Abortion bans discourage all kinds of doctors from red states

Abortion bans discourage all kinds of doctors from red states


In a few years, Olgert Bardhi’s skills will be in demand. A first-year resident in internal medicine at the University of Texas Southwestern Medical Center in Dallas, he wants to be a full-fledged physician by 2025 in a nation is facing a shortage of primary care physicians.

The problem for Texas: Because of the state’s strict anti-abortion laws, Bardhi isn’t sure he wants to stay there.

Although he doesn’t provide abortion care right now, laws restricting the procedure have created confusion and uncertainty about which treatments are legal for miscarriage and prevent him from even counseling pregnant women patients on the possibility of abortion, he said. Assisting in an abortion in Texas also exposes doctors to civil lawsuits and criminal prosecution.

“It definitely bothers me,” Bardhi said. “If a patient comes in and you can’t give them the care you need for their well-being, maybe I shouldn’t be practicing here. The thought has crossed my mind.”

He balances his concern with the feeling that he can do more good by staying, including advising patients on obtaining birth control.

Bardhi’s uncertainty reflects a broader hesitancy among some doctors and medical students who are reassessing their career prospects in red states where laws governing abortion have changed rapidly since the Supreme Court struck down Roe v. Wadeaccording to interviews with healthcare professionals and advocates for reproductive health.

A major medical recruiting firm said it recently had 20 obstetrician-gynecologists turn down positions in red states because of abortion laws. The reluctance extends beyond those interested in providing abortion care, as laws meant to protect a fetus can open doctors up to new liabilities or limit their ability to practice.

It is still unclear how thorough career decisions have been made amid the upheaval and confusion since the Supreme Court’s decision regarding Dobbs v. Jackson Women’s Health Organization will translate into a permanent geographical shift. But amid a national shortage of reproductive health practitioners, the early evidence suggests that red states have at least put themselves at a disadvantage in the competition for key frontline providers, experts said.

One great healthcare professional firm, AMN Healthcare, said clients in states with abortion bans 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, an AMN Healthcare company, cited 20 cases since the Supreme Court ruling in which prospects specifically refused to move to states where reproductive rights are targeted by lawmakers.

“Talking to about 20 candidates who say they will decline to practice in these restrictive states, that’s certainly a trend we’re seeing,” Florence said. “It will certainly affect things going forward.”

Three candidates rejected one of the firm’s recruiters, who was working to fill a single job in fetal medicine in Texas, he said: “All three expressed fear that they could be fined or lose their license to do their job.”

In another example, a doctor contacted by phone by an AMN Healthcare recruiter trying to fill a position in an antiabortion state “just said, ‘Roe versus Wade’ and hung up,” Florence said.

Florence said the shift has particularly serious implications for small, rural hospitals, which can afford only a small number of maternal specialists or, in some cases, just one.

“They can deliver hundreds of babies every year and see thousands of patients,” he said. “The potential absence of an OB/GYN that could be in your community, if not for the Supreme Court decision, is very significant. The burden will be borne by the patients.”

Tellingly, Florence added, none of the recruiters had met a single doctor who wanted to practice in a state because it had banned abortion.

In a 2021 Kaiser Family Foundation survey, 75 percent of OB/GYNs said their practices do not provide abortions for the purpose of terminating a pregnancy.

Still, broadly written abortion bans across the United States have cast a chill over the broader practice of reproductive health, say mainstream medical leaders who support abortion rights. In states without exceptions for the life and health of the woman, they say, routine standards of care are scrapped.

They are concerned that restrictions on training new doctors will undermine the recruitment of young talent. They are concerned about restrictions on fertility treatment. They expect conservative lawmakers to seek to ban certain types of birth control, including IUDs and Plan B drugs. Most Republicans in the US House voted last month against a measure protecting the right to contraception.

In addition, many OB/GYN physicians, even if they do not perform abortions themselves, believe strongly in patient autonomy and decision-making, academic and clinical leaders said.

“Even doctors in restrictive states have never had to deal with this kind of political interference and legal oversight,” said Eve Espey, chair of the department of obstetrics and gynecology at the University of New Mexico and a physician at the UNM Center for Reproductive Health. . “It’s an incredible intervention in a wide range of reproductive health services.”

A third-year OB/GYN resident at FN. M., Alana Carstens Yalom attended medical school at Tulane University, in New Orleans. She had entertained the idea of ​​returning to Louisiana for her medical practice. Not any more. She wants abortion care to be part of her OB/GYN practice, and Louisiana has a ban.

