Ratekin, Sherin and Taylor: The Uncertainty of Medical Training Post-Roe
Roe v. Wade’s overturn will dramatically impact access to quality training for abortions and obstetrical emergencies, residency applications and patient care.
This September, fourth-year medical students around the world will spend countless hours perfecting their applications for residency positions. In order to practice medicine in the United States, students must obtain impeccable grades throughout their undergraduate years, demonstrate competence and compassion during four years of medical school and learn innumerable clinical skills during their three to seven years of residency. Only then are they able to start their careers as physicians. While this journey can be difficult and overwhelming, it is also incredibly rewarding, offering us the chance to help people through some of their most vulnerable and formative moments in life.
Those of us writing this letter are interested in careers that will incorporate reproductive health into our everyday practice. More specifically, we went into medicine for the opportunity to empower people with information and options about their reproductive health, and to provide care that helps patients meet their reproductive goals.
Abortion care is a critical aspect of that health care delivery. It not only provides patients with autonomy over their choices and lives, but it is also often a necessary and life-saving medical procedure — such as in the case of ectopic or high-risk pregnancies that require termination for the health and safety of the pregnant patient. Unfortunately, for students like us who are hoping to cultivate careers providing full-spectrum reproductive health care, the path to doing so became far more difficult after the Supreme Court overturned Roe v. Wade in June.
As part of accreditation, Obstetrics and Gynecology residency programs must provide training, or access to training, in performing abortions. Though there are more than 230 Ob/Gyn residency programs in the U.S., only 106 programs have abortion care integrated into their curriculum as a designated Ryan Family Planning Program. Ryan programs guarantee abortion and contraception training as part of their family planning rotations for residents, either on site in their teaching hospitals or through partnerships with local abortion clinics. Of these 106 programs, only half are in states that are now protective of abortion rights. The remaining programs are in states that have either already severely restricted abortion access or may likely restrict access in the future. The unfortunate reality is that the next generations of reproductive care providers will likely not get the training they need to manage abortions, miscarriages, ectopic pregnancies and other gynecological emergencies.
Matching into an Ob/Gyn residency program is already competitive. Now, graduating medical students seeking to receive comprehensive abortion training may only apply to residency programs in states where it remains legal, making the already competitive application pools at these sites even more so. This may make it even more difficult for students to secure a position at one of their programs of choice. Students who match into an Ob/Gyn program in states that have banned or severely restricted abortion may have to travel to other states during their training to learn how to perform abortion care and manage obstetric emergencies, which may be a significant barrier to them.
As medical students hoping to provide full spectrum reproductive health care, we are in difficult positions. We are uncertain how the overturning of Roe will affect our ability to apply for and match into residency programs that meet our needs as future reproductive health care providers. Once we complete our training and earn our medical licenses, we are scared of how abortion restrictions and the criminalization of care will impact our medical licenses and ability to practice. Most importantly, we are worried how this uncertain future will endanger the health of all our future patients and their families.
Only time will tell how the overturning of Roe will impact the number of physicians qualified to provide full spectrum reproductive health care in states without protected abortion rights. What we do know is that the impact will extend far beyond people seeking elective abortion. Without adequate staffing of physicians trained in abortion care, millions nationwide may not be able to get the care they need when faced with an ectopic pregnancy, or in need of miscarriage management. Eventually, they may not be able to find an Ob/Gyn at all, as providers choose to practice in less hostile regions. Diminished access to care is not the future of medicine that we envisioned when we started our medical careers. We must do better. Lawmakers in New Hampshire, Vermont and across the country must act now to ensure that doctors are able to freely provide the care they need to patients and their families.
Carly Ratekin, Maggie Sherin and Delaney Taylor are students at the Geisel School of Medicine graduating in 2024. This column was written with the assistance of Ashley Yang Med’24, Katie Allan Med’24, Lily Greene Med’24 and Sarah Matsunaga Med’24. The views and opinions expressed here are not necessarily those of Geisel, and they may not be used for advertising or product endorsement purposes.
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