OB-GYN Residency Programs Face Tough Choice on Abortion Training

With applications for next year’s class of residents underway even as state abortion laws mutate, program directors in restricted regions are struggling with what assurances about abortion training they can make to candidates.

That is among the reasons that many medical students have said they are applying only to programs where abortion is legal. Public health experts predict that in a few years, patients in abortion-prohibited states, where the ranks of obstetricians are already shrinking, will experience even greater barriers to reproductive health care.

A reviewing committee of the accreditation council debated whether simulation modeling, a staple of medical education that is a precursor to direct care, would suffice for residents who could not travel to another state. In abortion training, for example, residents watch videos and practice on low-tech uterine models, including papayas. The committee decided that simulation was not an acceptable substitute.

The council has made abortion training a component of its family planning requirements since at least the mid-1980s. But by the mid 1990s, when the number of abortion clinics was decreasing and threats against providers were rising, the council stated its requirements explicitly.

Around that time, Congress passed another in a series of “federal conscience” provisions ensuring that programs — as well as individuals — refusing to perform abortions and therefore risking loss of accreditation could not be discriminated against by such means as losing federal or state funding.

Even if funding for programs that resist offering abortion rotations is guaranteed, the effect of the council’s citation, probation or denial of accreditation is potent, said Greg Care, a lawyer who represents residents. Medical students won’t apply to a program without accreditation, he said, “And a lot of academic medical centers live and die on residents being cheap labor.”

Dr. Maja Grzejdziak, a first-year OB-GYN resident at Texas Tech University Health Science Center, El Paso, said that residents would then have to transfer to complete their training. “It would be a big deal for the community, because residents take care of so many people at nonprofit hospitals especially,” she said.