Editor’s note: This is the second in a two-part series on the implications for health care following the decision to overturn Roe v. Wade.
Alana Carstens Yalom is a third-year obstetrics and gynecology resident at the University of New Mexico. She attended medical school at Tulane University in New Orleans and had the idea of returning to Louisiana for her medical practice. But not anymore. She wants abortion care part of her OB/GYN practice, and Louisiana has a ban.
“Now I don’t even think that’s an option for me,” she said in a report by Christopher Rowland in The Washington Post.
Physicians, medical students and medical residents have said in interviews that they are concerned about the impact that the overturning of Roe v. Wade would have on the profession. How to navigate careers in the new landscape is a major topic of discussion among physicians and trainees.
Mary Rose Porter, a native of Austin and a student at Baylor College of Medicine in Houston, said she would apply for residencies in her home state, but the rest of the choices on her list would only be for states where the abortion is legal. Porter, a member of Medical Students for Choice, said that in the long run, she didn’t expect to practice medicine in Texas.
In Nebraska, maternal-fetal specialist Emily Patel joined a group of obstetrician/gynecologists forming a local political action committee to urge the state legislature not to ban abortion. They warn of the “downstream effects” of an abortion ban on broader reproductive health.
A common example is of a woman whose waters broke in her 18th or 19th week. Health care risks for the mother and fetus of continuing this pregnancy include developmental problems for the fetus and infection for the woman.
But under Nebraska’s proposed abortion ban, Patel said, it’s unclear whether even explaining termination options in such a circumstance would be legal.
“A doctor (doesn’t)…wants to be in a position where he’s going to be criminally prosecuted for providing routine care and advice,” Patel said. “Those states where the bans go into effect will struggle to recruit the next generation of OB/GYNs.”
Hospital systems in states where abortion is restricted, including Texas, Utah, Mississippi, Alabama and Ohio, did not respond to requests for comment or declined to answer questions about how which they will address the challenges of retention and recruitment.
Abortion opponents say concerns about legal risks and restrictions beyond elective abortions are overblown. One such naysayer is Sandy Christiansen, an OB/GYN who serves as the medical director of a CareNet pregnancy center in Maryland that encourages women to continue their pregnancies.
“There shouldn’t be any problems treating a miscarriage with medication or surgery,” she said, but acknowledged some confusion. “Hopefully the laws that come will clarify some of these things.”
However, the prospect of clarifying the laws offers little comfort to doctors who are now faced with crucial decisions that could mean a patient’s life or death solely depending on where they are treated.
Officials in some states are working to clarify how abortion bans will be enforced. The Louisiana Department of Health recently released a list of 25 fetal conditions that would warrant terminating a pregnancy.
Legal uncertainties imposed by states restricting access to abortion only add to the burden on OB/GYNs who pay some of the highest rates of malpractice and accompanying insurance costs.
The federal government has said the United States needs 9,000 more obstetricians/gynecologists and the shortage will reach 22,000 by 2050.
In Michigan, an old pre-Roe abortion ban was renewed after a recent court ruling. The impending ban prompted Tim Johnson, a high-risk pregnancy care veteran at Michigan Health, to consider leaving the state. If Michigan’s abortion ban persists, he said he may move to Maryland.
“I always said if (Roe) got knocked down quickly like that, it would be terribly disruptive,” Johnson said. “We’re starting to understand how disruptive that really is.”
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