Abortion ban discourages all doctors from red states


In a few years, Olgert Bardi’s skills will be in high demand. A first-year resident in internal medicine at the University of Texas Southwestern Medical Center in Dallas, will be a fully qualified physician by 2025 in the state Facing a shortage of primary care physicians.

The Texas problem: Due to the state’s strict anti-abortion laws, Bardi is unsure if he will stay there.

Although it does not currently offer abortion care, laws that limit this procedure have been created Confusion and uncertainty About what are the legal treatments for abortion and prevent it even from counseling the pregnant woman Patients on the option of abortion, he said. Aiding and abetting an abortion in Texas also exposes doctors to civil lawsuits and criminal prosecution.

“It definitely annoys me,” Bardy said. “If a patient comes along, and you are unable to provide him with the care you are supposed to give him for his well-being, I probably shouldn’t train here. The idea crossed my mind.”

He’s balancing his anxiety with feeling he can do more good by staying, including advising patients about getting contraceptives.

Bardi’s uncertainty reflects a broader reluctance among some doctors and medical students who are reconsidering their career prospects in red states where laws governing abortion have changed rapidly since the Supreme Court’s overturn. Raw vs. Wadeaccording to interviews with health care professionals and reproductive health advocates.

One large medical staffing firm said it recently had 20 obstetricians and gynecologists turning down their positions in red states due to abortion laws. The reluctance extends beyond those interested in providing abortion care, because laws intended to protect the fetus can open clinicians to new responsibilities or limit their ability to practice.

It is still not clear how accurate professional decisions are made amidst turmoil and confusion Since the Supreme Court’s decision on Dobbs vs Women’s Health Jackson It will translate into a permanent geographic shift. but middle national shortage From reproductive health practitioners, early evidence suggests that red states, at least, are putting themselves at a disadvantage in competition for essential providers, experts said.

A large number of health care workers AMN Healthcare said clients in states that ban abortions have more trouble filling vacancies because some potential OB/GYN candidates won’t even consider opportunities in states with new or pending abortion bans.

Tom Florence, president of Merritt Hawkins, a subsidiary of AMN Healthcare, cited 20 cases since the Supreme Court ruling in which prospects specifically refused to move to states where lawmakers target reproductive rights.

“Speaking to nearly 20 candidates who say they would refuse to practice in those restrictive states, it’s definitely a trend we’re seeing,” Florence said. “It’s definitely going to affect things going forward.”

One of the company’s recruits, who had been working for one job in maternal-fetal medicine in Texas, was rejected by three candidates, who said, “All three expressed fear that they might be fined or lose their license to do their jobs.”

In another example, a doctor who was contacted by an AMN Healthcare recruiter by phone trying to fill a position in an anti-abortion situation “simply said, ‘Roe v. Wade,’ and hung up,” Florence said.

This shift has particularly serious implications for small rural hospitals, which can provide only a few obstetricians, or in some cases, only one doctor, Florence said.

“They can give birth to hundreds of babies every year and see many thousands of patients,” he said. “The potential absence of a gynecologist/gynaecologist in their community, if not for a Supreme Court decision, is critical. Patients will bear the burden.”

It’s worth noting, Florence added, that none of the recruits met a single doctor seeking practice in a state because abortion was banned.

In a 2021 Kaiser Family Foundation survey75 percent of obstetricians and gynecologists said their practices do not provide abortions for the purposes of pregnancy termination.

However, widespread written abortion bans across the United States have cast a shadow over the broader practice of reproductive health, say leaders of mainstream physicians who support abortion rights. In states where there are no exceptions to women’s life and health, they say, routine standards of care are abolished.

They are worried about that Training limits For new doctors will undermine the recruitment of young talent. They are concerned about restrictions on Infertility treatment. They expect conservative legislatures to seek bans on certain types of Contraception, including the IUD and Plan B drugs. Most Republicans in the American House They voted last month against A measure to protect the right to contraception.

In addition, many obstetricians and gynecologists, even if they do not perform the abortions themselves, strongly believe in patient autonomy and decision-making, academic and clinical leaders said.

“Even physicians in restricted states have never had to contend with this kind of political interference and legislative oversight,” said Eve Espy, chief of obstetrics and gynecology at the University of New Mexico and a physician at the UNM Center for Reproductive Health. . “It’s an amazing intrusion into a wide range of reproductive health care.”

A 3rd year OB/GYN resident at the United Nations. M., Alana Carstens Yalom attended Tulane University School of Medicine, in New Orleans. She had considered returning to Louisiana for her medical practice. Not anymore. She wants abortion care to be part of her OB/GYN, Louisiana Prohibition clinic.

“Now I don’t think that’s even an option for me,” she said.

Doctors, residents, and medical students said in interviews that they were concerned about the impact on the profession. They said how to navigate jobs in the new landscape is a major topic of discussion among both clinicians and trainees.

