LARC provision by family medicine residents: Interest, Barriers, and Gender Differences

Research Statement
To evaluate family medicine residents’ interest in providing LARCs in future practice and identify barriers to LARC training in residency.

Background and relevance of the study
Long-acting reversible contraception (LARC) such as implants and IUDs are highly effective birth control methods and use has been increasing over the past several years [1,2]. Physicians’ ability to offer LARCs is important for patient access. However, a 2014 national study showed that few family medicine physicians offer implants (11%) or IUDs (19.7%) overall, and male physicians are much less likely to provide LARCs than females [3], despite LARC training being a recommended part of family medicine residency training by the American Academy of Family Physicians[4].

Design and Methods
Residents received general contraceptive and LARC training in their continuity clinics, OB/GYN rotations, and electives at Planned Parenthood. A cross-sectional anonymous online survey was sent to all residents at our family medicine residency program in May 2021, and simple statistics were used for analyses.

Results
All 21 residents (100%) completed the survey. Most considered it “very important” for family medicine physicians to provide implants (86%) and IUDs (81%). However, female versus male residents reported much higher rates of being “very likely” to provide implants (91% vs 30%) and IUDs (91% vs 20%) in their future practice. The most common barrier (“moderate” or “significant”) to LARC training was lack of time (81%). Other barriers included too few patients requesting LARCs (76%) and doing initial contraceptive counseling but placement done by different clinician (57%).

Conclusions
Most residents considered LARC training and placement to be very important for family physicians, but interest in providing LARCs was significantly higher amongst female versus male residents.

Significance
Gender differences with regards to interest in provision after training needs to be evaluated on a national scale. Major barriers which need to be addressed are that LARC placement takes time and requires a higher volume.