field of family planning. Previously marginalized, the provision of complex abortion and contraception care is now recognized as equal to other OBGYN subspecialties. Over the past decade, many states have passed an increasing number of abortion-related restrictions; this has created a concern that some states may attempt to further restrict abortion provision by limiting care to CFP subspecialists. However, in contrast to this concern, the leadership of the CFP fellowship community has served as a nexus over the past 10 years to address threats to abortion access []. The experience during the COVID pandemic has shown the value of formal partnerships between Complex Family Planning and other OBGYN organizations; for instance, the CFP leadership co-authored 14 statements with other medical and subspecialty societies, including the Joint Statement on Abortion Access During the COVID-19 Outbreak []. This statement has been used widely, both at the local level to advocate for patient care and at the state level to counter policies restricting or prohibiting abortion access during the pandemic.

July 2020 marks an historic moment in recognizing family planning as an academic subspecialty. This landmark is an opportune time for the CFP fellowship and the Society to merge into a single unified organization. Having worked in parallel for many years, together we will continue to advance a vision of just and equitable abortion and contraception informed by science. New generations of CFP fellowship graduates will continue to provide care in complex cases, serve as trusted referral sources for health care providers, develop clinical practice guidelines, and advocate for evidence-based care at the institutional, state, and federal levels.