We Keep Showing Up
Reproductive Health Care Work in 2025.
Friends and family ask me what it’s like to work in reproductive health care right now. Long story short: it’s really hard. We are belt-tightening amidst the budget cuts to Medicaid and Medicare. It’s incredibly unfair to our patients. Watching services be slowly stripped away as funding dries up is demoralizing and sets a pall over clinic life. It will increase the already high rates of burnout in healthcare. Nevertheless, we persist. We continue to find joy in small wins. We continue to advocate for the best possible care for our patients. As long as our clinic doors are open, we will show up for our community.
Join me on the day of our most recent cuts:
At 7:30 this morning, after an hour on the road and already stuck in traffic, I sent a message to my new and temporary center director letting her know I would be late. I was still over two hours away from the rural reproductive health clinic that I agreed to support during a colleague’s leave. The center director was incredibly gracious about it. The rural clinics in my clinic network are used to staff traveling long distances to make sure their community has healthcare. When I arrived, I dove in and began a laundry list of quality assurance tasks. I travelled all this way to ensure that our patients have point of care tests that are accurate and that no supplies or medications are expired. Our patients appreciate that they can come into our clinic, work with a clinician, and then leave with medications in hand and lab work completed.
After lunch, I had a chance to connect with my teammates at this new-to-me clinic. They gave me advice on which local park to check out and where to go for dinner. Then we dove into our monthly staff meeting. My agenda item was a presentation on pain control during in-clinic procedures. Over the course of four years with my organization, I have seen consistent and intentional improvement in our ability to keep patients comfortable during their gynecologic procedures. We’ve added a telehealth appointment option ahead of IUD procedures specifically to discuss pain management and we now have a majority of our clinicians trained in paracervical blocks that ease pain. We work with vulnerable populations with a majority of our clients relying on medicaid and public assistance for their visits. These vulnerable populations, and women of color specifically, are more likely to have their pain overlooked and dismissed by healthcare teams. We earn community trust by making our clinics a safe space where patients know their needs will be understood and addressed. On-going pain management conversations ensure that our care is patient centered and trauma informed.
And then, at the end of a day spent working to do better by our patients, we got an email that felt like a slap in the face to the concept of “patient-centered.” It came from our medical director at 4:24 PM. We would no longer be able to dispense many medications on-site that were previously available, including acyclovir for herpes outbreaks. We would also be scaling back on the lab work that we offered in the clinic. Among others, we will no longer be providing hepatitis C screening, a test that is indicated screening for all pregnant people, on site. We will now send patients to an outside lab for this test. They will have to pick up their acyclovir from the pharmacy. Our patient population already has trouble making it to their appointments. Asking them to take this extra step means that many of them will not get the medication or bloodwork that they need.
My medical director is a profoundly positive presence in our organization. Even though we don’t often see each other in person, she approaches every interaction with palpable warmth. She always answers the phone with a chipper, “Claire! It’s so nice to hear from you!” She respects and affirms the work of her non-physician colleagues (NPs, PAs and CNMs). When I read her email, my thoughts quickly turned to how much it must have hurt her to have to send it. It’s so frustrating to watch services get stripped away a little at a time when I know that my organization’s leadership is working hard just to keep our clinic doors open. It is demoralizing. It makes me mad. It makes me sad. And our current federal administration wants it that way. So I will return to work tomorrow and keep providing my patients excellent sexual and reproductive health care. Because that is my training. No woman-hating mother fuckers are going to bully me out of showing up.