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When Isabella Rosario Blum graduated from medical school and was considering training programs to become a family physician, she received some candid advice. She said, “If she wants to be trained to provide abortions, she shouldn't stay in Arizona.”
Blum primarily focused on programs in states such as California, Colorado and New Mexico, where access to abortion and, by extension, abortion training are likely to remain protected. Arizona has enacted a law banning most abortions after 15 weeks.
“I want to get all the training I can,” she said, “but of course there would be limits.”
In June, she will begin her residency at Swedish Cherry Hill Hospital in Seattle.
Graduates of U.S. medical schools for the second year in a row are more likely to apply for residency positions this year in states with abortion bans or other significant abortion restrictions, according to new statistics from the Association of American Medical Colleges (AAMC). was low.
State battles over abortion access have created a lot of uncertainty for pregnant patients and their doctors since the Supreme Court overturned the constitutional right to abortion in 2022. But that uncertainty has also seeped into the world of medical education, forcing some new doctors to take their state's abortion laws into account when deciding where to start their careers.
Fourteen states, mostly in the Midwest and South, have banned nearly all abortions. A new analysis by AAMC, reviewed exclusively by KFF Health News before publication, found that states with near-total abortion bans saw a 4.2% drop in applications to residential programs; It found that states with abortion bans saw a 0.6% decrease. It remains legal.
Remarkably, the AAMC's findings highlight the broader problems that an abortion ban could pose to the state's medical community, especially in a time of health care worker shortages. AAMC tracked a significant drop in interest in residency in states that restrict abortion, as well as physicians in most specialties. This includes gynecologists and emergency room physicians, who are likely to treat pregnant patients, as well as aspiring doctors in other specialties.
“For a state with severe restrictions on reproductive rights, it is alarming that so many new physicians, regardless of specialty, are choosing instead to pursue training in other states. ” wrote Atul Grover, executive director of the AAMC Research and Action Institute.
The AAMC analysis found that the number of applicants to obstetrics and gynecology training programs in states with abortion bans decreased by 6.7%, compared with a 0.4% increase in states where abortion is legal. For internal medicine, the decline observed in states where abortion is prohibited was more than five times that in states where abortion is legal.
“Geographical gap”
The AAMC said in its analysis that continued decline in interest in anti-abortion states among new doctors could ultimately “adversely impact access to care in those states.” said.
Dr. Jack Resneck Jr., immediate past president of the American Medical Association, said the data points to further post-industrial outcomes.Roe vs. Wade Era.
The AAMC analysis notes that even in states that ban abortion, residency programs are filling up, largely because there are more medical graduates than residency slots available in the U.S. and abroad. This is because there is a lot of raw material.
Still, Resneck said, “We're very concerned.” For example, a doctor who is not adequately trained in abortion may not be able to deal with potential complications such as miscarriage, ectopic pregnancy, or infection or bleeding that may result from miscarriage.
Those working with students and residents say their observations support the AAMC findings. “People don't want to go to places where evidence-based practices and human rights in general are restricted,” said Beverly Gray, an associate professor of obstetrics and gynecology at Duke University School of Medicine.
In North Carolina, nearly all abortions are prohibited after 12 weeks. Women who experience unexpected complications or whose baby is found to have a fatal birth defect late in their pregnancy may not receive care there.
Gray said she was concerned that the abortion ban would “impact the ability of the best and brightest to come to North Carolina,” even though Duke is a very popular destination for medical residency training. Stated.
Rohini Kousalya Shiva will begin her obstetrics and gynecology residency at MedStar Washington Hospital Center in Washington, D.C., this year. She said she would not consider programs in states that ban or severely restrict abortion, but would instead apply to programs in Maryland, New Hampshire, New York and Washington, D.C.
“We are doctors,” said Kousariya Siva, who attended medical school in Virginia and previously served as president of the American Medical Student Association. “We should be providing the best evidence-based care to our patients, and we can't do that if we don't have abortion training.”
Another consideration: Most graduating medical students are in their 20s, “the age when people start thinking about putting down roots and starting a family,” Gray said, adding that students who ask about politics during residency interviews He added that he has noticed an increase in
And because most young doctors build their careers in states where they do their residency, “people don't feel safe living in states where they could become pregnant” with strict restrictions. said Debra Stulberg, director of family medicine at the hospital. University of Chicago.
Stulberg and others worry that voluntary selection of states with abortion restrictions will exacerbate physician shortages in rural and underserved areas.
“The geographic disconnect between where the needs are and where people are choosing to go is very problematic,” she says. “There is no need for more people to be concentrated in urban areas that already have good access.”
From Tennessee to California
Hannah Wright-Olson will begin her obstetrics and gynecology residency at the University of California, San Francisco this summer after attending medical school in Tennessee, which has one of the most drastic anti-abortion laws in the country.
It wasn't an easy decision, she said. “I feel some guilt and sadness about walking away from a situation where I feel like I might be able to help,” she said. “I am deeply grateful to the program that trained me and to the patients of Tennessee.”
Wright-Olson said some of her fellow students have applied to the program in anti-abortion states “because we believe now more than ever we need pro-abortion health care providers in anti-abortion states.” said. In fact, she said, she was so convinced that she could provide abortion training to programs that she even applied to programs in anti-abortion states.
“We felt there was no 100% guarantee of perfection. We saw how quickly things could change,” she said. “I'm not particularly confident that California and New York aren't also threatened.”
Blum said that as a condition of her medical school scholarship, she must return to Arizona to practice as a clinician, but it is unclear what her access to abortion will be. But she worries about the long-term effects.
“Residents, if you can't get training in the state, you're probably less likely to settle and work in the state,” she says.
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