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Credentialing Internists for Long-Acting Reversible Contraceptive Placements

“With training, [internal medicine (IM)] physicians can become qualified to place, manage, and remove [long-acting reversible contraceptives (LARCs)],” authors of an Ideas and Opinions article write. Based on a review of privileging practices in a convenience sample of 17 IM departments, the authors note: “Unfortunately, we observed wide variations in credentialing requirements for IM physicians who seek to offer LARC care; thus, [primary care physicians] face barriers to LARC provision in many communities. These barriers are unnecessary given the safety of LARC procedures, especially when compared with that of typical IM core privileges. Credentialing decisions should be informed by procedure type and prior experience. Given the national crisis of reproductive health care after the Supreme Court’s ruling in Dobbs v Jackson Women’s Health Organization, there is an urgent need to streamline credentialing and increase provision of contraceptive services by IM physicians.”

Placement of LARCs such as intrauterine devices (IUDs) and contraceptive implants is included in “residency training in family medicine and obstetrics and gynecology but has not traditionally been part of IM training,” the authors note. “In response, the Society of General Internal Medicine’s Women and Medicine Commission developed core competencies for training in sex- and gender-based women’s health. These competencies include education for IM trainees on reproductive planning, abortion care, and all forms of contraception. This document also outlines the following standards for LARC credentialing: U.S. Food and Drug Administration–mandated training and 1 direct observation in order to place and remove contraceptive implants, focused training to place IUDs, and minimal training for IUD removal. These recommendations are informed by reassuring safety data; for example, serious complications with IUD placement such as uterine perforation are rare (1/1000). Core IM privileges often include higher-risk procedures such as paracentesis, which is 10 times more likely to result in serious complications than IUD placement.…”

Source: Annals of Internal Medicine