Navigating the impact of state abortion restrictions
Dr. Andrew Yacht is senior vice president of academic affairs and chief academic officer for Northwell Health and professor of medicine and associate dean of graduate medical education at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.
Less than a year since the Supreme Court overturned Roe v. Wade, it’s already clear how severe abortion restrictions or bans in about two dozen states are influencing how medical professionals consider their futures. The limitations around the country are causing consternation throughout teaching hospitals and academic medicine, even where abortion is legal.
Healthcare leaders will have to evaluate this new landscape closely. We’ll have to demonstrate wisdom and ingenuity in assessing the impact on both physicians and patients, starting with an understanding of where doctors are willing—or unwilling—to practice.
That could cause an obstetricsgynecology brain drain, ultimately reducing access to other primary care and specialty services provided by OB-GYNs.
A recent survey published in the Journal of General Internal Medicine asked more than 2,000 predominantly early- to mid-career doctors and medical students how state abortion restrictions may influence their practice location preferences. More than 82% of respondents reported they preferred to work or train in states with preserved abortion access.
Eleven out of the 12 states with current or anticipated complete—or nearly complete—abortion bans as of August 2022 already had below-average numbers of active physicians per 100,000 people, according to the researchers. They added that, if even a fraction of surveyed physicians and trainees follow through on their geographic preferences, restricted states risk exacerbating existing doctor shortages and worsening health outcomes for their citizens.
Academic medical centers are in a bind. They’re squeezed between providing abortion training mandated by the Accreditation Council for Graduate Medical Education and running afoul of state abortion restrictions.
Without available abortion training, medical students are creating workarounds. For instance, many are now using papayas as uterine models. Though ingenious, students shouldn’t be responsible for creating their own opportunities to learn a life-saving medical skill that their curricula should provide.
Healthcare leaders must step forward to meet these challenges, including those posed by a lack of funding. To maintain a pipeline of OB-GYNs, residents training in restricted states will have to assume a significant financial burden to travel to non-restricted states to complete their training. A hospital’s Medicare funding for graduate medical education doesn’t transfer when residents leave their primary training site, let alone the state. Federal funding for training often doesn’t cover all the associated costs. Hospitals and health systems can’t always fill those gaps.
We can look to a patchwork of potential solutions, but each has challenges. Private programs, like the Midwest Access Project and the Kenneth J. Ryan Residency Training Program in Abortion and Family Planning, connect residents with training in abortion-protected states but provide limited opportunities.
An alliance of 21 states has
communicated its plans to continue advocating for strengthening state laws and constitutions to protect reproductive rights; we don’t yet know their other objectives. Will these states cover educational and living expenses for residents in restricted states to train in their states? Doing so creates a conundrum—they could fund outof-state doctors to learn how to safely perform abortions, only for the clinicians to return to restricted states where they’re unlikely to perform the procedure.
Hospital, health system and medical school leaders must press the need for interstate coordination among medical schools and health systems, partnerships with private training programs, and more funding. It’s important because the lack of training opportunities also affects residents who are training in abortion-protected states. Out-of-state residents forced to travel strain capacity and dilute training for other residents.
Maternity care deserts already exist in restricted states, according to the nonprofit March of Dimes. Abortion and abortion training restrictions will worsen the existing scarcity of maternal care and lessen the professional resources needed to attract clinicians to train and eventually settle in those states. It’s worth noting that 85% of OB-GYNs are women, according to the American Medical Association. These women may be weighing their own reproductive health concerns when they consider residency and practice locations.
Anti-abortion legislation and court cases—including the battle over medical abortion and one of the most common abortion pills, mifepristone—are reshaping clinical work and training opportunities, along with patients’ medical options. It’s undeniably messy for doctors and creates fewer safe environments to treat patients. Hopefully healthcare leaders can help meet the challenge and the needs of patients
n throughout the nation.
“Academic medical centers are in a bind. They’re squeezed between providing abortion training [mandated for accreditation] … and running afoul of state abortion restrictions.”