COLUMBIA, SC (AP) — Students of obstetrics and gynecology and family medicine — two of the most popular medical residencies — face tough choices about where to advance their training in a landscape where legal access abortion varies from state to state.
Abortions are typically performed by OB-GYNs or family physicians, and training usually involves observing and assisting with the procedure, often in outpatient clinics. Many doctors and students now worry about non-existent or poor training in states where clinics closed or abortion laws were tightened after the Supreme Court struck down Roe v. Wade.
In some cases, applicants who wish to perform abortions as part of their career pursue residencies in states with more liberal reproductive laws and perhaps pursue their careers there as well – potentially creating less permissive states for a shortage of OB-GYNs, observers said. .
“Choosing a state where I will be limited or where I won’t have full access is essentially depriving myself and my future patients of the quality of care that I can provide,” said Deborah Fadoju, a student. in fourth-year medicine from Ohio State who said she looked at programs along the East Coast, where many states have laws protecting abortion.
As an OB-GYN, Fadoju said, she should be able to “do all the work.”
On the other hand, students who oppose abortion may find more accommodations in residency programs in states that broadly ban the procedure.
Dr. Christina Francis, board member and CEO-elect of the Pro-Life American Association of Obstetricians and Gynecologists, said her organization has already received requests from students seeking information about residencies in which they would not have to make an abortion referral.
“Now we see residents and medical students who don’t want to participate in abortions saying, ‘We’re going to seek residency positions in places where abortion might be restricted’ because – theoretically and I think it will play out – there should be less pressure on them.
OB-GYN residency programs must provide education on abortions, according to the Accreditation Council for Higher Medical Education, although residents with religious or moral objections can opt out. A Sept. 17 update said programs where abortions are illegal must provide that experience elsewhere. There are no similar requirements for family medicine programs.
Doctors need the ‘muscle memory’ that only hands-on education can give, especially for abortions, said Pamela Merritt, 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 trying to do a biopsy?” Merritt said. “We would never debate how to educate people without physical interaction with the patient about any other major health issue.”
A research team led by Emory University in Atlanta is interviewing third- and fourth-year medical students across the country and in all specialties about their residency application decisions after the ruling that overturned Roe.
The team is still analyzing the data, but early results show many candidates are wondering where to continue their training, according to Emory medical students Nell Mermin-Bunnell and Ariana Traub, who also co-founded an advocacy group that supports the right to abortion.
“There are a lot of unknowns, and it’s scary for people applying for residency,” Mermin-Bunnell said. “There really are a lot of question marks, and the way health care is practiced is changing rapidly.”
More than three-quarters of about 490 respondents said access to abortion is likely or very likely to influence decisions about where they live, the researchers said. The survey did not directly ask respondents for their position on abortion, to avoid introducing bias.
Connor McNamee, a third-year family medicine resident 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 while a challenge is pending.
McNamee is now exploring options in Virginia, where abortions are more widely available. He was open to eventually returning to Ohio, but 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 a huge part of my career,” McNamee said.
The majority of medical residents end up practicing in the state where they completed their residency, according to a 2021 report from the Association of American Medical Colleges — and some doctors worry that fewer interns means fewer OB-GYNs in states with strict abortion restrictions.
In South Carolina, student fears about access to reproductive health education (for their careers) and abortion services (for themselves) have hampered recruitment of medical residents and fellows said Dr. Elizabeth Mack, president of the South Carolina chapter of the American Academy of Pediatrics, who testified in August before lawmakers for tougher abortion restrictions.
Francis, of the anti-abortion obstetricians 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 the 6,007 OB-GYN residents were in a state deemed certain or likely to ban abortion if the Supreme Court overturns Roe, according to an article published online in April by the journal Obstetrics & Gynecology.
President Joe Biden vowed on Tuesday to codify abortion rights if Democrats retain enough congressional seats — but while such federal protections remain elusive, medical education officials are considering ways for residents of Restrictive states to continue abortion training, including allowing travel to more permissive states.
Such “travel rotations” have been proposed by the American College of Obstetricians and Gynecologists, but the sheer volume of need makes it difficult to bridge the gap, according to the Obstetrics & Gynecology article.
The Ryan Program, based at the University of California, San Francisco, piloted travel rotations for students to train outside of Texas last year, according to its director, Dr. Jody Steinauer.
Steinauer suggests the programs work together to help fund travel rotations and guide residents through the process of obtaining medical licensing in new states. She also suggests strengthening simulation abortion training to teach basic skills.
She fears the legal changes will jeopardize training in emergency skills like safely emptying a uterus after a miscarriage or abortion.
Surgical procedures for miscarriages and abortions are the same — which Francis said should allow residents to be trained without participating in the abortion.
Residents could 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 — which restrictions make difficult.
“Not having comprehensive, integrated abortion education often leaves people with skill deficits,” Steinauer said. “Programs are really going to have to help their learners, who are able, to travel to other states for training.”
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