COLUMBIA, SC (AP) — Students in obstetrics-gynecology and family medicine — two of the most popular medical residencies — face tough choices about where to continue their education in a landscape where legal access to abortion is state-to-state varies.
Abortions are usually performed by OB-GYNs or primary care physicians, and training generally involves observing and assisting with the procedure, often in outpatient clinics. Many doctors and students are now concerned about nonexistent or substandard education in states where clinics have closed or where abortion laws were otherwise tightened after the Supreme Court overturned Roe v. Wade.
In some cases, applicants seeking abortions as part of their careers take residencies in states with more liberal reproductive laws and may continue their careers there as well — possibly establishing less tolerant states for a shortage of OB-GYNs, observers said.
“If I choose a state where I will be restricted or not have full access, I’m essentially doing myself and my future patients short of the quality of care I can provide,” said Deborah Fadoju, a fourth-year medical student at Ohio State University. State who said she was watching programs along the East Coast, where many states have laws protecting abortion.
As an OB-GYN, Fadoju said, she should be able to “do the full job.”
On the other hand, anti-abortion students may find more accommodation in residency programs in states that largely prohibit the procedure.
dr. Christina Francis, a board member and elected CEO of the American Association of Pro-Life Obstetricians and Gynecologists, said her organization has previously received requests from students seeking information about residencies that don’t require them to apply so much. reference to abortion.
“Now we see residents and medical students who don’t want to participate in abortions saying, ‘We’re going to look for places to stay in places where abortion might be restricted’ because – theoretically and I think this will come true – there needs to be less pressure on that.” exercised on them.”
OB-GYN residency programs must provide training in abortions, according to the Accreditation Council for Graduate Medical Education, although residents with religious or moral objections may opt out. A Sept. 17 update said programs where abortion is illegal should provide that experience elsewhere. There are no comparable requirements for family medicine programs.
Doctors need the “muscle memory” that only practical education can provide, especially for abortions, said Pamela Merritt, the executive director of Medical Students for Choice, which promotes access to abortion education.
“How many surgical hours do you want a liver specialist to have before they try to do a biopsy?” said Merrit. “We would never discuss how to educate people without physical interaction with the patient about another important health care issue.”
A research team led by Atlanta’s Emory University is examining third- and fourth-year medical students across the country and in various specialties about their residency application decisions following the ruling that overturned Roe.
The team is still analyzing data, but early results show many applicants are struggling with where to pursue further education, according to Emory medical students Nell Mermin-Bunnell and Ariana Traub, who also co-founded an abortion rights advocacy group. supports.
“There are a lot of unknowns, and it’s scary for people applying for residency,” Mermin-Bunnell said. “There are really just a lot of question marks, and the way healthcare is practiced is changing rapidly.”
More than three-quarters of the roughly 490 respondents said access to abortion was likely or very likely to influence decisions about their whereabouts, the researchers said. The survey did not directly ask respondents for their views on abortion, in order to avoid bias.
Connor McNamee, a third-year physician assistant at the University of Toledo, began exploring abortion training outside of Ohio last summer. A state law bans most abortions after heart activity is detected, but a judge has blocked it as a challenge continues.
McNamee is now looking at options in Virginia, where abortions are more widely available. He was open to eventually returning to Ohio, but he now says abortion limits are “the final 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.
The majority of medical residents eventually practice in the state where they completed their residency, according to a 2021 report from the Association of American Medical Colleges — and some doctors fear fewer interns will mean fewer OB-GYNs in states with strict restrictions on abortion.
In South Carolina, students’ fears about access to reproductive health education (for their careers) and abortion services (for themselves) have hindered the recruitment of medical residents and fellows, said Dr. Elizabeth Mack, chair 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 midwives group, said she hopes new restrictions could open the door for students who are otherwise interested in OB-GYN but oppose abortion to enter the field.
Nearly 44% of 6,007 OB-GYN residents were in a state considered certain or likely to ban abortion if the Supreme Court overturned Roe, according to a paper published online in April by the journal Obstetrics & Gynecology.
President Joe Biden pledged Tuesday to codify abortion rights if Democrats retain enough seats in Congress — but while such federal protections remain elusive, medical education leaders are brainstorming ways for residents in restrictive states to continue abortion training, including allowing travel to more tolerant states.
Such “travel rotations” have been suggested by the American College of Obstetricians and Gynecologists, but the sheer need makes it difficult to bridge the gap, according to the Obstetrics & Gynecology article.
The Ryan program, based out of the University of California, San Francisco, last year conducted travel rotations for students to train outside of Texas, according to its director, Dr. Jody Steinauer.
Steinauer suggests programs work together to help fund travel rotations and guide residents in obtaining medical permits in new states. She also suggests supporting abortion simulation training to teach basic skills.
She fears changes in the law will jeopardize training in emergency skills, such as safely emptying a uterus after a miscarriage or abortion.
The surgical procedures for miscarriage and abortion are the same — something Francis says should allow residents to be educated without participating in abortion.
Residents can still learn a lot from miscarriage care, Steinauer said, but routine abortion training correlates with greater preparedness in all early pregnancy loss management, including counseling and complications. And, she said, residents need to see enough patients to feel competent — something limitations make difficult.
“If people don’t have integrated, complete abortion training, people often have deficiencies in their skills,” Steinauer said. “Programs will really need to support their students, who can, to travel to other states to get an education.”
James Pollard is a member of the Corps for the Associated Press/Report for America Statehouse News Initiative. Report for America is a national, not-for-profit service program that places journalists in local newsrooms to report on classified issues
JOIN THE CALL