In the Dobbs v. Jackson Women's Health Organization decision in late June, the Supreme Court overturned constitutional abortion protections established in Roe v. Wade. Now, physicians have expressed concerns over potential discrepancies in residency abortion training that might arise in more conservative regions.
Nearly 45% of obstetrics and gynecology residencies are located in states that are likely to outlaw abortions, if they have not already done so. Prior to the Dobbs decision, many residents training under restrictive jurisdictions were already traveling to more lenient, neighboring states to receive more in-depth abortion training, Time Magazine reported.
Benjamin Brown ’08 MD’12, professor of obstetrics and gynecology at the Warren Alpert Medical School, told The Herald that “abortion is essential (and) contraception is essential.”
Brown explained that “because these are types of care that people need consistently throughout their reproductive lifespan, … it is absolutely essential that OB/GYNs are trained to provide this care.”
“Abortion is healthcare. It’s not just an elective procedure,” said Beth Cronin, Rhode Island section chair for the American College of OB/GYNs and associate program director for the University’s OB/GYN residency program. Cronin explained that many complications of pregnancy can only be treated through an abortion.
Mindy Sobota ’95, associate professor of medicine and clinician educator, noted that the decision comes with moral implications for healthcare providers. “When you have a patient who is pregnant who really doesn’t want to be pregnant, and you can prevent so much hardship for that patient, but you’re unable to do that, it’s heartbreaking,” Sobota said.
“The ripple effect from the Dobbs decision is not only going to affect the people immediately impacted today,” Brown added. In coming years, individuals seeking reproductive healthcare might suffer “because their provider couldn’t get (abortion) training when they were in that phase of their career.”
In Rhode Island, abortion rights remain protected through the state’s 2019 Reproductive Privacy Act. The act also ensures that medical professionals across the state can access abortion training of a legally protected caliber. Cronin said that she feels confident that the University’s residency program will continue to provide residents with patient-centered, quality abortion training.
But beyond the Ocean State, prospective reproductive healthcare workers are grappling with the implications of more stringent abortion policies on their medical training.
In an email to The Herald, a medical student in Texas — who requested anonymity for fear of personal repercussions — wrote that they witnessed “tough conversations among physicians about how frustrating the Supreme Court decision was” during a clinical rotation within an OB/GYN department. In Texas, abortions are banned at any stage of pregnancy.
For many patients in places like Texas, traveling out of state is the only means by which they can legally obtain an abortion. “Most patients I have seen do not have the means to travel out of state,” they noted.
With an interest in adolescent medicine, they worry “about the pregnant teens who will no longer have abortion as an option.” But, in any residency program, they maintain that “it’s important for students to be familiar with termination of pregnancy.”
When asked if the new law deters them from pursuing fellowships in Texas, they expressed uncertainty. “It’s important for people who grew up here and are familiar with the politics and culture to stay here as physicians, but the state’s conservative policies make it hard.”
With over 1,000 medical students applying to the Brown’s OB/GYN residency program, Cronin noted that many of the applicants who reside in restricted states are favoring Brown’s curriculum due to the opportunity to provide abortion care under legal protections.
Brown said that, at the University’s medical school, “as our graduating medical students are thinking about where they want to pursue training, they are having to make decisions about whether they feel that they will be able to get comprehensive, medically-accurate, patient-centered care in states where abortion is restricted.” Many of his students are worried that they will be unable to gain such training.
Sobota added that the increase in medical students seeking residency in states with legally upheld abortion rights might lead to a shortage of physicians in states with more stringent reproductive rights. An increasing number of physicians have moved away from states where they could be criminally prosecuted for providing the essential reproductive care to patients who need it.
“If this patient comes in and has this complication, can I do what is medically necessary to save their life, or will I be prosecuted?” Cronin asked. “Where is that line?”
“I am concerned that (physicians) will not feel safe in settings where abortion is highly restricted,” Brown added. This “may lead to a shortage of providers in some of those areas.”
The four healthcare professionals who spoke with The Herald all emphasized the adaptability of the field to abortion restrictions, especially over the last decade.
They said that the medical field has a long history of adapting to support reproductive healthcare. “Providing care in many parts of this country has been a herculean task for a long time,” Brown said. But the Dobbs decision might prove difficult for the field to adjust to.
Sobota said that “a move toward demedicalizing abortion in general” is one way to ensure that changes to medical training do not harm communities in need. This might include increasing advocacy surrounding access to medication abortion pills, she added.
Cronin highlighted the possibility of training out-of-state residents at the University in abortion care as a way to ensure regions with stringent abortion laws still have access to well-trained healthcare providers.
In the University’s internal medicine residency program, Sobota has been “training all primary care residents in medication abortion,” which she described as “unusual for internal medicine.”
“Only a few residencies are really teaching residents and even fewer giving them the opportunity to offer this service in their residency practice,” she explained. “We are working nationally to broaden that training.”
For some doctors, the fear remains that the Dobbs decision may result in a new generation of undertrained physicians.
“I have concerns (that) in five years, in 10 years, in 20 years,” Brown said, “a person who needs abortion care … is going to have someone sitting across the room from them who is not well-trained and who cannot provide that care.”