American doctors must overcome increasing hurdles to receive basic abortion training after Roe

The fall of Roe v Wade turned Dr. Jasmine Chan’s career upside down.

As a medical student, born in Texas popular to offer abortions as an OB-GYN. But in 2022, as Chan prepared to apply for a residency — a kind of yearlong internship after medical school — she worried that the quirks of the placement process would hold her back in Texas, which banned abortions after the U.S. Supreme Court overturned Roe.

“I met with my advisors and I had really strong heart-to-heart conversations about how I couldn’t see myself practicing medicine if it didn’t include an abortion,” Chan said. Instead of becoming a gynecologist, she decided to become a general practitioner – a less competitive specialty that increases her chances of finding residency in a state that protects access to abortion.

Now, two years into her residency program in New Jersey, Chan is preparing to finally get the training she’s wanted her entire career. But like many other doctors undergoing abortion training after Roe’s death, she will still have to overcome hurdles that didn’t exist two years ago.

In the coming months, in addition to her daily work, Chan will undergo abortion training at two different clinics, the nearest of which is three hours away. In the fall she will have to move completely for training in a third clinic.

She’ll have to jump through all those hoops because there simply aren’t enough clinics left to train America’s future doctors on a relatively quick, simple procedure. that one in four women will experience at some point in their lives.

When the U.S. Supreme Court overturned Roe exactly two years ago, it paved the way for more than a dozen states to ban nearly all abortions. It also plunged the American medical training system into chaos. Because a lot Hospitals have refused this for a long time perform most abortions, residents who want to learn the procedure often have undergone training at abortion clinics. But now those bans have been lifted so many clinics, there are just not enough facilities to train all residents.

“Clinical training sites are already overloaded just trying to meet patient needs, making it much less likely that they will accept as many trainees or as many days as they used to,” said Latona Giwa, executive director of the Midwest Access Project, a nonprofit organization that helps a range of health care professionals receive training in reproductive health care, including abortion instruction.

But if they don’t, she said, “We will not have the next generation of abortion providers.”

Doctors across the country already say the abortion ban has forced them to delay caring for pregnant women in medical emergencies. But as abortion training becomes scarcer, or accessible only to doctors like Chan, who have the time and money to overcome a logistical obstacle course, fewer doctors will have the skills to deal with dangerous pregnancy complications, including miscarriages, which often occur with receive the same treatment. procedures used in abortions.

Abortion training may soon become even harder to access. Project 2025, a playbook written by the influential think tank the Heritage Foundation in anticipation of a second Donald Trump administration, recommends that the Department of Health and Human Services “ensure that the training of medical professionals (doctors, nurses, etc.) and doulas are not used for abortion training.”

Project 2025 too recommends punishing institutions that fail to survive easier for medical professionals to refrain from abortion training for reasons of conscience.

Although the language is ambiguous, enforcing it could ultimately lead to banning or even criminalizing abortion training, said Mary Ziegler, a professor at the University of California, Davis, who studies the legal history of reproduction.

“It sounds like, ideally, they want to defund any kind of federal support, direct or indirect, for training or essentially have some kind of Hyde Amendment,” Ziegler said. referring to a nationwide rule banning the use of federal dollars for abortions. Residency programs and medical schools, like virtually all American educational institutions, receive funding from the federal government.

“It’s just so siloed.”

It has never been particularly easy for American doctors to learn to perform abortions. The hospital systems that run medical schools and residency programs are deeply hierarchical institutions that rely on public dollars — and so they tend to shy away from issues as controversial as abortion. In 1992, twenty years after the U.S. Supreme Court first decided Roe, only 12% of gynecology care programs routinely offered training in abortion. Three years later, the Accreditation Council for Graduate Medical Education decided for the first time to mandate OB-GYN residency programs teach physicians how to perform abortions.

Still, as of 2018, only 64% of OB-GYN residencies offered routine, dedicated abortion training. In the meantime, hospitals provided only 3% of all abortions – and usually only in high-risk pregnancies or cases of fetal abnormalities. That left the burden of training to abortion clinics.

To help close the gap, there is a national initiative called Ryan Residency Training Program (RRTP) helps provide OB-GYN residents with clinics for training.

In 2021, when Texas passed a six-week abortion ban, the RRTP stepped up to help residents leave the state for abortion training. But the process turned out to be a bureaucratic nightmare. while programs and clinics struggled to obtain the proper paperwork and regulatory approvals.

“Oh my God, it took six months before even the first resident could travel,” said Dr. Jody Steinauer, leader of the RRTP. “That’s how hard it is to set this up.”

After Roe fell, the Accreditation Council for Graduate Medical Education announced it would require OB-GYN programs to offer residents training in abortion or send them to states where they can get it. However, a council spokesperson declined to say how many gynecology programs currently met that requirement. There are now nearly 1,300 gynecologist residents living and working in states with near-total abortion bans—all of whom must leave the state for hands-on training in abortion.

The RRTP has helped 16 programs in states with abortion bans establish partnerships to help residents travel out of state for training.

States with abortion bans, which typically have among the highest maternal mortality and morbidity rates in the country, now face a growing shortage of obstetricians and gynecologists. There are even fewer gynecologists signing up for residency programs therein states. For example, Louisiana experienced a 17% decline; Alabama experienced a 21% decline; Missouri, 25%.

Besides gynecologists, family medicine physicians are the specialists most likely to learn how to perform abortions. But they are not required to complete that training — and those who want to, even in blue states, cannot necessarily acquire it.

“There’s just a lot more competition for training spots,” says Erica Chong, executive director of the Reproductive Health Education in Family Medicine (Rhedi) program, the family medicine version of the RRTP.

Dr. Amy Hoffman is a family medicine physician who lives in Pennsylvania, a state that allows abortions. But while her institution supports her desire to learn to perform abortions, it does not have faculty with the skills to teach her. At this point in her residency, she doubts she will get the training.

“I need to find a month where I can leave my residency and give myself months and months to finalize the medical agreements,” Hoffman said.

Her daily work is hard enough. Residency programs allow residents to work up to 80 hours per week; they can also make them work 28-hour shifts.

“Every doctor in every specialty has seen a cesarean section, an appendectomy or treated diabetes, but the majority of doctors have never seen abortion care or performed the procedure,” Hoffman said. “It’s just so isolated and inaccessible to both patients and students.”

A leap into attention

Advocates in the medical education community are pleased that, since Roe fell, so many new providers want to be trained in abortion. A handful of new residency programs have already joined the Rhedi program. Steinauer said there is now “a lot more collaboration, within states, within regions, at the national level” among agencies looking to expand their abortion training.

The Midwest Access Project received nearly 50 applications in the first application cycle after Roe’s demise. At the time, that was the highest amount it had ever received.

Now the nonprofit receives anywhere from 100 to 200 applications each cycle. Only about 50 people can still be admitted per cycle, but it gives Giwa hope.

“That’s a huge number with a big impact because every time one abortion-trained provider is added to a community or region, a state, they can train ten times as many providers and ideally they can do that in primary care,” Giwa said. She envisions a future in which… “You can just get your allergy medicine and your abortion pills from the same person, and it’s not such a huge additional ordeal.”