Title: Promoting Transparency in Medical Education and Access to Training in Settings Affiliated
with Religious Healthcare Organizations
WHEREAS hospital consolidations have led to an increasing number of affiliations, mergers and sales
involving religiously-affiliated hospitals around the country.1,2
WHEREAS physicians, including trainees, treating patients at religiously-affiliated healthcare
institutions often must follow certain guidelines, such as the Ethical and Religious Directives for Catholic
Health Care (ERDs).
WHEREAS the ERDs may limit the healthcare that a physician can provide, including, but not limited
to, reproductive services, sexual health, end of life care, and healthcare services for the LGBTQ
community.3,4,5,6
WHEREAS medical students, residents, and fellows at religiously-affiliated training programs may
rotate at sites at which the provision of healthcare services and educational opportunities are affected by
ERDs, with the potential to restrict the content of training.
WHEREAS nationwide, nearly 15 percent of all hospital beds are now under the control of Catholic
Health Care and 10 of the 25 health systems are Catholic-sponsored.1
WHEREAS in California, one in three family medicine residency programs are affiliated with religious
institutions, training as many as 350 of the 1073 family medicine residents. 7
WHEREAS religiously-affiliated hospitals can place restrictions on patients and families’ decisions
concerning the use or withdrawal of life-sustaining treatment8 or denials of standard treatment for women
with pregnancy complications.9,10,11
WHEREAS primary care physicians working in religiously-affiliated institutions often report
experiencing conflict over religiously based policies.12
RESOLVED that the _AFP will include information about religious affiliation and denomination if
associated with restrictions on health services and training, as filters on the (state) Residency Program
Directory, and further be it
RESOLVED that the policy of the _AFP will be that (state) medical training programs should be
transparent about their religious affiliations as well as about the potential impact on health services and
training at their institutions with all prospective medical students, residents, and fellows.
RESOLVED that the _AFP will urge the AAFP to include information about religious affiliation and
denomination if associated with restrictions on health services and training, as filters on the AAFP
Residency Program Directory.
RESOLVED that the _AFP will urge the AAFP to adopt the policy that medical training programs should
be transparent about their religious affiliations as well as about the potential impact on health services and
training at their institutions with all prospective medical students, residents, and fellows.
Prepared by the TEACH Program, December 2014
REFERENCES
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12
13.
Uttley L, Reynertson S, Kenny L, Melling L. Miscarriage of Medicine: The Growth of Catholic Hospitals and the Threat to
Reproductive Health Care. ACLU FoundationThe Merger Watch Project. December 2013. Accessed at:
https://www.aclu.org/sites/default/files/assets/growth-of-catholic-hospitals-2013.pdf (12/9/14).
Abelson R. Catholic Hospitals Expand, Religious Strings Attached. New York Times. February 20, 2012.
Freedman LR and Stulberg DB. Conflicts in Care for Obstetric Complications in Catholic Hopsitals. AJOB Primary Research. 2013;
4(4):1-10.
Stulberg DB, Lawrence RE, Shattuck J, Curlin FA. Religious hospitals and primary care physicians: conflicts over policies for patient
care. J Gen Intern Med. 2010;25(7):725-730.
United States Conference of Catholic Bishops. Ethical and Religious Directives for Catholic Hospital Services. Nov 2009. Fifth
Edition. Accessed at: http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-DirectivesCatholic-Health-Care-Services-fifth-edition-2009.pdf (12/9/14).
Rubin S, Grumet S, Prine L. Hospital Religious Affiliation and Emergency Contraceptive Prescribing Practices. Am J Public Health.
2006 August; 96(8): 1398–1401.
Data collected from AAFP Residency Directory accessed from https://nf.aafp.org/Directories/Residency/Search as well data collection
from individual program websites (see attached Excel File)
United States Conference of Catholic Bishops, Ethical and Religious Directives for Catholic Health Care Services (5th ed. 2009),
available at http://www.usccb.org/issues-and-action/human-life-and-dignity/health-care/upload/Ethical-Religious-Directives-CatholicHealth-Care-Services-fifth-edition-2009.pdf
Freedman L, R Landy & J Steinauer, When There’s a Heartbeat: Miscarriage Management in Catholic-Owned Hospitals, 98 Am. J. of
PuB. HeAltH 1774 (2008); Lori R. Freedman & Debra B. Stulberg, Conflicts in Care for Obstetric Complications in Catholic
Hospitals, 4 Am. J. of BioetHicS PRim. ReS. 81 (2013).
Stulberg DB, Hoffman Y, Dahlquist IH, Freedman LR. Tubal ligation in Catholic hospitals: a qualitative study of ob-gyns'
experiences. Contraception. 2014 Oct;90(4):422-8. doi: 10.1016/j.contraception.2014.04.015. Epub 2014 May 4.
Erdely, SR. Could Your Doctor Deny You Health Care?, Self, May 2007, available at http://www.self.com/health/2007/05/denial-ofhealth-care?printable=true; Letter from Judy Waxman, Vice President Health and Reproductive Rights, National Women’s Law
Center, and Jill C. Morrison, Senior Counsel at National Women’s Law Center, to Marilyn Tavenner, Thomas E. Hamilton, and James
Randolph Farris, M.D., Centers for Medicare & Medicaid Services (Jan. 20, 2011) (citing studies), available at
http://www.nwlc.org/sites/default/files/pdfs/nwlc_cms_complaint_jan_2011.pdf
Stulberg DB, Lawrence RE, Shattuck J, Curlin FA. Religious hospitals and primary care physicians: conflicts over policies for patient
care. J Gen Intern Med. 2010 Jul;25(7):725-30. doi: 10.1007/s11606-010-1329-6. Epub 2010 Apr 6.
Guiahi M, Maguire K, Ripp ZT, Goodman RW, Kenton K. Perceptions of family planning and abortion education at a faith-based
medical school. Contraception. 2011 Nov;84(5):520-4. doi: 10.1016/j.contraception.2011.03.003. Epub 2011 Apr 15.
Prepared by the TEACH Program, December 2014