Abortion Bans Affect Future Doctor's Training and Specialization Choices
The recent Supreme Court decision to overturn the federal right to an abortion has left many medical school students uncertain about their future training and career prospects. The ruling has led to a patchwork of laws across the United States, with some states making it all but impossible to receive comprehensive reproductive health care training, including abortion practices. As a result, the number of medical school students applying to residency training programs has declined, with applications to programs in states with abortion bans dropping the most.
According to the Association of American Medical Colleges, interest in the ob/gyn specialty has taken a notable dip, with applications dropping 5% nationwide and twice as much in states where abortion is banned. Emergency medicine has also seen a significant decline in applications. Although all ob/gyn residency positions and most others were filled, experts are concerned that the shift could exacerbate maternal health care and abortion deserts that already exist in more than a third of US counties.
Most physicians stay in the area where they trained. If programs in states with abortion bans shift to less desirable training plans, more and more students could prioritize being in less restrictive states for residency and eventually to practice, creating a "tiered system of health care." 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 training around family planning.
Dr. Kristyn Brandi, an ob/gyn in New Jersey and chair of the board of directors for Physicians for Reproductive Health, warns that long-term, this could create a “tiered system of health care.” However, experts say it will be important to track the preferences for medical school students in the years to come. Last year’s graduating class applied to residency programs just months after the Supreme Court’s ruling. They had to make decisions before seeing exactly how the programs would react and adjust.
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 training around family planning. The Zucker School of Medicine at Hofstra/Northwell has long participated in the Ryan Residency Training Program that offers a specific focus on abortion and family planning. Dr. Nagaraj Gabbur, who is the director of the ob/gyn residency program there, said that this specialized curriculum is usually one of the top reasons applicants give for why they want to practice there – and especially in the latest round of interviews.
However, for programs outside of “haven states” like New York, this could involve an out-of-state rotation. But for Brandi, rotational programs are just a “Band-Aid” that doesn’t address the underlying issues challenging reproductive health care – and doesn’t consider the livelihood of the individual trainee. Also, most of the physicians in the ob/gyn field are women, and even if certain training programs suffice, there might be personal concerns about living in states where abortion is banned.
As Levy and her peers consider a major step forward for their lives and career, discussions on the topic are constant – and complicated. There are a lot of mixed emotions as people weigh many different factors, including clinical interests, logistics of the role, personal preference for location and broader implications. Some feel strongly that they should train in a state that has preserved access to abortion, while others feel that there may be opportunity for advocacy in more restrictive environments.
“It’s almost less so about the state itself and more so about the program’s attitudes and responses to the decision and the ways in which they’ve affirmed their commitment to making sure great care is provided in their states,” Levy said.
Ultimately, the impact of the Supreme Court decision on medical school students and the future of reproductive health care remains uncertain. The decline in applications to residency training programs in states with abortion bans is a cause for concern, but Despite the complexity of the situation, many medical students are determined to fight for reproductive health care rights, both for themselves and their future patients.
“There is an interest in being advocates and being activists and trying to make a difference in the realm of reproductive health,” Levy said.
To that end, medical students and physicians are working to ensure that comprehensive reproductive health care remains a priority, regardless of state-level restrictions.
Dr. Anne Davis, an ob/gyn in New York and consulting medical director for Physicians for Reproductive Health, said that the organization is working to support states that are moving to expand access to reproductive health care services, including abortion.
“We’re doing everything we can to try to support states that are moving in the right direction,” she said.
Medical students are also getting involved in the fight for reproductive rights. Last year, when the Supreme Court decision was announced, medical students across the country organized a “White Coat Brigade” to protest the ruling and demand continued access to comprehensive reproductive health care.
“Medical students are often the first ones to see the effects of these laws on our patients,” said Dr. Dorothy Furgerson, an ob/gyn in California and a member of Physicians for Reproductive Health. “We’re on the front lines of this.”
Levy and her fellow medical students are also taking steps to ensure that they are well-equipped to provide comprehensive reproductive health care, regardless of the state in which they end up practicing.
“Medical students are really engaging with each other and with advocacy organizations to try to figure out how we can continue to be good providers in a changing landscape,” Levy said.
One way that medical students are doing this is by seeking out elective rotations in family planning and abortion care, in addition to their required coursework.
“We’re doing everything we can to make sure that we’re getting the best possible training and that we’re going to be able to provide the best possible care to our patients,” Levy said.
Ultimately, the fight for reproductive health care is far from over, and medical students and physicians alike will need to continue to advocate for their patients and their profession.
“We have to keep fighting for our patients, for their autonomy, for their right to access safe, comprehensive reproductive health care,” Davis said. “We’re not going to stop until we’ve achieved that goal.”