The Progressive Populist Today Blog: Editorial: Docs Flee Red States

Friday, May 26, 2023

Editorial: Docs Flee Red States

Women in Republican-ruled states may find that physicians willing to put up with political harassment and possible criminal charges for using their expertise to treat maternity cases are fewer and farther between.

A recent survey found most third- and fourth-year medical students planning to practice in obstetrics and gynecology (OB/GYNs), as well as prospective surgeons and specialists in internal medicine, say they do not plan to practice in states that have banned or restricted abortion, Erika Edwards reported for NBC News May 18. The survey of 494 medical students in 32 states was conducted by third-year medical student Ariana Traub, currently attending Emory University’s School of Medicine. She found 57.9% of respondents “were unlikely or very unlikely to apply to a single residency program in a state with abortion restrictions,” while over 76% said access to abortion care would influence their decision on where they pursue their residencies.

Edwards reports: “The reluctance to be a medical resident — young doctors who train in hospitals or clinics after graduating medical school — in states with abortion bans could further strain health care shortages in many parts of the country.”

The US already faces a shortage of between 37,800 and 124,000 doctors in coming years, according to the American Association of Medical Colleges. There was also a significant drop in the number of medical students pursuing OB/GYN residencies in states with strong abortion policies.

Faced with the prospect of being told they cannot practice medicine the way they were taught — and they face criminal charges for doing so — students are electing to leave or avoid those states that have criminalized or otherwise prohibited abortion care. Dr. Beverly Gray, residency director at Duke University’s School of Medicine, explained the dilemma facing these future doctors:

“It is hard to walk into work every day and be told that you can’t provide the care that might save a patient’s life,” Gray said. “There’s tremendous moral injury with being put in that situation, to be asked to care for people and not allowed to do the right thing.”

Edwards notes these (mostly younger) students also weigh their own personal circumstances when deciding where to practice: “In fact, 72.7% of respondents said that abortion access changes would likely or very likely influence where they would start a family.”

An exodus could affect broader medical coverage for women who rely on OB-GYNs for routine and urgent gynecological care unrelated to pregnancy, such as menstrual disorders, endometriosis, and pelvic pain.

The same soul-searching by prospective and current physicians described in Traub’s survey is prompting alarms in many red states, particularly in Texas.

Anticipating the Supreme Court’s June 2022 decision in Dobbs v. Jackson Women’s Health Organization, Texas banned all abortions, with only narrow yet vague exceptions to save the life of the pregnant person and a potential penalty of life in prison for offending physicians.

“It meant no longer providing the standard of care that we would have prior to Dobbs,” Leah Wilson, who had worked as a labor and delivery nurse at a San Antonio hospital for about a year and a half, told Sophie Novack of Slate (March 21). “It meant patients sitting there for days, actively losing nonviable pregnancies, and us waiting for something to go bad enough that we could help them.”

Wilson left her job soon after. “There were a couple of cases just within a few weeks of each other that I really, really, really struggled with,” she said, including a patient who miscarried at 19 weeks pregnant. “And it was enough to say, You know what? I’m not doing this anymore.”

Almost every provider Novack spoke with said they have thought about leaving their practice or leaving Texas in the wake of S.B. 8, the state law that allowed outsiders to seek bounties for reporting abortions, and Dobbs. Several have already moved or stopped seeing patients in Texas, at least in large part because of the abortion bans.

“If I ever touch a patient again, it won’t be in the state of Texas,” said Charles Brown, chair of the Texas district of the American College of Obstetricians and Gynecologists (ACOG), who stopped seeing patients last year after decades working as a maternal fetal medicine specialist. Many of those Novack spoke with who haven’t left yet are still thinking about it regularly—people who have family and homes and lives in Texas and would not otherwise have considered moving.

In 2022, 15% of Texas’ 254 counties had no doctor, according to data from the state health department, and about two-thirds had no OB-GYN. Texas has one of the most significant physician shortages in the country, with a shortfall expected to increase by more than 50% over the next decade, according to the state’s projections. The shortage of registered nurses, around 30,000, is expected to nearly double over the same period. Already, Texans in large swaths of the state must drive hours for medical care, including to give birth. According to recent research from the nonprofit March of Dimes, it is among the worst states for maternity care access, which has gotten worse in the past two years, mostly due to a loss of obstetrics providers.

Texas has experienced the most rural hospital closures in the US in recent years. Of the remainder, just 40% of Texas hospitals still have labor and delivery services.

Other policies and factors have stretched providers in Texas for many years, from having the highest uninsured rate in the country to low Medicaid reimbursement rates to the demonization of science. recent attacks on transgender health care, and now the abortion bans, Tom Banning, CEO of the Texas Academy of Family Physicians, told Novack. “The first rule of holes, when you’re trying to get out of the hole, is to stop digging,” he said. “We just continue to dig the hole that we’re in deeper.”

More than a dozen Texas women have joined the Center for Reproductive Rights’ lawsuit against the Texas law, which prohibits abortions unless a mother’s life is at risk — an exception that is not clearly defined. Texas doctors who perform abortions risk life in prison and fines of up to $100,000, leaving many women with providers who are unwilling to even discuss terminating a pregnancy.

“Our hope is that it will allow physicians at least a little more comfort when it comes to patients in obstetrical emergencies who really need an abortion where it’s going to effect their health, fertility or life going forward,” Molly Duane, the lead attorney on the case, told the Associated Press. “Almost all of the plaintiffs in the lawsuit tell similar stories about their doctors saying, if not for this law, I’d give you an abortion right now.”

Dr. Brown worries that, absent clarity and changes from state leaders, a mass exodus could soon occur. “We have not had the front-page photo of the doctor in handcuffs yet. When that happens, I think that will be the napalm,” he said. “Once that first arrest is on the front page of the paper, that will be a defining moment for a lot of people.”

And hard-right Republican leaders can take credit for making Texas more complicated for problem pregnancies. — JMC