CNN
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the supreme court decision that struck down the federal right to abortion created a patchwork of laws in the United States and widespread uncertainty. Among those with questions are the nation’s future doctors.
Morgan Levy, a student at the University of Miami medical school, said the impacts of the ruling immediately became a point of contention among his peers. She will apply for her residency training programs this fall and now she has to assess whether and how the new laws will affect what she is taught.
“More than ever, I recognize the importance of good, comprehensive, evidence-based reproductive health care,” said Levy, who plans to train as an OB/GYN. In some states, however, it has become “almost impossible” to obtain formal training in family planning, including abortion practices.
“There’s definitely a consideration of making sure the training programs that I’m applying to can provide the kind of training that I’m going to need to be able to do that for my patients.” she said.
And new data suggests that these restrictions are having an impact on where, and what, future doctors plan to practice.
The number of medical school students applying to residency training programs fell last year, with applications to programs in states that ban abortion dropping the most, according to a new study. analysis of the Association of American Medical Colleges.
Interest in the specialty of obstetrics and gynecology has dropped markedly, with applications falling 5% nationwide and twice as much in states where abortion is prohibited. Emergency medicine also saw a significantly large drop in claims.
Despite the decline in applications, all OB/GYN residency positions and most others were filled. So while there isn’t an immediate shortage of doctors-in-training, experts say the change is cause for concern.
“I worry about exacerbating these abortion and maternal health care deserts that already exist. We already have a gap,” said Dr. Kristyn Brandi, an OB/GYN in New Jersey and chair of the board of directors for Physicians for Reproductive Health. “That’s why we need more OB/GYNs to join the field to help build practice in places where we’re losing providers for other reasons.”
More than a third of US counties have limited or no access to maternity care, according to a new study. report – and there is notable overlap between maternity care deserts and states where access to abortion is limited.
Most doctors stay in the area in which they trained. If programs in states that ban abortion shift to less desirable training plans, more and more students may prioritize being in less restrictive states for residency and, eventually, practice.
In the long term, that could create a “tiered system of care,” Brandi said.
However, experts say it will be important to track the preferences of medical students for years to come. Last year’s graduating class applied for residency programs just months after the Supreme Court ruling. They had to make decisions before seeing exactly how the programs would react and adjust.
“For the next year or two, things are going to be really uncertain for people. And I think a lot of people didn’t want to get involved in that uncertainty, not knowing what they were signing up for,” Brandi said.
For Levy and others, perhaps more important than the specific location of a program is evidence that there is a strong and well-established commitment to family planning training.
“That’s really a green flag to me when programs have a really formal plan,” Levy said.
The Zucker School of Medicine at Hofstra/Northwell has long been involved in the Ryan Residency Training Program which offers a specific focus on abortion and family planning.
Dr. Nagaraj Gabbur, who is the director of the OB/GYN residency program there, said this specialized curriculum is often one of the main reasons applicants give for wanting to practice there, and especially in the recent round of interviews.
For programs outside of “safe haven states” like New York, this could mean out-of-state rotation.
But to Brandi, the rotating programs are just a “Band-Aid” that doesn’t address the underlying issues challenging reproductive health care, and they don’t consider the livelihood of the individual learner.
Also, most doctors in the field of obstetrics and gynecology are women. Even if certain training programs suffice, there could be personal concerns about living in states where abortion is prohibited, she says.
“This can affect not only the care they want to provide as physicians, but also the care they can receive themselves,” Brandi said.
As Levy and his peers consider a big step forward for their lives and careers, the discussions about it are constant and complicated.
“It’s not a black-and-white or red-versus-blue kind of thing,” Levy said.
There are a lot of mixed emotions as people weigh many different factors, including clinical interests, logistics of the position, personal preference for location, and broader implications.
Some strongly believe they should train in a state that has preserved abortion access, while others, like Levy, feel there may be opportunities for advocacy in more restrictive settings.
“It’s almost less about the state itself and more about the program’s attitudes and responses to the decision and the ways in which they have affirmed their commitment to ensuring that excellent care is provided in their states,” Levy said.