Physicians worry about ob-gyn training, recruiting, retention with Ohio's new abortion law

Obstetrics and gynecology physicians in Ohio who are training future doctors are concerned about teaching, recruiting and retaining doctors after the U.S. Supreme Court overturned Roe v. Wade and Ohio's six-week abortion ban became law.

More: Ohio's six-week abortion ban becomes law hours after Supreme Court's Dobbs decision

The American College of Obstetricians and Gynecologists “is very concerned about the impact the laws will have on medical student and resident education. We are also concerned about the effect these laws will have on the ability of Ohio's medical schools and residencies to attract the best trainees," said Dr. Amy Burkett, a hospital-based ob-gyn specialist in Northeast Ohio who is District V legislative chair and immediate past Ohio section chair for the national organization.

“We are worried about the ability to retain ob-gyns in Ohio when we are already under a physician shortage,” Burkett said.

A study in April by UC San Francisco and UCLA found that nearly half of obstetrics and gynecology residency programs in the U.S. could lack abortion training if Roe v. Wade was overturned.

More: Abortion bans could leave close to half of US obstetrics residents with inadequate training

That includes Ohio, where the law criminalizes all abortions performed after the detection of fetal cardiac activity, which is about six weeks into a pregnancy (four weeks after conception), except to save the mother's life.

Patients seeking what would now be illegal abortions would not be prosecuted under this new law, but providers could face fifth-degree felony charges and up to one year in prison. The law has an exception to save the life of a patient but no exceptions for rape or incest.

A proposed state House bill would put a full ban on all abortions, if passed.

More: The day Roe v. Wade fell: Reactions inside and outside Greater Akron's only abortion clinic

Ohio training institutions will be working on ways to secure education for residents and students, with guidance from accreditation organizations, Burkett said.

Accreditation rules require obstetrics-gynecology medical residencies — programs for new physicians focused on their specialties after medical school — to provide training or access to training on the provision of abortions.

The Accreditation Council for Graduate Medical Education already is exploring alternative pathways for completing training. It requires programs to have a curriculum for family planning, including training in the complications of abortions, and the opportunity for direct procedural training in terminations of pregnancy.

Finding that out-of-state training for resident physicians in Ohio “will involve figuring out locations, travel budget and lodging accommodations,” said Burkett. “With up to half the states vying for spots, the logistics are going to be difficult, but we are committed to assuring our trainees learn all the necessary procedures to provide full-scope, evidence-based practice to the women in Ohio.”

In a statement after the Supreme Court decision was announced to overturn women's constitutional right to an abortion, the Ohio section of the American College of Obstetricians and Gynecologists said it “puts physicians in fear of retribution for providing evidence-based, appropriate, lifesaving care, and it makes patients afraid to turn to us for this health care. This decision fundamentally, irreparably, and devastatingly compromises the patient-physician relationship.”

The decision represents “a frightening era for health care professionals who must fear criminal, professional, and civil penalties for providing evidence-based, appropriate care,” the statement said.

Added Burkett: “In all of these discussions, it is important we place the women we care for in the center of the discussion ... Women in Ohio have chosen abortion as a part of their health care.  These patients deserve to be able to receive evidence-based compassionate care in Ohio.  They should not have to travel to another state to get appropriate care.”

More: Their pregnancies fall just outside Ohio’s new six-week abortion ban. What do they do now?

Will post-Roe changes impact doctor recruitment in Ohio?

In a phone call with reporters last week, Dr. David Hackney, a maternal fetal medicine specialist and chair of the Ohio chapter of the American College of Obstetricians and Gynecologists, said he is very concerned about recruitment of high-risk obstetricians to Ohio.

“It’s a life-or-death issue for the state. If I’m able to recruit more high-risk obstetricians to Ohio, then the women and the patients in the state will do better and if I do not, then they do not,” he said.

The abortion restrictions in the state make it more complicated, he said.

“A lot of people talk about the fear of criminal charges, the fear of going to jail and that it’s certainly one of the things which will potentially inhibit people from wanting to come to the state,” Hackney said. “But probably the biggest driver is having to watch your patients suffer when you know there are ways you could give them the care they need.”

