By Melinda Young
OB/GYN abortion training programs have been negatively affected by logistical and financial burdens in the nearly three years since the U.S. Supreme Court overturned Roe v. Wade and universal abortion access rights with its decision in Dobbs v. Jackson Women’s Health Organization on June 24, 2022.1 A new study found the Dobbs decision made it more difficult for many OB/GYN residencies to provide abortion training and affected training experiences across the United States.1
Investigators conducted qualitative, in-depth interviews with Ryan program directors at U.S. academic medical centers.1 The Kenneth J. Ryan Residency in Abortion training program, which is a nonprofit, has helped some institutions pay for partnerships between residency programs in restricted states and unrestricted states.
“The study aimed to explore the challenges faced by Ryan program directors and OB/GYN residency program directors in providing abortion training in the post-Dobbs era, particularly focusing on logistical, financial, and clinical barriers,” says Danielle Vachon, MD, assistant professor in the division of complex family planning, department of obstetrics, gynecology, and reproductive sciences at the University of California San Diego.
The Accreditation Council for Graduate Medical Education (ACGME) requires all obstetrics and gynecology residents to have access to abortion training. The requirement is not waived for residents in states with abortion bans or restrictions, even if they may not be able to obtain abortion training at their own institutions.1,2
Program directors said they experienced stressors and had difficulty satisfying requirements for abortion training in restrictive states. They had burnout and faced challenges in recruitment and clinical care post-Dobbs decision.1 “Ryan directors experienced stressors related to the administration of Ryan programs post-Dobbs, including perceived difficulty satisfying requirements for abortion training in restrictive states, burnout, and increased financial needs to support training partnerships,” Vachon says. “Directors face challenges in recruitment and clinical care post-Dobbs.”
One stressor that directors experienced in restrictive states was difficulty complying with ACGME abortion training requirements. They worried about trainee competency and program accreditation, she says. Their potential solution was establishing training partnerships with out-of-state institutions, but this had its own logistical and financial burdens.
“There are a lot of common challenges, whether in a restrictive or nonrestrictive environment,” Vachon explains. “In restrictive states, they tried to comply with ACGME requirements, and in unrestricted states, they experienced the challenges of taking on more trainees, having higher client cases, delays in care, higher patient volume, and more complex cases.”
Since OB/GYN practice remains popular overall, OB/GYN residency spots have not been unfilled, she notes. “It’s really competitive to be an OB/GYN; we don’t have enough residency spots for the amount of students applying,” Vachon says. “The demographics of people matching in these areas is slightly different.”
Vachon’s study focused on what OB/GYN program leaders thought about recruitment. They reported having challenges recruiting faculty for their residency programs. “Faculty would leave the state, potentially for a less restrictive environment, and it was difficult to recruit new faculty into restrictive areas,” she explains. “They didn’t have as big a problem with retainment, but recruitment was a problem they brought up.”
It appeared that it was difficult to recruit faculty from a state with more abortion protections to a state with abortion bans and restrictions. “Directors in both restrictive and unrestrictive states reported burnout due to increased workloads and lack of compensation,” Vachon says. “Restrictive laws have resulted in delays and complications in patient care in restrictive states, while unrestrictive states face higher patient volumes and more complex cases.”
Another challenge for recruitment and clinical care post-Dobbs involves financial constraints, including costs associated with travel, lodging, and state-specific licensing for out-of-state training, she notes. While medical students typically pay for their own out-of-state training, residents do not — most of the time, she says. There is some financial support for residents who need to travel out of state for required medical training. But when that training involves abortion training, it becomes more complicated.
For instance, the four-decades-old Hyde Amendment restricts government funding from paying for abortions. “This can be interpreted widely, depending on the institution and whether they’re afraid of getting public funding revoked if they have anything to do with anything that has that word [abortion] in it, even if it’s a legal thing and part of the training requirement,” Vachon explains. “They don’t want the public perception of their paying for abortions.”
