Medical residents from other states are receiving instruction at the University of New Mexico Center for Reproductive Health in response to the U.S. Supreme Court’s Dobbs decision.
One way that the U.S. Supreme Court’s Dobbs decision, which overturned Roe v. Wade last year, has impacted abortion care across the U.S. is in medical training. Obstetrics and gynecology students studying in states where abortion is banned can no longer receive integrated abortion care training into their years of study. Dr. Jody Steinauer, director of the University of California-San Francisco Bixby Center for Global Reproductive Health, said during a press conference this month that OB-GYN medical students now have to travel to states, such as New Mexico where abortion is legal, to study abortion care.
“Normally, an OB-GYN provider would receive integrated abortion care training over the years of the student’s studies. Now, medical students in states where abortion is banned are only receiving about four weeks of training,” Steinauer said.
Dr. Amber Truehart, medical director of the UNM Center for Reproductive Health, said the center is “getting a variety of people looking for abortion training.”
Truehart said medical residents studying at medical schools in states where abortion is banned are now coming to the UNM Center for Reproductive Health for a one-month rotation to receive the training. Truehart said this is happening nationally in other states where abortion remains legal.
She said, in addition, students who are not just OB-GYN residents are applying to the UNM Center for Reproductive Health for abortion training. Those students include psychiatric residents and nurse midwives.
“They’re reaching out, trying to figure out medication abortion or surgical abortion; how they can help,” Truehart said.
Truehart said psychiatric providers already provide counseling and prescribe medications to help their patients. Medication abortion is a two-step regime regulated by the U.S. Food and Drug Administration. The FDA loosened some of its restrictions around prescribing the first of the two drugs, mifepristone, earlier this year. Currently, mifepristone can be prescribed and dispensed by a health care medical provider who meets certain qualifications and is certified by the FDA’s mifepristone regulations program.
Rebecca Griffin, a spokesperson for the Bixby Center, said that after just one year since the Dobbs decision, we’re “only beginning to see the impacts on abortion training and what that means for the workforce and abortion care.”
Researchers at the Person-Centered Reproductive Health Program at the University of California-San Francisco recently published a paper in The American Board of Family Medicine about the potential of integrating abortion care into family practice medicine.
The researchers found, when they interviewed a small cohort of family physicians in 2019, that many felt that abortion fits within the scope of their care. But the practice has become a specialized form of care almost exclusively managed at clinics, so family physicians don’t practice it.
The researchers also found that family physicians are, at times, frustrated that they can’t offer abortion care since they usually develop relationships with their patients. The researchers also noted that if family physicians did offer such care, it could help to alleviate the abortion desert issue that impacts rural parts of the U.S., including New Mexico.
Truehart said that instead of the Dobbs decision instilling fear for providers, the opposite effect has happened.
“These kinds of laws have made people vocal and empowered, especially in New Mexico. The laws protect us here. Here people feel empowered to see what kind of role they can play,” Truehart said.
Truehart said abortion access has been under attack for a long time and that abortion was difficult for many individuals to access before the Dobbs decision sent the question of legality back to states to decide.
“People have potentially been thinking about it (for) a while. Dobbs pushed them to be more vocal and forward facing,” Truehart said.
A double standard of care?
For medical professionals in states, such as Texas, where abortion is banned, the Dobbs decision has led to moral distress for many in the profession.
Dr. Tony Ogburn, a general OB-GYN physician now located in south Texas, said the Dobbs decision has changed many things about the practice of care. Before relocating to south Texas, Ogburn worked for Indian Health Services in Gallup, then moved to UNM where he spent 18 years.
Ogburn said the Dobbs decision has increased challenges to accomplish higher levels of abortion care because it is simply not available because of the law in some states and, sometimes, patients can’t travel to states such as New Mexico where abortion is still legal.
Ogburn said the situation causes moral distress for both practitioners, as well as for students studying in anti-abortion states.
Ogburn said the distress doesn’t just impact the OB-GYN provider but all the medical staff who interact with a patient. He said that in the facility where he works, nurses and anesthesiologists become frightened to be involved in providing care for a patient who might be suffering an ectopic pregnancy, which is a nonviable pregnancy outside the uterus that could cause life-threatening bleeding in the pregnant person.
“There’s a significant amount of angst often. It starts to wear on a lot of people,” Ogburn said.
Flor Hunt, executive director of Training in Early Abortion for Comprehensive Healthcare (TEACH), said that abortion is so safe, many medical students may not witness complications if their training is not integrated into years of medical study.
“Learning to empty a uterus is not brain surgery. It is so safe, you need a lot of experience under your belt [to see complications occur],” Hunt said.
Steinauer said there are about 30,000 medical students who are being educated to become doctors in the most restricted states.
“I’m worried these doctors will finish their training without basic knowledge of abortion care,” Steinauer said.
Truehart said the fact that there could be varying levels of abortion care training for OB-GYN medical students as a result of states banning abortion since Dobbs is very concerning.
“It makes me very concerned for women,” Truehart said.
She said this could affect pregnant people, even if they live in states, such as New Mexico, where the next generation of OB-GYN medical students are receiving integrated abortion care into their years of training.
“If you’re in the Dallas airport and you have pregnancy complications, you could get a doctor who’s only got one month of training taking care of abortion complications,” she said.
Hunt said that in abortion safe-haven states abortion clinics are overwhelmed with the volume of patients and they “don’t have the capacity to take on learners under their belt.”
Truehart said that in Albuquerque, more clinics have opened since Dobbs and more private clinics are considering becoming available to medical students who need the one-month training.
Other changes since Dobbs
Truehart said another result of Dobbs is that the UNM Center for Reproductive Health is now seeing a disproportionate number of very complex patients. The patients are often now at a higher gestational age in pregnancy and requiring more complex care, she said.
Truehart said that when the Texas six-week ban went into effect in 2021, there was a “big wave of patients,” but since Dobbs, it’s “not just the volume is higher, but they are also more complicated patients.”
She said the center also has to do more work to make sure the patients are safe and obtain their medical records from out of state.
Truehart said another difference since Dobbs is that the UNM Center for Reproductive Health has become part of a system of university hospitals around the country that offer abortions on a sliding scale because the pregnant person coming from out-of-state may lack insurance. She said the abortion care takes place in the hospital and the sliding scale fee is also available for in-state patients as well.