Q&A with the Scholars: Practicing Medicine and Teaching Family Planning
Marguerite Duane, M.D., M.H.A., FAAFP, a board-certified family physician, is co-founder and Executive Director of the Fertility Appreciation Collaborative to Teach the Science, an organization dedicated to educating healthcare professionals and students about the scientifically valid natural or fertility awareness based methods of family planning. She also serves as an Adjunct Associate Professor at Georgetown University, and is a co-founder of Modern Mobile Medicine, a direct primary care house-calls based practice serving patients of all ages in the D.C. metropolitan area. Dr. Duane is one of our nearly 40 associate scholars. In this interview, she discusses community health centers, direct primary care, and natural or fertility awareness based methods of family planning.
You worked as a family physician and medical director at two community health centers in the Washington, D.C., area. What are these community health centers, and what range of services do they provide?
Duane: I served as the medical director of the Spanish Catholic Center (SCC), now known as the Catholic Charities Health Center, for almost five years until 2012. During my tenure, SCC provided health, education, and social services to over 40,000 clients annually, primarily low-income and limited English proficient immigrants in the greater Washington, D.C., region. Since 1967, SCC has served this community from their Mount Pleasant location, and has expanded to sites in Hyattsville, Gaithersburg, and Wheaton, Maryland. Our focus is the Hispanic population, but our doors are open to all in need, regardless of race, nationality, sex, sexual orientation, age, background, belief, or circumstance. The Medical and Dental Services fulfill a vital community need by providing high-quality services to uninsured members of the Hispanic communities in the greater D.C. area. While the Medical Centers provide critical access to primary care—including adult and pediatric preventive, primary care, sick care, and health education—the Dental Centers maintain oral health services for clients and also provide preventative care for children and adults. I also oversaw the Archdiocesan Healthcare Network of volunteer physicians, who provide specialty care to uninsured patients in need.
In the debate regarding whether Planned Parenthood should continue to receive federal funding, community health centers (CHC’s) play a large role. Advocates of Planned Parenthood argue that defunding the business would deny women the health care they need, perhaps especially poor and minority women. Are CHC’s equipped to provide for the needs of Planned Parenthood’s patients, and do you think CHC’s are a better option for women? Why?
Duane: Yes, CHCs are much better equipped to provide for more comprehensive health care needs of women, as I describe in this 2015 article in National Review:
Planned Parenthood touts its role in providing ‘affordable sexual and reproductive health care to millions of women, men, and teens,’ but where does a young woman go who is struggling with her weight? What health-care services does Planned Parenthood offer a woman with a strong family history of heart disease? Or what if a woman has symptoms of asthma or eczema or depression? Or maybe you’re a mom with several young children: You need a pap smear and they need well-child visits, and, given your crazy schedule, it would be best to get all your care in the same place.
For all these needs and more, CHCs are there. Today, they serve the primary health-care needs of 23 million patients in over 9,000 locations across America. That’s about nine times more than the 2.7 million women and men Planned Parenthood serves at its 700 health centers.[1] And CHCs provide all kinds of health care, including everything that Planned Parenthood does and then some — except abortions.
You are also a co-founder of Modern Mobile Medicine, through which you provide direct primary care house-calls for patients. What motivated you to start this organization? Do you see this as an important model of care for the future of health?
Duane: I was motivated to start Modern Mobile Medicine with my family medicine colleague, Dr. Matt Haden, to restore and renew the relationship that we, as doctors, can have with our patients. As a family physician, I care for men, women and children of all ages. Through the Direct Primary Care model, my patients pay me directly for the primary care services I provide via a monthly membership fee. This fee covers the cost of regular wellness visits, acute care visits, calls for late-night concerns and many other reasons why patients need a doctor.
Since we eliminate the insurance middle man, the cost savings are incredible and as such, I do not need to see as many patients as the physician in a traditional practice. In fact, the traditional primary care physician has a panel of 2,000-3,000 patients whereas the typical direct primary care doctor has a panel size of 500-600 patients. Therefore, I have much more time to spend with patients to address their health care needs. My experience as medical director of the Catholic Charities Center where we served low-income, uninsured patients, showed me that it is possible to provide high-quality care at a low cost when the patients pay directly for that care.
To learn more about direct primary care for the poor and how my experience at the Spanish Catholic Center influenced my views, please read my guest blog at Common Sense Family Doctor.
You also work as a teacher and promoter of natural family planning. Can you offer a couple of the most important benefits to couples of practicing NFP, and tell us why you think it important to teach this practice?
Duane: I am co-founder and Executive Director of FACTS, the Fertility Appreciation Collaborative to Teach the Science, an organization dedicated to educating our healthcare colleagues and students about modern natural or fertility awareness based methods and the science supporting their effectiveness for family planning and broader medical applications. I think it is critical that all medical professionals who care for women and men of reproductive age should be knowledgeable about these methods and be able to offer accurate information about how they work and where to learn more.
While the term natural family planning or NFP may be more familiar, the phrase fertility awareness based methods (FABMs) highlights that these methods offer a wide array of benefits for women as well as for couples. When women learn to chart their cycle, it can provide a valuable way for them to monitor their overall health and if they notice changes or abnormalities, they can work with trained clinicians to identify any potential problems and seek treatments that actually address the underlying medical issues, rather than merely suppressing the woman’s reproductive cycle. Also, women who use NFP/FABMs for family planning can avoid the myriad side effects associated with artificial birth control, especially hormonal methods, that can increase a woman’s risk for blood clots, heart attacks, strokes and even cancer, including breast and cervical cancer.
For couples, there are many other benefits as highlighted in this recent article just published about the use of the sympto-thermal method. Couples who use NFP/FABMs share responsibility for planning their family size and spacing, which can lead to more shared responsibility when it comes to caring for and raising children.
Finally, I am on the board of an organization called TeenSTAR, which is dedicated to educating young people about their developing sexuality and the gift of their fertility in a manner that helps them develop a healthier respect for their body. I am a firm believer that we should teach adolescents to chart the signs of their cycle to help them better understand the normal physical changes they experience.
Why are you pro-life? If you had 60 seconds to explain to someone why you have pursued the work that you have throughout your career, what would you tell them?
Duane: I believe every human being has inherent value and dignity from the moment they come into existence at the time of their conception until their death. As a physician, I took the Hippocratic Oath in which I stated: “I will use treatment to help the sick according to my ability and judgment, but never with a view to injury and wrong-doing. Neither will I administer a poison to anybody when asked to do so, nor will I suggest such a course. Similarly, I will not give to a woman a pessary to cause abortion.” As such, it is my duty to respect every human life.
As to your second question, I felt called to be a physician when I was just eight years old and witnessed the birth of my baby sister at home. From that moment, I was deeply impressed by the beauty and miracle of human life and the important role of the physician in caring for patients. I also learned about the incredible power and ability of women who are adequately informed about their health and the true capability of their bodies. My work has led me to look for opportunities to empower men, women and children to appreciate their physical capabilities and respect the incredible beauty of the human body and our ability to create new life.
Dr. Duane’s full biography can be found here.
[1] Editor’s Note: Since this article appeared, the number of federally qualified health center sites has grown to 10,500 and the number of total male and female patients visiting Planned Parenthood facilities has declined to 2.5 million total patients, with approximately 2.0 million women seeking contraceptives and 324,000 abortions performed. See https://lozierinstitute.org/fact-sheet-reallocating-planned-parenthoods-federal-funding-to-comprehensive-health-centers/ and https://www.plannedparenthood.org/files/2114/5089/0863/2014-2015_PPFA_Annual_Report_.pdf.
