As the patient’s labor stretched into the evening, the heartbeat disappeared, leaving Stiles free to perform the dilation and extraction. The resident working alongside Stiles should have known how to perform the procedure. But instead, the resident revealed, “I’ve never done this before.” Thanks to Ohio’s abortion ban, the resident had never had a chance to learn how to do perform a typical procedure—even in cases of medical emergencies.In the months since Roe’s overturning, countless doctors have confronted abortion bans that, they say, have forced them to defy medical guidelines and their oath to do no harm. But amid that health care crisis, there’s another, burgeoning terror, one that’s set likely haunt medicine for years to come: Can doctors still learn how to do abortions?The answer is worrying. At least 13 states have now banned almost all abortions, and hospitals in those states can no longer teach the next generation of doctors how to perform the procedure. Although Roe’s overturning has spurred more doctors to pursue abortion training, experts told VICE News, the few places that can provide that information are dwindling and overrun. Abortion providers’ ability to keep up what promises to be a decades-long fight over the future of abortion is now imperiled.
The patient’s only choice was to grit her way through labor and deliver a stillborn.
The administrator is even worried that people at the institution where they work may try to sabotage plans to train residents. Before the ban, when the program sent its residents to Planned Parenthood for training, an official initially refused to sign off on the agreement, the administrator said. Now, the administrator said, “We’re almost stuck cold-calling places to see if they’ll take residents.”
“We’re almost stuck cold-calling places to see if they’ll take residents.”
Residency programs and hospitals weren’t at the starting line when the Supreme Court overturned Roe. They were 50 yards back.
Dr. DeShawn Taylor, an OB-GYN who runs an Arizona clinic that offered abortions before the state banned them, told VICE News earlier this year that even before Roe’s fall, the stigma of the procedure has made doctors less able to diagnose and handle miscarriages and ectopic pregnancies.“It already has started to be a situation where even miscarriage was starting to be marginalized and pushed out to let the abortion providers handle it,” Taylor said. Abortion hasn’t fared much better in medical schools. “Abortion is one of the most common medical procedures,” Stanford University researchers concluded in a 2020 study. “Yet abortion-related topics are glaringly absent from medical school curricula in the U.S.A. with half of medical schools including no formal training or only a single lecture.” When medical school ends, students aren’t free to simply pick where they go to residency. Instead, they spend the last year of school applying to a nationwide program called the Match, which will ultimately use an algorithm to sort out which residents go where. If students try to decline their match, they will likely have to wait another year to start residency—and run the risk of ruining their medical careers before they even really get started.
“It already has started to be a situation where even miscarriage was starting to be marginalized and pushed out to let the abortion providers handle it.”
“My hope was that I could potentially get based in a place where I have a close friend or family member that would let me crash with them. But I imagine it would cost at least maybe $5,000 for lodging and transportation and everything.”
If she can’t cover the costs, Scott’s program could be found to be out of compliance with accreditation requirements.Those new rules about “support” don’t apply to family medicine residents. With 30 affiliated family medicine residencies, RHEDI is far smaller than Ryan. But two of its programs, in Idaho and Montana, are also facing the prospect of being unable to train doctors in-state. “They're trying to be creative and see if they can set up a satellite clinic across the border so people have been getting trained,” said Erica Chong, RHEDI’s executive director.Since Roe’s overturning, several people involved with abortion training told VICE News, doctors’ interest in learning about the procedure has skyrocketed. RHEDI had numerous residency programs in New York and North Carolina ask how to join, Chong said. But part of the problem, she said, is that the abortion clinics who may normally teach residents are now seeing a surge in requests for training. “They're also receiving lots of requests from especially all of the OB-GYN residents who are now having a really challenging time. So it's a lot of people who are looking to get trained and not that many training slots.” The Midwest Access Project, a nonprofit that helps connect a range of health care professionals with reproductive health care training like abortion, received 49 applications for help in its first application cycle after Roe’s overturning. That’s the most applications the organization has ever received in a single cycle. But, Midwest Access Project Executive Director Lynne Johnson warned, “We’re going to start declining more people as a result of the decision.”
“My greatest fear is that something would happen to our residents.”
The fear is that, unless overworked doctors start taking extraordinary steps, there’s likely just not enough places for everybody—including doctors who have graduated from residency and are further along in their career—who wants to learn how to do abortions to do so. And with a new Match cycle now underway, residency programs in states with abortion bans will potentially get far fewer applicants, while programs in liberal regions will be flooded.“I was hoping that the increased demand would lead to more days and then more training spots and everyone would jump in together to make sure that happens. But it's so much more complicated than that, than just saying, ‘Yes, everyone comes in and train,’” said Dr. Julia Eicher, a family medicine resident who works at a RHEDI-affiliated program in New York City. “What I've been seeing in my personal experience is, ultimately, there's maybe the same amount or maybe a little less training available now that all this is happening.”
“It's a lot of people who are looking to get trained and not that many training slots.”
This summer, North Carolina family medicine resident Dr. Chelsea Daniels had the rare chance to spend a few weeks working solely at a Planned Parenthood clinic. But when a more senior doctor, from Hawaii, had wanted to get training in abortion, there wasn’t enough room for both Daniels and that doctor to work at the clinic, Daniels said. Instead, Daniels ended up working at another Planned Parenthood in Chicago.“I blew through my savings to do this,” Daniels said. “It could have been essentially free, had I been able to live in my apartment and just drive down the road.”“If you're in a spot where you can't afford it, then you just lose out on the training, which is pretty unacceptable,” she continued.All of these plans are built on one foundational premise: that doctors can safely cross across state lines. But that foundation is rickety at best, because the country is now pitted against itself in a kind of abortion arms race. Half the United States wants to protect the procedure, while the other is determined to eradicate it. And each side wants to undermine the other. Although abortion providers have spent years traveling into red states into perform abortions, rather than live permanently among hostile neighbors, abortion opponents have already started to push for laws to cut down on what they’re now calling “abortion tourism” for both patients and providers. In early June, the top anti-abortion groups who architected Roe’s toppling discussed strategies for attacking interstate travel for abortion. In July, Congressional Republicans blocked a bill meant to protect the practice. The governors of liberal states like Colorado and Washington, meanwhile, have vowed to ignore other states’ requests to investigate or extradite people for breaking abortion laws.But come January, when many state legislatures go back to work, the legal landscape of abortion could shift again. While conservative states might not be able to restrict interstate travel this year, the campaign to chip away at and ultimately destroy Roe took decades. And it worked.“It's likely only going to get worse, especially as all this stuff gets more siloed geographically,” said Eicher, the family medicine resident in New York. “There's going to be huge portions of the country where there's no one there who's ever done an abortion or known anyone to do an abortion.”
“I blew through my savings to do this,” Daniels said. “It could have been essentially free, had I been able to live in my apartment and just drive down the road.”