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

Doctors, medical residents and medical students said in interviews that they are concerned about the impact on the profession. How to navigate careers in the new landscape is a big topic of discussion among doctors and interns alike, they said.

Mayrose Porter, an Austin native who is a student at Baylor College of Medicine in Houston, said she will apply for residency in her home state, but the rest of the choices on her list will only be in states where abortion is legal. In the long term, Porter, a member of Medical Students for Choice, does not expect to practice medicine in Texas.

“The idea that myself and other future doctors are just not going to be here is sad for me personally and sad for the community,” she said, emphasizing that she was speaking only for herself, not Baylor. “There is a certain guilt that I am leaving the community I grew up in.”

In Nebraska, Methodist Health System in Omaha has only two specialists with expertise in high-risk pregnancies who can also perform dilation and evacuation procedures to remove a fetus. The hospital only allows abortion in situations that threaten the woman’s health and life. A group of Nebraska OB/GYNs, including method specialist Emily Patel, has formed a local political action committee to urge the legislature not to pass an abortion ban.

They warn more generally about the “downstream effects” of an abortion ban on reproductive health.

A common example is for a woman whose water has broken around 18 or 19 weeks. The risks of continuing the 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 under the proposed Nebraska abortion ban, Patel said, it’s not clear whether even explaining termination options in such a circumstance would be legal.

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

It’s the kind of legal uncertainty and danger that top doctors will try to avoid, she added: “These states where bans go into effect will have trouble recruiting the next generation of OB/GYNs.”

Abortion opponents said concerns about legal jeopardy and restrictions beyond elective abortions are overblown.

“There’s a lot of mythology and misunderstanding about what this means for reproductive health,” said Sandy Christiansen, an OB/GYN who is medical director of a Maryland Care Net pregnancy center, which encourages women to continue their pregnancies. “There shouldn’t be any problem” in treating a miscarriage with medication or surgery, she said.

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

She acknowledged some confusion: “Hopefully the laws that will come will clarify some of these things.”

Another member of the anti-abortion physician group, Susan Bane, associate professor at Barton College, a small Christian-affiliated institution in North Carolina, said she believes reluctance to move to states with abortion bans will be limited to the small percentage of OB/GYN doctors who wish to perform elective abortions.

“If you’re going to medical school and you want to be an obstetrician and you want to do an abortion, you want to pick a state where it’s 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 answer questions about how they are approaching potential retention and recruitment challenges.

A large health system based in Utah, Intermountain Healthcare, lists 10 open positions for OB/GYN doctors on its website, most of which are specialties it is recruiting for. An Intermountain spokeswoman, apparently inadvertently, included a Post reporter in an email to the public relations team after The Post asked about challenges in filling these vacancies in light of Utah’s abortion law: “We need to strategize a response for to politely decline so we can keep you out of this problem.”

Doctors said they are grappling with the fallout from broadly worded legislation written by politicians without detailed medical knowledge. The environment creates a high level of legal and professional risk for specialists, said David Turok, an associate professor of OB/GYN at the University of Utah who is also a board member of Physicians for Reproductive Health, which supports abortion rights.

“What we have are laws that are not representative of medical practice, that are not framed in ways that we think or talk as medical professionals,” Turok said, “and that makes it confusing.”

Officials in some states are working to clarify how abortion bans will be used. The Louisiana Department of Health on Monday issued a list of 25 fetal conditions that could warrant termination.

The legal uncertainty increases the burden on OB/GYN. The must respond to deliver babies 24 hours a day, emergencies are emotionally stressful, and practitioners face some of the highest rates of malpractice lawsuits and accompanying insurance costs.

The federal government has said the U.S. needs 9,000 more OB/GYNs and that the shortage will reach 22,000 by 2050.

In Michigan, an old, pre-Roe the abortion ban was renewed after the Supreme Court verdict. The looming ban has Tim Johnson, a veteran of high-risk pregnancy care at Michigan Health, considering moving out of state. Although he is 73 and no longer performs elective abortions, he still treats patients and is not ready to retire. If Michigan’s abortion ban stands, he may move to Maryland to practice, he said.

“I always said if (Roe was overturned) quickly like this, it would be terribly disruptive,” he said. “We’re starting to understand how truly disruptive it is.”

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