Will a Post-Roe world cause an OB/GYN brain-drain?

Yes.

This consequence of overturning Roe v. Wade is not getting enough attention.

I’ve participated in several meetings with OB/GYN colleagues since the Supreme Court ruled that the state’s interest in a pregnant person’s health and future is more important that the individual’s right to privacy and autonomy. I’ve heard an array of alarming remarks.

Our world practicing obstetric care has become a living hell.

– OB/GYN in Mississippi.

Medical students don’t want to rank our OB/GYN residency.

– Residency program in the South with an abortion ban.

I thought I was going to become an OB/GYN, but now I’m not so sure.

– Medical student in Louisiana.

Some people think that abortion restrictions only affect people wanting to terminate their pregnancies. They do not.

These restrictions impact all potential patients seeking gynecologic care and the physicians serving them. Why? Training. And access. OB/GYNs gain certain skills needed to manage pregnancy complications by managing abortion care.

With current and pending abortion restrictions, 45% of OB/GYN programs will no longer offer training in abortion skills which are the same as miscarriage management skills. Since 10% of clinically recognized pregnancies end in miscarriage, these skills save lives.

Many medical students have already said they are now afraid to enter the field of OB/GYN (with potentially criminalized care), and OB/GYN residents have said they don’t want to train or practice in states with anti-abortion laws.

This could result in certain states having increased numbers of pregnancies because of lack of abortion access, fewer OB/GYNs, and less skilled OB/GYNs.

This is not a good combination for anyone who seeks OB/GYN care, whether pregnancy related or not. It’s not good for people who seek care for fibroids or abnormal bleeding, or who need surgery on their ovaries, uterus, cervix, vulva, and vagina. There will be increased waiting times—among other consequences.

The co-chair of an ACOG (American College of Obstetricians and Gynecologists) committee, Dr. Constance Bloom said, “…. We are very concerned that without adequate training and access to care for these patients, the maternal mortality rate will rise.” (OB.GYN. News, June 2022).

The maternal mortality rate in the US is already higher than any other industrialized country, and it’s rising. It is typically higher in states with abortion bans and is significantly higher for women of color.

Forcing women to undergo birth and the increased related risks, instead of safer abortion procedures, is not justified ethically. Being forced to deliver suboptimal care, as a physician, is another source of stress for OB/GYNs.

Although I believe the field of OB/GYN will lose people to other specialties, we can ease practice across state lines, which could increase the care for people in states with a paucity of providers.

One solution is to create a national medical licensing system. Such a system doesn’t exist now. Physicians need to get a separate license to practice in each state – an onerous, expensive, and time-consuming process.

This requirement was amended to ease travel during COVID-19, and there is no convincing reason to maintain separate state licensing. A national licensing system would also centralize the reporting of complaints.

If patients are now required to cross state lines for basic reproductive healthcare, physicians should be able to travel to care for them. We must think creatively about how to compensate for the assault on reproductive healthcare, the practice of OB/GYN, and the repercussions affecting half of our population.