‘A Whole Generation of People Who Don’t Know How To Take Care of People’: Training Ob-Gyn Medical Residents In a Post-Roe World

Of the 6,007 current ob-gyn residents in the U.S., about half are in residency programs in the 26 states certain or likely to ban abortion now that Roe is overturned. (Flickr)

“I feel disgusted,” my friend and fellow fourth-year medical student Sarah reacted, upon hearing the Supreme Court was overturning Roe v. Wade, confirming the leaked draft opinion and our worst fears. Sarah is a fourth-year medical student planning to specialize in ob-gyn— she’ll be part of the first class applying to residency in a post-Roe America, where training in reproductive healthcare will be significantly limited across the country. And her worries should be our worries. Although I’m applying to a different field, I am still a woman of childbearing age whose care might be dramatically affected by this existential change in teaching—which comes not from the medical literature, but from the Supreme Court.

The procedures for surgical abortion are called dilatation and curettage (D&C) for first-trimester abortions, and dilatation and evacuation (D&E) for second-trimester abortions. These same procedures are also needed in a variety of other conditions—like after a miscarriage, to look for an ectopic pregnancy, to stop life-threatening vaginal bleeding or to clear cancerous cells out of the uterus.

Sarah, who asked that I change her name to avoid any backlash on her residency applications, already realizes ob-gyn residents gain most of their experience with these procedures during their family planning rotation. Research confirms that residents who are trained with a robust family planning education are better equipped to counsel patients on contraception, early pregnancy options and miscarriage. Residents who are trained in providing abortion care are more competent in caring for patients with early pregnancy loss or miscarriage. In hospitals that do not provide this training, patients who have miscarriages are often bounced around from the emergency department to the obstetrics office, and are less likely to get clear information on their options and follow-up care after a miscarriage.

As a medical student, I have seen situations in which pregnancy does not go as planned and know how important good training can be when doctors must act quickly and decisively. If I ever have a miscarriage, or a life-threatening bleed, I want to be treated in a place where state laws don’t hamper the training of my doctors.

Dr. Lauren Thaxton, an ob-gyn professor at the University of Texas Dell Medical School, has had to field a lot of questions from medical students like Sarah wondering how the legal landscape will affect their training.

“My personal take is that it’s really hard to learn in an environment of scarcity and an environment of fear. And I think that those are two things that are very realistic in some of these restrictive states,” she told me.

Senate Bill 8 banning abortion after six weeks and creating an abortion vigilante system has been the law of the land in Texas since Sept. 1, 2021—meaning Thaxton and other medical education professionals in Texas have been facing what many more programs across the country will soon come to know in this new post-Roe landscape. Dell Medical School’s obstetrics and gynecology residency program, which prided itself on being a program committed to reproductive healthcare, has had to stop sending its residents to family planning clinics, due to a steep drop in patient volume.

A study in the American College of Obstetrics and Gynecology estimated that of the 6,007 current ob-gyn residents, about half are in residency programs in the 26 states certain or likely to ban abortion now that Roe is overturned. Forty-four percent of current ob-gyn trainees would be certain or likely to lose access to in-state abortion training—a staggering statistic that does not even include trainees in other specialties who also provide reproductive healthcare, or medical students like Sarah who haven’t started residency yet.

Even states with protected abortion care will feel the ripple effects of the coming wave of anti-abortion laws now that Roe is overturned. After Texas’s S.B. 8, women have been flooding to nearby states like Oklahoma and requiring later abortions.

“It’s really hard when you are overwhelmed with the number of patients you’re seeing everyday, to train in that environment,” Thaxton said.

Thaxton’s program and many others in restrictive states are struggling to find ways to meet national guidelines and ensure adequate family planning training for their residents. Meanwhile, Sarah is putting together her application list: all programs that prioritize family planning and reproductive health training, all in states without trigger bans. I myself am terrified to live in a country where regressive laws will mean that my doctor, my mother’s doctor, my friends’ doctors may be less well-trained in a procedure we may someday desperately need—whether that be as an abortion, or a miscarriage, or a cancer treatment.

“You are our future generation of healthcare providers,” Thaxton told me. “If you limit your education now, then there’s the risk that that lack of training outlives changes in policy. Because you’ll have a whole generation of people who don’t know how to take care of people.”

Sign and share Ms.’s relaunched “We Have Had Abortions” petition—whether you yourself have had an abortion, or simply stand in solidarity with those who have—to let the Supreme Court, Congress and the White House know: We will not give up the right to safe, legal, accessible abortion.

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Amanda Yijun Wang is a fourth-year medical student at Columbia University Vagelos College of Physicians and Surgeons. She holds a BA from Dartmouth College, where she studied human geography and economics.