COLUMBIA, SC – Students in obstetrics, gynecology and family medicine – two of the most popular medical residencies – face difficult decisions about where to further their education in a landscape where legal access to abortion varies from state to state.
Abortions are typically performed by OB-GYNs or general practitioners, and training generally involves observing and assisting with the procedure, often in outpatient clinics. Many doctors and students are now concerned about the lack of or substandard education in states that have closed clinics or otherwise tightened abortion laws after the Supreme Court Roe v. Wade had picked up.
In some cases, applicants looking to perform abortions as part of their careers seek residency in states with more liberal reproductive laws and may also continue their careers there — potentially setting up less permissive states for a shortage of OB-GYNs, observers said.
“Choosing a state where I am restricted or do not have full access essentially means putting myself and my prospective patients short in terms of the quality of care I can provide,” said Deborah Fadoju, a fourth-year Ohio medical student who said she looked at programs on the East Coast, where many states have laws protecting abortion.
As OB-GYN, Fadoju said, she should be able to “do the full range of work.”
On the other hand, students who are opposed to abortion may find more lodging in residency programs in states that widely prohibit the procedure.
dr Christina Francis, board member and elected CEO of the American Association of Pro-Life Obstetricians and Gynecologists, said her organization has previously received inquiries from students looking for information about residencies where they don’t even have to do an abortion referral.
“Now we’re seeing residents and medical students who don’t want to have abortions and they’re like, ‘We’re going to look for posts in residency in places where abortions might be restricted,’ because — theoretically, and I think that’s going to have an impact there.” there should be less pressure on them.”
OB-GYN residency programs are required to provide abortion training, according to the Accreditation Council for Graduate Medical Education, although residents with religious or moral objections may choose not to. A Sept. 17 update said programs where abortion is illegal must provide that experience elsewhere. There are no similar requirements for family medicine programs.
Doctors need the “muscle memory” that only hands-on training can give, especially for abortions, said Pamela Merritt, executive director of Medical Students for Choice, which promotes access to abortion education.
“How many hours of surgery do you think a liver specialist should have before attempting a biopsy?” Merritt said. “We would never discuss how to educate people about other important health issues without physical patient interaction.”
A research team led by Emory University in Atlanta is surveying third- and fourth-year medical students across the country and in every specialty about their decisions to apply for a residency following the ruling that overturned Roe.
The team is still analyzing data, but early results show that many applicants are grappling with where to train, according to Emory medical students Nell Mermin-Bunnell and Ariana Traub, who also co-founded an advocacy group promoting the right to abortion begins.
“There are a lot of unknowns and it’s scary for people applying for residency,” Mermin-Bunnell said. “There’s really just a lot of question marks and the way healthcare is practiced is changing fast.”
More than three-quarters of about 490 respondents said access to abortion was likely or very likely to influence decisions about where they lived, the researchers said. The survey did not ask respondents directly about their attitude towards abortion to avoid bias.
Connor McNamee, a third-year general practitioner at the University of Toledo, began researching abortion training outside of Ohio last summer. A state law bans most abortions after heart activity is detected, but a judge has blocked them while a challenge rages on.
McNamee is now exploring options in Virginia where abortion is more widely available. He’d been open to eventually returning to Ohio, but now says abortion limits there are “the last nail in the coffin” for him.
“I can’t really be an abortion provider in Ohio, and that’s an important part of my career,” McNamee said.
According to a 2021 report by the Association of American Medical Colleges, the majority of medical professionals practice in the state where they completed their residency training — and some doctors worry that fewer trainees in states with tough abortion restrictions will mean fewer gynecologists.
In South Carolina, student fears about access to reproductive health education (for their careers) and abortion services (for themselves) have hampered recruiting of physicians and fellows, said Dr. Elizabeth Mack, president of the South Carolina branch of the American Academy of Pediatrics, who testified in August before lawmakers pushing for tougher abortion restrictions.
Francis, of the Anti-Abortion Obstetrics Group, said she hopes new restrictions could open the door for students otherwise interested in OB-GYN but opposed to abortion to enter the field.
Nearly 44% of OB-GYNs’ 6,007 residents were in a state that is believed to be certain or likely to ban abortion if the Supreme Court overturns Roe, according to a paper published online in April by the journal Obstetrics & Gynecology.
President Joe Biden vowed Tuesday to codify abortion laws if Democrats retain enough seats in Congress — but while such federal safeguards remain elusive, medical education leaders are considering how residents in restrictive states can continue abortion training, including those Permission to travel to more permissive states.
Such “travel rotations” have been proposed by the American College of Obstetricians and Gynecologists, but the sheer scale of the need makes it difficult to fill the gap, according to the Obstetrics & Gynecology paper.
Based at the University of California, San Francisco, the Ryan program, according to its director, Dr. Jody Steinauer conducted pilot trips for students to train outside of Texas last year.
Steinauer suggests the programs work together to fund travel rotations and guide residents through the process of obtaining medical license in new states. She also suggests increasing abortion simulation training to teach basic skills.
She worries legal changes could jeopardize training on emergency skills like how to safely empty a uterus after a miscarriage or abortion.
The surgical procedures for miscarriage and abortion are the same — something Francis said should allow residents to be educated without having an abortion.
Residents could still learn a lot from miscarriage management, Steinauer said, but routine abortion training correlates with greater preparation for all early-stage pregnancy loss management, including counseling and complications. And she said residents need to see enough patients to feel competent – something restrictions make difficult.
“Without integrated, full abortion education, people are often left with deficits in their skills,” Steinauer said. “Programs need to really support their learners who are able to travel to other states for further education.”
James Pollard is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that brings journalists into local newsrooms to cover undercover topics.