Myrose Porter, an Austin native and a student at Baylor College of Medicine in Houston, said she would apply for residencies in her home state, but that the rest of the options on her list would only be in states where abortion is legal. In the long run, Porter, a member of the Medical Students for Choice Program, does not expect to practice medicine in Texas.

“The idea that myself and other future doctors won’t be here is sad for me personally and sad for the community,” she said, stressing that she was only speaking for herself, not Baylor. “There’s some guilt I’m letting go of the society I grew up in.”

In Nebraska, the Methodist Health System in Omaha has only two specialists who are experienced in high-risk pregnancies and can also perform dilatations and evacuations to remove the fetus. The hospital allows abortion only in cases that threaten the health and life of the woman. A group of Nebraska OB/GYNs, including Methodist maternal embryologist Emily Patel, formed a local political action committee to urge the legislature not to pass an abortion ban.

They warn of the “downstream effects” of the abortion ban on reproductive health more broadly.

A common example is a woman whose waters have broken around 18 or 19 weeks. The risks of continuing that pregnancy to the health of the woman and the fetus include developmental problems for the fetus and the risk of infection for the woman.

But Patel said that under Nebraska’s proposed abortion ban, it’s not clear whether even explaining termination options in such circumstances would be legal.

Imagine that we are in a state of embargo, and the fetus is beating with a pulse, and the patient sitting in front of me is not sick. “This is going to be a tough situation for a doctor,” Patel said. “The doctor will not want to be in a position where they will be criminally prosecuted for providing routine care and advice.”

And it’s the kind of legal uncertainty and risk that top doctors will seek to avoid, she added: “These countries where the ban is going to start will have a hard time recruiting the next generation of OB/GYNs.”

Abortion opponents said concerns about legal risks and restrictions beyond elective abortions were exaggerated.

“There are a lot of myths and misconceptions about what this means for reproductive health,” said Sandy Christiansen, M.D., obstetrician and gynecologist and medical director of the Maryland CareNet Pregnancy Center, which encourages women to continue pregnancies. She said “there shouldn’t be any problems” with treating the miscarriage with medication or surgical intervention.

“They shouldn’t worry about their licenses if they’re practicing a standard of care,” said Christiansen, who is a member of the American Society of Pro-Life Obstetricians and Gynecologists.

She admitted with some confusion: “Hopefully you’ll clarify the laws that are to come some of these things.”

Another member of the Doctors’ Anti-Abortion Group, Associate Professor Susan Bean, at Barton College, a small Christian-affiliated institution in North Carolina, said she believes reluctance to move to states where abortion is prohibited would be limited to a small percentage of obstetrics and gynecology. Doctors who want to perform elective abortions.

“If you were going to go to medical school and wanted to be an obstetrician and wanted to have abortions, you would choose a country where the law would be legal,” she said.

Hospital systems in states with abortion restrictions, including Utah, Texas, Mississippi, Alabama and Ohio, did not respond to requests for comment or declined to respond to questions about how they handled potential retention and enlistment challenges.

A large health system based in Utah, Intermountain Healthcare, lists 10 OB/GYN doctor vacancies on its website, which are more than any specialty they are hiring for. An Intermountain spokeswoman, apparently inadvertently, included a Post reporter in an email to the PR team after I asked The Post about the challenges filling those vacancies in light of Utah’s abortion law: Stay away from this issue.”

Doctors said they are grappling with the fallout from broad-worded legislation written by politicians without detailed medical knowledge. The environment creates a high degree of legal and occupational risks for professionals, said David Turok, associate professor of OB/GYN at the University of Utah and also a board member of Physicians for Reproductive Health, which supports abortion rights.

“What we have are laws that don’t represent medical practice, that aren’t framed in ways that we think or talk about as medical professionals, and that makes it confusing,” Turok said.

Officials in some states are working to clarify how to enforce the abortion ban. The Louisiana Department of Health released on Monday List of 25 fetal cases may justify termination.

Legal uncertainty adds to the burdens on OB/GYNs. that they Obstetrics must respond 24 hours a day, emergencies are emotionally stressful, and practitioners experience some of the highest Malpractice Claim Rates and associated insurance costs.

Federal government He said The United States needs 9,000 obstetrics and gynecology and the shortage will reach 22,000 by 2050.

In Michigan, it was oldRo The abortion ban was renewed after the Supreme Court ruling. The looming ban has prompted Tim Johnson, a veteran of high-risk pregnancy care at Michigan Health, to consider getting out of the state. Although he is 73 and no longer offers elective abortions, he is still treating patients and is not ready to retire. If the abortion ban continues in Michigan, he said, he may move to Maryland to practice it.

“I always said if (Ro flipped) at such a speed, it would be terribly devastating,” he said, “We are beginning to understand how annoying it really is. “