Abortion Bans Create OB/GYN Residency deserts across the country
Check out the rest of our Campus Dispatch stories here. You can read the rest of Campus Dispatch’s stories by clicking here.
Emily hated abortion when she was a teenager and before she became an OB/GYN resident in Tennessee. Emily was first exposed to abortion by her teachers in high school. It was there that the adult teachers first exposed Emily to the concept of abortion.
“The only encounter that I’d had with abortion was someone showing me very graphic videos that I’m not even certain of now were actual abortions, and being like, ‘Look, isn’t that so scary?'” Emily, who requested to use a pseudonym to protect her anonymity, said.
She stopped identifying as Catholic in college, where, by the time she was 21, she realized her stance on abortion.
“It just clicked,” she said. I was shocked to learn that she wasn’t anti-choice. I am very supportive of others’ choices.”
Her specialty also clicked with her when she did her OB/GYN rotation during her third year in medical school.
“We did a c-section and I thought, ‘That’s metal.'” Emily said, “That was really cool.” Then, after learning more about abortion care, I thought, “Whoa, this is really cool and I feel like I could do this well.” Two years have passed since the Supreme Court overturned Roe V. Wade. This means that two rounds of medical school graduates have applied to residency programs. In states that have banned or limited abortion, there are fewer applicants to residency programs. The Association of American Colleges (AAMC) Research and Action Institute found that this trend continued for the second consecutive year. Programs located where abortion remains legal experienced a 0.6 percent decrease in applicants, but residency programs in abortion ban states experienced a 4.2 percent decrease–seven times greater than in states with no abortion restrictions.
Fourteen states have total abortion bans. Tennessee’s trigger law enacted a total abortion ban shortly after the Dobbs ruling. It has been in effect ever since. In other states, there are gestational limitations that limit how far a woman can go into pregnancy before she is able to get an abortion. Five states have gestational limitations of six to twelve weeks. Abortion is illegal in these five states six weeks after the last period. This occurs before most women know they are pregnant. Six states have gestational limitations ranging between 15 and 22 weeks. World Health Organization states that gestational limitations may force women to travel to places where abortions are legal or to obtain unsafe, illegal abortions. Despite a slight increase in OB/GYN applications, states that have banned abortions experienced a 6.7 per cent decrease in OB/GYN applicants from the previous cycle. States without restrictions saw a 0.4 percentage increase in OB/GYN applicants. The number of OB/GYN applicants has increased by 0.6 per cent. )
“While almost all residency positions are filled due to a shortage of training positions, states with reproductive health-care restrictions may have a harder time attracting candidates of choice.”
– Kendal Orgera, lead research analyst for the AAMC Research and Action Institute
This does not mean residency positions go unfilled in states with abortion restrictions, but many of these residents choose to leave and practice medicine elsewhere, according to Kendal Orgera, lead research analyst for the AAMC Research and Action Institute and co-author of the analysis.
“While almost all residency positions are filled due to a shortage of training positions, states with reproductive health-care restrictions may have a harder time attracting candidates of choice,” Orgera told Rewire News Group. “Because about half of trainees stay to practice in that state, this may have long-term implications for the ability to serve patients across communities in some states.”
Dobbs has exacerbated the issue of health-care or maternity-care deserts in parts of the United States, which means people must travel far distances, sometimes outside of their home states, for various kinds of OB-GYN services–not just abortions.
“The most obvious type of care you have to leave the state to get is abortion care,” said Dr. Nikki Zite, professor and vice chair of the University of Tennessee’s Graduate School of Medicine OB-GYN department. “But if there’s not an OB-GYN in your county because OB-GYNs either are retiring and you can’t replace them or people are leaving because they’re afraid of being criminalized, then there’s not even somewhere to go for contraceptive care or other OB-GYN care.”
