The Supreme Court ruling overturning the federal right to abortion is likely to curtail the ability to train doctors in comprehensive reproductive healthcare, physicians said Friday.
Roughly 44% of the nation's current obstetric and gynecology residents train in states that are poised to ban abortions, CEO of the American College of Obstetricians and Gynecologists Maureen Phipps said Friday on a call with reporters.
"The impact on physician training will be dire and the consequences will be long lasting," Phipps, who is a physician, said.
Access to abortion training is required in residency programs in order to maintain accreditation, according to the Accreditation Council for Graduate Medical Education. Residents may choose to opt out of such training due to religious or moral objections.
Of the about 6,000 obstetrics and gynecology residents across the country, about 2,600 are located in one of 26 states that are certain or likely to ban abortions, according to an April study by researchers at the David Geffen School of Medicine at UCLA and University of California, San Francisco.
Researchers concluded that the rollback of Roe v. Wade will leave "nearly one half of U.S. obstetrics and gynecology residents without access to this fundamental facet of reproductive care, thus affecting care for future patients."
Jessica Moore, a third-year OB-GYN resident in Florida, said she’s enraged by Friday’s decision eliminating the constitutional right to an abortion and the effect it will have on training.
“These are skills that we need to take care of all of our patients,” Moore said. “The operative skills are the same whether you're providing a termination or whether you're providing a procedure for an early pregnancy loss.”
As abortion becomes a state issue, Moore said she’s concerned about how it will affect her interaction with patients. Florida passed a ban on abortion after 15 weeks, which is being challenged in court.
“I'm terrified of how that'll change my counseling. I'm very comfortable with the way that I counsel patients for their option for termination if it is associated with a genetic defect ... or if they are, God forbid, a victim of rape or incest,” Moore, who also is an organized member of the committee of interns and residents, said.
The Supreme Court ruling raises questions about how training programs can continue to teach abortions in states that enact near or total abortion bans, like in Missouri and Ohio. The Ryan Program helps residency programs across the country integrate abortion care into their teachings with more than 100 Ryan Programs in the U.S., according to the group’s website.
Washington University School of Medicine in St. Louis, which is part of the Ryan Program, said it is working to assess how Friday's decision will affect training programs, according to a statement provided to Healthcare Dive.
Similarly, leaders at Cleveland Clinic in Ohio are still reviewing the decision and how it will impact patients and providers there.
The end of Roe will pose a significant challenge for medical education programs, Jennifer Nelson Carney, a lawyer at the firm Epstein, Becker & Green, who advises hospitals and health systems, told Healthcare Dive.
“Potentially, all abortion-related training may be available in only a limited number of states, which puts strain on those states and providers — in addition to the costs and hassle of moving residents around the country.”
In response to Roe’s fall, the accrediting body has already drafted changes to its requirements to accommodate OB-GYN residents that will train in states with restricted access to abortion.
The proposed revisions aim to maintain comprehensive reproductive healthcare training while also ensuring no resident, physician educator or residency program violates the law, the Accreditation Council for Graduate Medical Education said in a statement.
The proposed requirements now state that if a program is within a jurisdiction that legally restricts abortions, the program must provide access to clinical experience elsewhere, and program support must be provided.
However, researchers cautioned in their April report that it may not be feasible to set up traveling rotations for these residents due to the sheer amount of clinicians that would need to travel — almost half of the OB-GYNs in training. In another complicating factor, researchers said facilities rely on residents to provide clinical care and traveling would likely be disruptive to that care.
For residents unable to travel, the accrediting body proposed that “a combination of didactic activities, including simulation, and assessment on performing a uterine evacuation (surgical and medical) and communicating pregnancy options.”