OB/GYN Residency Programs Face a Difficult Decision About Abortion Training

Special for Infobae of New York Times.

Many medical residency programs that train the next generation of obstetricians and gynecologists face a treacherous decision.

If they continue to provide abortion education in states where the procedure is banned, they could be prosecuted. If they don’t offer it, they risk losing their credentialing, which in turn would make their residents ineligible for specialty board certification and jeopardize the hiring of faculty and medical students.

The dilemma became apparent last month, when the Accreditation Council for Graduate Medical Education formally reaffirmed its long-standing requirement that OB/GYN residency programs offer abortion education.

“A legal body, the state, says abortion is a crime, and an accrediting body says it’s a critical part of training,” said Mary Ziegler, a law professor at the University of California, Davis, who specializes in the history of abortion. “I can’t think of anything like that.”

Teaching the procedures used for abortions has long been a required element of the OB/GYN residency curriculum in the United States. “We believe that abortion, or the evacuation of the uterus, is a fundamental procedure for OB/GYN. It is also used to treat miscarriages and pregnancy complications such as infections and bleeding,” said John Combes, a spokesman for the council, which accredits more than 12,000 medical residencies. “So it’s a technique that you have to learn.”

The council stated that, to avoid running afoul of state laws restricting abortion, a program can maintain accreditation by having residents rotate to a clinic in a state where abortion is legal; however, some program directors fear that path is also fraught with legal dangers.

More than 20 program directors and residents of states with abortion restrictions declined to be interviewed by The New York Times about their plans, based on advice from lawyers. Those who spoke emphasized that they were speaking on their behalf and not as representatives of their institutions.

Some faculty members said that as lawmakers increasingly seek to prevent citizens from having out-of-state abortions, they feared setting up training in other states could make them vulnerable to private lawsuits or even being charged with complicity in a crime. The attorneys general of Oklahoma, Tennessee and Texas, among the states that ban abortion, did not respond to requests for comment on whether they would pursue such cases.

Ken Paxton, the Texas attorney general, has already faced the council. Last year, before abortion rights were eliminated, he issued a ruling saying that Texas residency programs did not have to make abortion mandatory training.

A recent analysis published in Obstetrics and Gynecology estimated that about 45 percent of the 286 U.S. OB/GYN residency programs were located in states that were likely or certain to ban abortions, affecting about 2,600 of the 6,000 residents from the country. The authors reported that, in 2020, 92 percent of residents said they had access to abortion education, a figure they predicted could now plummet to 56 percent.

Nikki Zite, a professor at the University of Tennessee School of Medicine’s OB/GYN residency program in Knoxville, Tenn., where doctors who perform abortions can be charged with a felony, said her program has been looking for rotations outside the state for its residents.

“However, the states around us are unconvincing,” he said. “Virginia and North Carolina seem safe for now, while South Carolina comes and goes. And everything could change in an election cycle. The strategy of ‘wait and see’ is not the best to practice medicine and to train residents who will practice medicine”.

Christina Francis, incoming director of the American Association of Pro-Life Obstetricians and Gynecologists, which practices in Fort Wayne, Indiana, a state whose near-total abortion ban was lifted by a judge, called the council’s accreditation requirement coercive.

“Instead of trying to force training programs to arrange for residents to be transported out of state for abortion training, the council should completely reevaluate its requirement,” he said.

Although programs must offer such training, the council allows a resident to opt out for religious or moral reasons.

Francis asserted that abortion training is not essential to OB/GYN practice and that residents could learn how to evacuate the uterus by managing miscarriages.

“This claim that if we don’t let abortions happen, doctors will be less trained is completely false,” he said.

Kate Dielentheis, associate director of an OB/GYN residency program in Milwaukee, Wisconsin, where abortion is prohibited, said residents who typically treat patients in a hospital rarely have the necessary volume of miscarriages in that setting to become competent, which is what they would earn during a rotation at a clinic that provides abortion care.

“What happens when there is a complication?” he asked. “That’s what volume in medical training is all about. It’s about being able to anticipate those complications and knowing how to handle them.”

His educational program is in negotiations to place residents on rotations at an Illinois clinic. He’s also dealing with other fallout: Dielentheis said a doctor he had been flirting with to join his faculty just turned him down, citing Wisconsin’s ban.

One center, the Kenneth J. Ryan Residency Training Program in Abortion and Family Planning at the University of California, San Francisco, which has provided training to departments across the country since 1999, reported that 22 of its program partners were in states with abortion restrictions. It’s helping connect many of them with programs in abortion-protected states.

The practical hurdles are daunting, including overwhelming demand for limited seats, differing state licensing and malpractice insurance regulations, and housing costs.

With applications for next year’s resident class underway, even as state abortion laws change, program directors in restricted regions are grappling with what guarantees on abortion training they can give candidates.

This is one of the reasons many medical students have said they are only applying to programs where abortion is legal. Public health experts predict that, in a few years, patients in states where abortion is prohibited, where the ranks of obstetricians are already thinning, will face even greater obstacles to accessing services. reproductive health services.

An accreditation board review committee debated whether the simulation model, a staple of medical education that is a precursor to direct care, would be enough for residents who can’t travel to another state. For example, in abortion training, residents watch videos and practice with low-tech uterine models, including papayas. The committee decided that simulation was not an acceptable substitute.

The council has made abortion education a component of its family planning requirements since at least the mid-1980s; But in the mid-1990s, as the number of abortion clinics dwindled and threats against providers increased, the council made its requirements explicit.

Around that time, Congress passed another of the “federal conscience” provisions that ensured that programs (as well as individuals) that refused to perform abortions, and thus risked losing accreditation, could not be discriminated against for means such as loss of federal or state funding.

Even if funding is guaranteed for programs that resist offering abortion rotations, the effect of citation, parole or denial of accreditation by the council is powerful, said Greg Care, an attorney representing residents. . Medical students will not apply to a program without accreditation, he noted, “and many academic medical centers rely entirely on residents because they are cheap labor.”

The new laws have already made it harder to hire medical students in states that ban abortion. Zite, treasurer of the Tennessee chapter of the American College of Obstetricians and Gynecologists, fears that programs that offer the full set of training will drive top candidates away from programs like hers. Although many medical students apply to her program to work with Appalachian patients, she said, “Will they continue to enroll with us, hoping we’ll be able to jump through all the hurdles to provide out-of-state training?”

The uncertainty has also rattled medical students, who typically apply for residencies in their final year of college. OB/GYN is a competitive field. According to the National Resident Matching Program, last year there were 2,044 OB/GYN applicants for 1,503 openings.

Ariana Traub, a second-year medical student at Emory University in Atlanta, helped conduct a survey of third- and fourth-year medical students about the impact of abortion turmoil. Although more than three-quarters of the 500 responses came from students applying to specialties other than OB/GYN, overall, 60 percent said they would not apply to programs in states with abortion restrictions.

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