Training and Workforce after Dobbs

Overview

Obstetric and gynecologic care is a critical aspect of overall health care for millions of Americans and their communities. Recently, however, legislative interference in the form of abortion bans has made it harder for obstetrician–gynecologists to maintain their practices and for medical trainees to receive comprehensive training in obstetric and gynecologic care. In order to ensure that this critical field of care is taught comprehensively and is sustainable for current and future generations of health care professionals, those who choose this specialty must have access to comprehensive education in obstetrics and gynecology and be supported through public policies that promote the sustainability of practice.

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Dobbs Impact

In the wake of the decision in Dobbs v. Jackson Women’s Health Organization, which overturned Roe v. Wade, the landscape of obstetric and gynecologic care shifted drastically. New challenges became apparent, and long-standing difficulties were exacerbated.

In states with abortion bans, medical students and residents are not able to receive the hands-on training they need in order to provide patients with comprehensive care. Medical students and residents play a crucial role in delivering patient care, so any restrictions on their education directly and immediately affect patient care. Abortion bans are also affecting established health care professionals’ decisions about where to train and practice. For example, hospital administrators in rural Idaho were forced to close their labor and delivery unit, as hostile abortion restrictions and a lack of qualified and available physicians made provision of care unsustainable for the small hospital. Those who live in that community now must travel at least 45 minutes to get to the nearest city with a labor and delivery unit.

The Dobbs decision has cast a shadow of uncertainty over medical students, residents, and physicians in practice alike. Nearly 60% of respondents in a survey of almost 500 third- and fourth-year medical students with interests across specialties reported that they were unlikely to apply for a residency in a state with abortion restrictions. And in a national survey of nearly 600 obstetrician–gynecologists, 55% of respondents reported being concerned that abortion bans would affect whether new obstetrician–gynecologists would enter the field.

What Is At Risk?

Physician Skill Sets

When training and educational curricula are determined by anything other than science and evidence, medical students, residents, and practicing physicians’ knowledge base and ability to administer the full scope of patient care are diminished. Abortion is an essential part of reproductive health care and cannot be separated from the full scope of obstetric and gynecologic care—and the training required to provide abortion care also imparts other equally necessary skills.

For example, abortion training teaches skills in uterine evacuation that are used to manage miscarriages and gives trainees the opportunity to develop and hone their ability to provide trauma-informed care, which is critical to all forms of obstetric and gynecologic practice.

Obstetric and Gynecologic Careers

In the first year since the Dobbs decision, many obstetrician–gynecologists have suffered the brutal compounding blows of having their expertise undermined, being forced to navigate a severely restricted version of their practice, and watching their patients suffer as they are told that they cannot receive the care they need. Sustaining a career in obstetrics and gynecology is difficult enough already; adding the burden of moral and emotional injury that occurs when clinicians cannot care for their patients in a way that is consistent with best medical practices and their ethical obligations makes practice even more challenging.

Access to Care

Obstetrician–gynecologists are already reporting that they have felt forced to leave their state of residence because of the sudden burden of severely restrictive abortion bans. As of 2022, about 35% of counties in the United States were classified as maternity care deserts—defined by March of Dimes as areas with no hospitals providing obstetric care, no birth centers, no obstetrician–gynecologists, and no certified nurse–midwives. Thousands of people already lack access to obstetric and gynecologic services, and even more may find that their communities become care deserts as obstetrician–gynecologists relocate to states in which they are able to practice guided by the full extent of their expertise and experience rather than by medically unnecessary ideology-based restrictions on care.

Patient and Community Health

People in all communities depend on reliable access to physicians who are trained in all aspects of obstetric and gynecologic care and can provide the best evidence-based care possible through patient-centered shared decision-making. Since Dobbs, relocations, restrictions in care and education, and violation of the privacy at the foundation of the patient–physician relationship have directly harmed patients, families, and communities.

Recommendations

It is critical that patients retain access to obstetric and gynecologic care; therefore, it is critical that physicians be able to continue to provide that care and that medical students and residents be able to learn to provide that care. Without protections for comprehensive education in obstetrics and gynecology and support for policies that make long-term practice of obstetrics and gynecology feasible and sustainable, students, residents, physicians in practice, patients, and communities will all suffer.

What can educators and institutions do to provide residents and medical students with comprehensive education?

• Work with education-focused organizations to identify innovative approaches to training, including connecting trainees in abortion-restrictive states with programs that provide access to training
• Identify accessible trainings that provide essential information about abortion care
• Register their residency programs to access the Patient-Centered Abortion Care Education (PACE) curriculum. Hosted by Innovating Education in Reproductive Health, PACE is a free program that offers the essentials of abortion care education, such as medical knowledge, technical skills, and evidence-based counseling and practices.

What can policy makers do to support sustainable obstetric and gynecologic practice?

• Restore access to abortion and ensure that medical decisions are made solely between a patient and their trusted health care professional
• Secure and create funding opportunities that increase the capacity of training programs in states that do not have abortion bans
• Protect residents and medical students’ ability to access training in abortion care outside their home state
• Promote and support efforts to identify and increase access to care in areas with shortages of obstetric and gynecologic care professionals and areas with shortages of in-network obstetric and gynecologic care professionals
• Provide protections for patients who seek abortion care outside of their home state
• Preventing patient records on reproductive care from being shared across state lines without their consent
• Protect providers from civil and criminal penalties for providing abortion care to patients who go out of state for abortion care
• Permit qualified advanced practice clinicians to provide abortion care