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Future doctors concerned about strict abortion laws in Ohio

The recent changes in law also affects students training to be physicians, said Sanjay Jinka, a fourth-year medical student at Northeast Ohio Medical University (NEOMED).

Jinka is a student member of the board of trustees and also CEO of the Student-Run Free Clinic on campus.

In speaking to his peers and colleagues since the law changed, “a lot of students may be dissuaded from pursuing this specialty, just based on these limitations and risks associated with it," he said.

“That being said,” he added, “there’s the other side of it, too, where I think a lot of students are motivated by the decisions that have been made and almost empowered by it. There’s a lot of students who want to enter the field now and provide the service that they feel is important.”

All medical students are required to do rotations in various specialties, including ob-gyn, as part of their rotation experience during their third and fourth year of medical school.

More: Akron-area employers vow to pay travel expenses for workers seeking out-of-state abortions

Jinka, who will be pursuing a residency in plastic surgery, completed about a month-long rotation in obstetrics and gynecology earlier this year in near his home town of Toledo.

Jinka’s ob-gyn rotation was at a Catholic-owned health system, which had some religious restrictions in place. For instance, he said, the health system did not offer emergency contraception or copper IUDs, so hormonal IUDs were used instead.

“My personal training may not have changed too much because we would refer patients who wanted an abortion” elsewhere, he said. However, his classmates at other hospital systems may have gotten other training that he didn’t and that is further restricted with the new laws.

More: 'This isn't like Texas': Experts say helping Ohio patients get abortion care isn't illegal

At the NEOMED Student-Run Free Clinic, direct care for pregnant patients has not changed since the law was overturned because the clinic would have referred any patients seeking surgical or medical abortions via medication to other providers, said Jinka. The clinic, which is run by student volunteers with physician advisers, is still able to prescribe emergency contraception and oral contraception.

The Student-Run Clinic is a free clinic held every Saturday except holidays at NEOMED and offers free primary care and non-emergency care for the community.

Since the abortion law was overturned, the volunteers at the clinic have been trying to educate its patients, many of whom don’t have good access to health care, Jinka said.

“In the last week, our volunteers are working really hard to make a pamphlet that details a lot of different information for our patients,” he said. “We recognize that many of our patients are from underserved and rural communities that may not have abortion clinics near them. They may not be able to travel to clinics and they may not even know about some of these changes.”

The clinic volunteers also want to step up efforts to educate patients on reproductive health and sexual health, he said.

Those efforts include sharing information about the free Ohio HIV/STI (Sexually Transmitted Infections) Hotline, known as OHIV, which provides a private toll-free hotline at 800-322-2437, free condoms and at-home HIV tests. More information can be found at www.ohiv.org 

Health system residency programs weighing next steps

In the Akron area, Cleveland Clinic Akron General and Summa Health have residency programs training future ob-gyn physicians. Representatives from the health systems said the programs were still working through how the changes would affect the training of their future doctors.

In a statement, Cleveland Clinic said: “Cleveland Clinic is reviewing how the Supreme Court’s decision will affect its medical education programs and is committed to making decisions under the law that are in the best interest of its students and patients.”

In a memo shared with staff and provided to the Beacon Journal by Summa, CEO Dr. Cliff Deveny cited a statement from the American Hospital Association to help its hospitals and health systems with “practical impacts on hospitals and health systems, including health care provided across state lines.”

“In the days ahead, we hope to learn more how the court's decision affects Ohio women's health providers and the community," Deveny wrote. "We will continue to keep you updated regarding this important decision."

Beacon Journal staff reporter Betty Lin-Fisher can be reached at 330-996-3724 or blinfisher@thebeaconjournal.com. Follow her @blinfisherABJ on Twitter or www.facebook.com/BettyLinFisherABJ. To see her most recent stories and columns, go to www.tinyurl.com/bettylinfisher

This article originally appeared on Akron Beacon Journal: Ohio's abortion laws affect training, recruiment, retension of doctors