As reported by Jan Hoffman for The New York Times, in order to satisfy their prerequisites for specialty board certification, OB-GYN physicians in post-graduate medical residency programs must comply with national requirements, which include training in the performance of abortions. Such training is considered essential—and characterized as a “core procedure”—for OB-GYN doctors, in order to properly treat common medical conditions such as miscarriage, infections, and other complications to pregnancy. And in order to receive accreditation, those medical residency programs—typically administered through schools of public health and occurring in hospitals or clinics—must provide that training.
But ever since a radical conservative majority on the U.S. Supreme Court overruled the right to abortion previously guaranteed by Roe v. Wade in June, several Republican-dominated states have passed laws prohibiting abortion and criminalizing its practice by physicians. As a direct result, residency programs that routinely provided their residents with training in abortion care are faced with a dilemma.
As Hoffman observes:
If they continue to provide abortion training in states where the procedure is now outlawed, they could be prosecuted. If they don’t offer it, they risk losing their accreditation, which in turn would render their residents ineligible to receive specialty board certification and imperil recruitment of faculty and medical students.
The absolute necessity of such training for OB-GYN doctors was recently reaffirmed by the Accreditation Council for Graduate Medical Education (ACGME). There is no exception for states whose Republican legislatures and governors have seen fit to transform the procedure into a criminal offense, although, as Hoffman reports, the guidelines permit a medical resident to “opt out” of such training for “religious or moral reasons.” Under the Council’s guidelines, a physician may also complete such instruction by serving a clinical rotation in a facility located in a state that permits doctors to perform abortions, but both hospital program directors and medical residents interviewed for The Times report expressed the fear that broadly drafted forced-birth laws in Republican-dominated states could still subject them to criminal prosecution.
Some faculty said that with lawmakers increasingly looking to block citizens from getting abortions out of state, they feared that establishing out-of-state training could make them vulnerable to private lawsuits or even charged with aiding and abetting a crime. Attorneys general from Oklahoma, Tennessee and Texas, among the states that ban abortion, did not respond to requests for comment about whether they would press such cases.
The Council’s accreditation guidelines have predictably raised the ire of forced-birth Republican politicians. For example, Hoffman cites Texas attorney general Ken Paxton, who has issued an opinion stating that Texas medical residency programs need not comply with the requirements. And some forced-birth physician organizations have called the guidelines “coercive,” suggesting they should be “re-evaluated,” presumably in order to deny their pregnant patients such care. As Hoffman notes, a recent study found “about 45% of the country’s 286 OB-GYN residency programs were located in states likely or certain to ban abortion, affecting about 2,600 of the country’s 6,000 residents.”
For physicians seeking to complete their residencies in states that have or will soon criminalize the performance of abortions, the allowance for “out-of-state” training comes with an array of practical obstacles, from varying licensing and malpractice insurance regulations to housing costs. Hoffman reports that as consequence, physicians have begun to avoid placements in states where abortion is or will soon be illegal. She cites one physician who had been “courted” to join a Wisconsin medical residence program’s faculty who ultimately turned them down, citing the state’s abortion ban.
But the more worrying trend for those who may need OB-GYN care in Republican states is the growing reluctance of medical students to practice in those states.
That is among the reasons that many medical students have said they are applying only to programs where abortion is legal. Public health experts predict that in a few years, patients in abortion-prohibited states, where the ranks of obstetricians are already shrinking, will experience even greater barriers to reproductive health care.
The reasons for this are practical, at least in part: An aspiring OB-GYN resident has little incentive to apply to a program that is not accredited. As Hoffman reports, the ACMGE explored the option of using “simulation” techniques such as virtual instruction or performance of “mock” abortions on models (and even papayas) to provide such training and concluded they were insufficient. Even those medical students who desire to treat patients in the poorest of these “red-state” areas have balked when they find their programs do not have sufficient resources to place them for out-of-state training.
RELATED: Medical students use papayas to learn abortion procedures in places where the practice is banned
The effects of all this are as predictable as they are ominous for anyone seeking OB-GYN care in Republican-led states: Because of the very real threat of potential criminal prosecution, many of the most qualified and talented medical students will naturally apply tor OB-GYN residency programs in states where abortion is legal; in turn, those programs become more selective, admitting only the top students. Meanwhile, students who simply may wish to practice OB-GYN in a “red state” are disincentivized to do so, by barriers to accreditation or the simple expense and logistics of obtaining such training out of their chosen state.
Finally, as Hoffman notes, the prohibitions against abortion in “red” states have deterred medical students pursuing careers in those states even in fields other than OB-GYN. She cites a study of third- and fourth-year medical students conducted for The Lancet Americas which interviewed those students about their preferred career placements; 60% wouldn’t apply to programs in forced-birth states. And “more than three-quarters of 500 responses” were from students pursuing specialties that were NOT obstetrics and gynecology.
That study specifically references the impact of the Supreme Court’s decision in Dobbs, concluding that medical students may avoid such states not simply because they want (and deserve) a “comprehensive education,” but also for their own well-being. As students “cluster” in the states where abortion care is not prohibited, “physician shortages and school enrollment in states with abortion bans will worsen.”
RELATED: Republican abortion bans have forced dozens of clinic closures
So patients who become pregnant in states that have prohibited abortion may soon be forced to choose between accepting substandard OB-GYN care—or no care at all.
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