Association of Primary Care Physicians’ Individual- and Community-Level Characteristics With Contraceptive Service Provision to Medicaid Beneficiaries

Abstract

ImportanceLittle is known about primary care physicians who provide contraceptive services to Medicaid beneficiaries. Evaluating this workforce may help explain barriers to accessing these services since contraceptive care access is critical for Medicaid beneficiaries’ health.ObjectiveTo describe the primary care physician workforce that provides contraceptive services to Medicaid beneficiaries and explore the factors associated with their Medicaid contraceptive service provision.Design, Setting, and ParticipantsThis cross-sectional study, conducted from August 1 to October 10, 2022, used data from the Transformed Medicaid Statistical Information System from 2016 for primary care physicians from 4 specialties (family medicine, internal medicine, obstetrics and gynecology [OBGYN], and pediatrics).Main Outcomes and MeasuresThe main outcomes were providing intrauterine devices (IUDs) or contraceptive implants to at least 1 Medicaid beneficiary, prescribing hormonal birth control methods (including a pill, patch, or ring) to at least 1 Medicaid beneficiary, the total number of Medicaid beneficiaries provided IUDs or implants, and the total number Medicaid beneficiaries prescribed hormonal birth control methods in 2016. Physician- and community-level factors associated with contraceptive care provision were assessed using multivariate regression methods.ResultsIn the sample of 251 017 physicians (54% male; mean [SD] age, 49.17 [12.58] years), 28% were international medical graduates (IMGs) and 70% practiced in a state that had expanded Medicaid in 2016. Of the total physicians, 48% prescribed hormonal birth control methods while 10% provided IUDs or implants. For OBGYN physicians, compared with physicians younger than 35 years, being aged 35 to 44 years (odds ratio [OR], 3.51; 95% CI, 2.93-4.21), 45 to 54 years (OR, 3.01; 95% CI, 2.43-3.72), or 55 to 64 years (OR, 2.27; 95% CI, 1.82-2.83) was associated with higher odds of providing IUDs and implants. However, among family medicine physicians, age groups associated with lower odds of providing IUDs or implants were 45 to 54 years (OR, 0.66; 95% CI, 0.55-0.80), 55 to 64 years (OR, 0.51; 95% CI, 0.39-0.65), and 65 years or older (OR, 0.29; 95% CI, 0.19-0.44). Except for those specializing in OBGYN, being an IMG was associated with lower odds of providing hormonal contraceptive service (family medicine IMGs: OR, 0.80 [95% CI, 0.73-0.88]; internal medicine IMGs: OR, 0.85 [95% CI, 0.77-0.93]; and pediatric IMGs: OR, 0.85 [95% CI, 0.78-0.93]). Practicing in a state that expanded Medicaid by 2016 was associated with higher odds of prescribing hormonal contraception for family medicine (OR 1.50; 95% CI, 1.06-2.12) and internal medicine (OR, 1.71; 95% CI, 1.18-2.48) physicians but not for physicians from other specialties.Conclusions and RelevanceIn this cross-sectional study of primary care physicians, physician- and community-level factors, such as specialty, age, and the Medicaid expansion status of their state, were significantly associated with how they provided contraceptive services to Medicaid beneficiaries. However, the existence of associations varied across clinical specialties. Ensuring access to contraception among Medicaid beneficiaries may therefore require policy and program approaches tailored for different physician types.

How do Specialists Address Contraceptive Care Compared to General Practitioners in a Federally Qualified Health Center in Maryland

“…Access to contraceptive care is of utmost importance to avoid continued disparities in reproductive health outcomes, and provider specialty is a determinant of access to contraceptive care in the FQHC setting and beyond. 17 Hence, without adequate mechanisms to ensure that eligible patients who need contraceptive care can receive the care that they need irrespective of their provider's specialty, there is a risk of deepening disparities in reproductive health outcomes due to unequal access to contraception. In a clinical setting where comprehensive primary care is expected to be delivered, it may benefit patients to have reproductive health-trained providers assigned to partner with primary providers.…”

Training in Residency and Provision of Reproductive Health Services Among Family Medicine Physicians

“…In addition, while FM physicians can provide abortion or management of pregnancy loss, only a small number actually do so . For the Medicaid population, only 10% of primary care physicians who saw Medicaid patients provided implants or IUDs . Medicaid is particularly important for reproductive health care, covering nearly 20 million women of reproductive age and more than 40% of all US births .…”

“… 4 For the Medicaid population, only 10% of primary care physicians who saw Medicaid patients provided implants or IUDs. 5 Medicaid is particularly important for reproductive health care, covering nearly 20 million women of reproductive age and more than 40% of all US births. 6 , 7 , 8 Although Medicaid coverage varies across states, Medicaid beneficiaries have also been shown to face a number of challenges in accessing care, including a lack of clinicians who accept Medicaid and longer wait times for appointments.…”