Texas abortion laws are forcing Houston OB-GYNs out of the state

Abortion restrictions Texas obstetrics and gynecology residency programs have forced young doctors out of state to learn about pregnancy termination, a grueling process that educators say is another example of abortion bans undermining reproductive health care.

At least one program in the Houston area, the University of Texas Medical Branch, has begun 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 were still working out arrangements for their own out-of-state courses. McGovern College of Medicine at UTHealth Houston declined to comment on its plans.

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

However, experts say it takes months of coordination to arrange a temporary rotation in another country, leaving some inexperienced doctors with few options.

said Dr. Anna Marie Connolly, chair of education and academic affairs at the American College of Obstetricians and Gynecologists. “The combined efforts of ACOG… and countless residencies in protected states directly address this risk to medical education and training.”

Basic skill

Connolly highlighted another organization that helps fill education gaps: the Ryan Residency Training Program, a national initiative that has supported Planned Parenthood training at more than 100 institutions since 1999.

The initiative has helped arrange out-of-state courses for 10 Texas OB-GYN residency programs, including the UTMB, since Senate Bill 8 went into effect in September 2021, allowing anyone to file a civil suit against someone who “aids or abets” their abortion

As of January 1, more than 1,100 residents in 56 OB-GYN residency programs were training in the nation’s strict lockdown states, according to Ryan’s Program.

“How can we make sure that all of this population gets the skills they need?” said Dr. Jodi Steinauer, director of research and evaluation for the Ryan Program.

Before the ban, many Texas programs offered week-long sessions at Planned Parenthood clinics, where residents could have first-trimester abortions. In addition to elective terminations, the same procedure to empty the uterus may be used to treat an incomplete miscarriage, a medical emergency, or a severe fetal abnormality.

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Residents can learn more about miscarriage in the hospital, and the American Association of Pro-Life Obstetricians and Gynecologists says miscarriage treatment alone provides adequate training.

Planned Parenthood provides more volume for residents to become confident in carrying out the procedure in other emergency situations, said Dr.

“Our interns who have the skills to deal with those (emergencies) can reduce the risk of other pregnancy complications,” he said.

Now, with Planned Parenthood clinics no longer offering abortion care, UTMB residents will have to gain that experience over the course of two weeks at Oregon Health & Science University in Portland. At least one other program is located in Texas, the University of Texas Dell Medical School at Austin Send residents to train in California.

difficult solutions

Arranging out-of-state rotations is a logistical feat, Steinauer said, since it takes up to nine months to put together a plan for housing, airfare, training permits, and other needs.

The university also incurs additional costs. To send two UTMB residents to Oregon for two weeks, it costs $5,216 for housing, $1,689 for air and airport transportation, $240 for parking and $370 for training permits, according to documents obtained through an open records application. Documents show that the Ryan program pays $1,500 per resident, with the rest paid for by the university.

There’s also pressure on the host institution, said Dr. Aileen Gariepy, director of complex family planning at Weill Cornell Medicine in New York City. Some programs that provide abortion care may have the capacity to accommodate residents only. With so few programs left to handle a large number of new learners, she said, “we may be damaging the training needs of all our trainees.”

She noted that Weill Cornell does not yet have space to accommodate residents from its affiliate, Houston Methodist, who has contacted the school about out-of-state rotations.

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

For organizations that have not finalized the plan, the says the American College of Obstetricians and Gynecologists “You may need to explore robust formal abortion training, simulation or distance learning as options to mitigate the lack of abortion training.”

ACGME appears to offer some flexibility for programs that do not yet offer an out-of-state option. When the review panel considers compliance next summer, the group said in a statement, it will only refer to programs or identify “areas for improvement” if it does not believe the institution is making an effort to offer an abortion clinical trial.

“A single citation is not likely to affect a program’s adoption status, provided the program shows progress in addressing the issue,” the group said. “ACGME recognizes that these are difficult times with complex issues.”

Save Texas Obstetrics and Gynecology

Besides the immediate challenge of meeting certification requirements, some educators He publicly expressed his concern That abortion laws would make it more difficult for the state of Texas to attract and retain obstetricians and gynecologists.

Of nine publicly funded OB-GYN residency programs in Texas, six saw a decrease in applicant numbers from 2020 to 2021, the year SB8 was enacted, according to documents obtained by The Chronicle. Seven of these programs experienced a decrease in the number of applicants in 2022.

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

However, at UTMB, many applicants asked about abortion training during interviews, he said. Even before Dobbs’ decision, previous abortion restrictions led medical school graduates to favor states that allow the procedure.

Dr. Preetha Nandi, a fourth-year resident of Boston, Massachusetts, grew up in the South and attended medical school in Georgia, which now bans most abortions. She said in an email that she knew state laws would limit her training, so she prioritized residency programs where she could see a high number of miscarriages.

She said she performs abortions in Boston on a weekly basis, whether it was a patient with severe heart disease who had failed contraceptives, someone whose waters had broken early at four months, or a patient diagnosed with a devastating fetal abnormality with a poor prognosis. .

Nandy writes, “Being able to provide safe and accessible abortion care as an intern in Massachusetts is a cornerstone that has grounded me in much of what I do as an OB-GYN.”

The former Houston medical student who is now training as a sophomore resident at Penn State said she feels equally concerned about abortion care. The resident asked not to be identified because she hopes to return to Texas and fears legal repercussions.

She said she loves Houston and hopes to stay for her stay. Her mentors challenged and inspired her. Texas lawmakers proposed Senate Bill 8 when I started applying to schools.

Ultimately leaving, she said, would give her the best chance of helping patients in her home state.

“Most people don’t want to go back,” she said, “unless they’re a Texan like me.” “It’s really unfortunate for patients, that it’s those people who go to an OB-GYN because they care so much about women’s rights that leave.”


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