More on our future doctor shortage

This is unsustainable.

Abortion restrictions have forced Texas obstetrician-gynecology residency programs to send young doctors out of the state to learn about pregnancy termination, a burdensome process educators say is another example of abortion bans undermining reproductive health care.

At least one Houston-area program, the University of Texas Medical Branch, began sending residents out of state this year, to a partner institution in Oregon. Two other local programs, Baylor College of Medicine and Houston Methodist, said they still are working out arrangements for their own out-of-state rotations. McGovern Medical School at UTHealth Houston declined to comment on its plans.

The changes follow revised requirements from the Accreditation Council for Graduate Medical Education, the standard-bearer for residency programs, which maintains that abortion training is essential for providing comprehensive reproductive health care. Requirements updated in September say OB-GYN programs in states that ban the procedure “must provide access to this clinical experience in a different jurisdiction where it is lawful,” with exceptions for residents who choose to opt out.

Experts, however, say it takes month of coordination to arrange a temporary rotation in another state, leaving some inexperienced physicians with few options.

“There is no question that the restrictions in place following the Dobbs decision pose a risk to the training of up to 45 percent of OB-GYN residents who are training in states where abortion care is restricted,” said Dr. AnnaMarie Connolly, chief of education and academic affairs at the American College of Obstetricians and Gynecologists. “The joint efforts of ACOG … and countless residencies in protected states are directly addressing this risk to medical education and training.”

[…]

Arranging an out-of-state rotation is a logistical feat, Steinauer said, as it takes up to nine months to develop a plan for housing, airfare, training permits and other needs.

The university also takes on additional costs. To send two UTMB residents to Oregon for two weeks, it costs $5,216 for housing, $1,689 for airfare and airport transportation, $240 for parking and $370 for training permits, according to documents obtained through an open records request. The Ryan program is paying $1,500 for each resident, while the university picks up the remaining expenses, documents show.

There also is a strain on the host institution, said Dr. Aileen Gariepy, director of complex family planning at Weill Cornell Medicine in New York City. Some programs that offer abortion care may only have the capacity to accommodate their own residents. With a small number of programs left to take on a crush of new learners, “we may be doing a disservice to the training needs of all of our trainees,” she said.

She noted that Weill Cornell does not have the space yet to take on residents from its affiliate institution, Houston Methodist, which has approached the school about an out-of-state rotation.

“This kind of legislative interference in medical care is unprecedented,” she said. “We didn’t have a plan for that.”

[…]

Beyond the immediate challenge of meeting accreditation requirements, some educators publicly have expressed concern that abortion laws will make it harder for Texas to attract and retain OB-GYNs.

Out of nine publicly funded OB-GYN residency programs in Texas, six saw a drop in applicants from 2020 to 2021, the year SB8 was enacted, according to documents obtained by the Chronicle. Seven of those programs saw a drop in applicants in 2022.

Experts caution against drawing conclusions based on those trends. Yaklic noted that the number of graduates interested in OB-GYN programs often fluctuates, and recent changes to the application process may have influenced the data.

Still, at UTMB, many applicants have asked about abortion training during interviews, he said. Even before the Dobbs decision, earlier abortion restrictions caused medical school graduates to favor states that allow the procedure.

See here for some background. It’s certainly possible that we’ll more or less get acclimated to how things are now and the system will limp along as degraded but basically functional, with the bulk of the cost being borne by the people with the least power and fewest resources. It’s also possible, as noted in the comments, that the Lege could pass a bill to outlaw out-of-state abortion training for medical students in Texas, and then we’ll see how bad things can get. All I’m saying is that our state’s forced-birth laws are going to have a negative effect on overall health care, and we are already starting to see it happen.

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