OB/GYN training programs try to adjust to post-Dobbs reality

• Some experts fear that if OB-GYN residents can't access comprehensive abortion training, handling complicated pregnancies later in their careers could be challenging, as abortions are the procedure sometimes used to handle lethal anomalies or pregnancy loss.
• The bans are already leading to a delay in care, with patients being forced to seek abortions later in their pregnancies or past their first trimester, when they might need a surgical procedure instead of a pill.

By the numbers: More than 1,100 current resident doctors training in 56 obstetrics and gynecology programs will need to leave the state they are learning in to receive abortion training, according to an analysis from the Kenneth J. Ryan Residency Training Program at the Bixby Center for Global Reproductive Health.

• Nearly 19% of obstetrics programs are in the "most restrictive" states, per the analysis.
• Half of OB-GYNs in states with abortion bans have had patients who want an abortion and could not get it, a KFF survey released today found.
• 55% of OB-GYNs say the Dobbs decision has "worsened" their "ability to attract new OB-GYNs to the field."

What's happening: Patients and medical residents alike are having to travel further distances to seek care or learn how to provide it.

• States, like Kansas, that border more restrictive states are seeing an influx of both patients and doctors seeking training, said Flor Hunt, executive director at the nonprofit Training in Early Abortion for Comprehensive Healthcare (TEACH) program.
• Many abortion clinics relocated after the Dobbs decision, like Whole Woman's Health clinics, previously based in Texas, which opened a New Mexico clinic earlier this year.
• The volume of procedures a resident sees in training matters for their competency so the states being flooded with demand are also important for those seeking training.
• "Abortion is so safe that many learners in their training won't come across a lot of complications," Hunt said. Medical students and residents must be in a clinical setting that sees a high volume of patients to learn how to treat any rare complications.

What they're saying: "It feels like we're abandoning our patients, but it feels like we have no option," Kelly Mamelson, a second-year OB-GYN resident in Florida, told reporters earlier this month.

• Mamelson will have to do abortion training out-of-state and plans to do a fellowship elsewhere since she cannot acquire the skills she needs in Florida, which passed a six-week ban that is currently being challenged in court.

How it works: Obstetrics training programs go through a complex process to find places where their students can learn how to perform abortions.

• Programs must have memorandums of understanding, licensing and logistics worked out, all things that can take at least six months to put together, Jody Steinauer, the director of the Bixby Center and leader of the Ryan Residency Program, told reporters this month.
• The Ryan Residency Program, which helps current OB-GYN training programs offer abortion training to students, has a dozen programs in states with restrictive abortion bans, and Steinauer said they are working to match those residents with rotations elsewhere.
• "It's going to be a long haul, but we are establishing partnerships," Steinauer told reporters earlier this month.
• Most programs have funds in place to send residents elsewhere to train, but the sheer volume of residents who need to be trained will make it challenging, Tony Ogburn, a Texas OB-GYN, told reporters during a press briefing this month.
• Medical residents in Texas and a handful of other states had to receive abortion training out of state even before the Supreme Court overturned Roe v. Wade due to state restrictions.

What's next: States where abortions remain legal are considering ways to expand training opportunities to students from restrictive states while limiting liability to their own providers.

• California lawmakers are considering a proposal to waive licensing requirements for medical school residents seeking abortion training in California at accredited programs.
• But the impact of the Dobbs ruling on abortion education is still coming into sharper focus.
• "If you're setting up [clinical] rotations a year in advance, there will be a lag in understanding where the volume is and where patients are going," Hunt said.