Depending on the location of a resident’s training, the challenges with funding can be variable, and that is one of the logistical hurdles that presents repeatedly, she adds. The costs are high, especially if someone is traveling from a state like Texas with a lower cost of living to a state like California with a high cost of living. Residents have to rent an apartment for a month, obtain transportation, and cover additional costs, which can total thousands of dollars. There are more than 100 Ryan programs.
The study proposed several solutions to address the burdens identified by the faculty of OB/GYN residency programs, including:
- Standardized licensing requirements: “Implementing uniform out-of-state licensure policies, as demonstrated by California’s AB1646, could reduce administrative burdens,” Vachon says. “This bill eliminates the requirement for out-of-state trainees to obtain a California medical license [to enter] the state for abortion training.”
- Financial support: “Expanding funding through philanthropic efforts or state-level advocacy could help cover travel, lodging, and administrative costs associated with out-of-state training,” she says.
- Administrative support: Programs can provide additional resources, such as dedicated administrative staff and tools, including standardized Program Letters of Agreement templates, checklists, and sample schedules. They also could streamline the establishment of training partnerships.
- Centralized matching programs: “A system for matching host and sending institutions could improve efficiency by detailing rotation dates, licensure mandates, and funding responsibilities,” Vachon says.
The new study’s findings will inform strategies for improving the delivery of abortion education in the hostile abortion climate since Roe v. Wade was overturned by the Supreme Court.
“We anticipate findings will enhance procedures to establish and maintain partnerships post-Dobbs and identify areas where philanthropy and advocacy can be effectively utilized,” Vachon says.
Some of the programs, advocacy, and actions needed are:
- Training and accreditation risks: “Programs in restrictive states must prioritize forming out-of-state partnerships to meet ACGME requirements and ensure residents graduate with essential competencies,” Vachon says.
- Need for advocacy: OB/GYNs and residency program leaders can advocate for policies that eliminate unnecessary licensing requirements and provide financial support — both of which are crucial for sustaining abortion training, she adds.
- Recruitment challenges: “Programs in restrictive states may struggle to recruit faculty and trainees, especially those concerned about the political and legal environment,” Vachon explains. “This could exacerbate workforce shortages in these states.”
- Mitigating burnout and moral distress: Residency programs need to address faculty burnout through compensation for increased workloads and resources for coping with moral distress.
- Interstate collaboration: “Residency programs must foster stronger collaborations with unrestrictive states to ensure comprehensive training, emphasizing standardized curricula and robust evaluation mechanisms to maximize training quality during out-of-state rotations,” Vachon says.
The study focuses on the current environment since the Dobbs decision and does not address what can be done if abortion access is further eroded under the Trump administration and with future Supreme Court cases. “I don’t want to make any leaping assumptions,” Vachon says. “But it may be getting a little bit better if we’re able to establish these [abortion training] partnerships and sustain them.”
If medical schools cannot make abortion training easier to obtain than it currently is, then training programs will become quite different depending on where they are located and the policies in those areas, she adds. “That’s the concern of educators involved in my study,” she says. “They want to make sure we’re able to meet our standards of educating future doctors of the U.S. and that we’re training them appropriately.”
References
1. Vachon D, Hildebrand MC, Averbach S, et al. The impact of Dobbs v. Jackson on abortion training in obstetrics and gynecology residency programs: A qualitative study. Contraception. 2024;Dec30:110808. [Online ahead of print].
2. Vinekar K, Karlapudi A, Bauer CC, et al. Abortion training in U.S. obstetrics and gynecology residency programs in a post-Dobbs era. Contraception. 2024;130:110291.
OB/GYN abortion training programs have been negatively affected by logistical and financial burdens in the nearly three years since the U.S. Supreme Court overturned Roe v. Wade and universal abortion access rights with its decision in Dobbs v. Jackson Women’s Health Organization on June 24, 2022.
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