The reality of being an OB-GYN resident in an abortion-restrictive state
Jonathan Riggs/Shutterstock
Residents have limited control over where their training will be completed. The Match is a placement process that requires medical school graduates to interview and apply at several programs in their chosen specialty, and then go through the application and interviewing process. When an applicant signs up to The Match, they are bound by a contract which binds him or her to the program that matches their profile. The applicants rank the programs that they interviewed with, and the programs rate the applicants. On Match Day applicants will open envelopes to reveal their algorithm-determined placement for the next three years of medical training. Residents can be placed in programs that they didn’t want, but which train them for the specialty they desire. Emily was one of those residents. Emily applied to every Ryan program, but OB/GYN is a highly competitive specialty. To widen her chances of matching, she applied to one non-Ryan program in Chattanooga.
“I had preferences and matched at my last ranked program, the only non-Ryan program that I interviewed at,” Emily said. “I was obviously devastated by that, because I really thought I would match at one of my top programs.”
Still, Emily was thankful to match at a specialty she loved and determined to make the best of her residency.
Hospital staffs are hierarchical, with the lowest-ranking residents who have been there the least time doing grunt work and reporting to their attending physicians. Residents are given a great deal of responsibility despite having little control over the patient’s care and receiving little respect from staff. Residents are also burdened with crushing student loan debt, which keeps them on the path of medicine in order to pay off. Emily stated that you are paid very little per hour. You’re at the mercy of your program attendings, administrators and what they think is right. You’re really at the mercy of your program attendings, the administrators, and what they think is right.”
Taking initiative to get the training they need
Austen Risolvato/Rewire News Group
As residents train to become doctors, they do not want their residency limited by abortion restrictions.
“Many want to train at programs where they can train on the full scope of health care, including abortion access,” Zite said.
OB-GYN residents in restrictive states are forced to leave the state to fulfill the graduation requirements set by the Accreditation Council for Graduate Medical Education (ACME). ACME requires OB/GYN residents have access to a residency that offers abortion care. The resident’s institution is required to support the residents in this endeavor. “I wanted to become an all-star,” said Emily. “I wanted to be a varsity-level abortion provider, and I was never going to get that in Chattanooga.”
After the Dobbs ruling in June 2022, Emily began reaching out to programs around the country for a visiting resident rotation. Emily contacted over 30 institutions, clinics and individuals, but either got no response, or was told that they couldn’t accommodate a visiting residency. In May 2023 she finally had a break. Emily’s fight to receive the abortion training essential to her career did not end there. Emily’s fight to get the abortion training she needed for her career didn’t end there. The GME office told her that it couldn’t spend federal funds on abortion care. Without getting paid, Emily could not keep up with her loans, and she was running into problems figuring out state insurance.
“The logistics of getting there were so hard,” Emily said. She had to figure out how to pay for her bills and get to Portland on top of all the other stresses she faced as a resident. Luckily, she received a $1,000 grant from Planned Parenthood, and Oregon Health and Science University paid the rest of her salary.
Despite the long road to Portland, Emily’s time there proved something crucial.
“It confirmed that I can do this advanced gestational age abortion care, and I think I’m the right person for it,” she said.
Emily said her residency program in Chattanooga is more conservative than she thought it would be, and she has worked with outwardly anti-choice people. Emily says she has to walk a thin line between what she believes is best for her patients and not causing upset with attending physicians. “So many people in the abortion world work in Oregon and California and Chicago, and it’s like abortion Disneyland.
They can do whatever they want, and they are well supported by their community and their other faculty members.”
Zite said clinicians can experience moral distress in the face of abortion restrictions.
“The more we learn in medicine, the more we want to be able to take care of situations that we encounter with our patients,” she said. “We can tell a patient that their pregnancy is impacted by a fetus that has no brain or no skull, but we can’t offer them termination of that pregnancy in Tennessee.”
Emily plans on leaving Chattanooga to practice medicine and looks forward to being able to provide the care she wants, but she said it’s important to not let stereotypes about Southern people being “just a bunch of rednecks who don’t know any better” justify abortion restrictions.
“These communities are full of very kind people who deserve the same level of care that is available to them as people in Oregon, New York, and California,” Emily said.
As Emily approaches her final year of residency, she plans to provide all the care she can as an OB-GYN resident in a place where abortion is banned.
“These areas are so deserving of passionate providers who actually care and are knowledgeable of their culture and community,” Emily said. “They’re deserving of providers who are educated on that and feel strongly about helping them in the same way they do people in more liberal communities.”
