How to save the next generation of abortion doctors

For decades, abortion education has been mandatory in the training of ob-gyn doctors.

Now, a year after the Supreme Court overturned Roe v. Wade, it is increasingly unavailable.

With abortion access vanishing in almost half of the country, Bay Area medical-training programs have launched a deliberate and concerted counteroffensive, hosting and helping future doctors from states where access is restricted. The goal is twofold: to ensure the nation doesn’t lose a generation of providers, and to arm doctors everywhere with the expertise to care for women who, now more than ever, need to understand the new complexities of being pregnant.

“It’s key that we learn how to counsel our patients on all of their options,” said 29-year-old Dr. Anita Vasudevan, who left her home state of Texas for UC San Francisco-sponsored abortion training at a primary care residency program at Sutter Santa Rosa Family Medicine. “Not only because it’s the right thing to do, but because it can be life-saving.”

A high school valedictorian and university honor student, Vasudevan misses her friends and family in Houston, where she dreamt of providing primary care to underserved patients.

But when Texas took steps to ban abortion, dramatically reducing her opportunity to learn, “I was really nervous,” she said. “Here, it’s just a choice that people have.”

Abortion doesn’t go away when it becomes illegal, advocates say — it just becomes less safe. For women seeking to understand their options, the U.S. needs clinicians in every state who are trained and ready, said Dr. Jody Steinauer, director of the UCSF Bixby Center for Reproductive Health and the Ryan Residency Training Program, a national project that finds educational slots for ob-gyn residents from restrictive states.

“We’re worried that doctors will finish their training not having the basic knowledge about abortion care and won’t be able to provide pre-abortion care, post-abortion care to their patients,” she said.

A family doctor may be the first person to whom a woman turns for help if she’s suffering from an unplanned pregnancy, a miscarriage or fetal problems. But only 6% of family medicine residency programs offer abortion training — and they’re almost exclusively concentrated in “safe haven” states such as California, said Flor Hunt, executive director of the Bay Area-based TEACH (Training in Early Abortion for Comprehensive Healthcare), which arranges “external rotations” in abortion care for family practice residents.

Even ob-gyn residents — trainee doctors who have committed to the specialty — who don’t plan to perform abortions must receive training in the procedure to be board certified to practice.

But nearly 20% of the nation’s 286 accredited ob-gyn programs operate in states with revived or new abortion bans; another 28% of programs are in states with major restrictions. And that puts medical schools and residency programs in a quandary: While states are criminalizing abortions, medical education and accreditation groups consider it an important skill.

The Accreditation Council for Graduate Medical Education requires ob-gyn residents to perform at least 20 surgical abortions to satisfy its requirements — and if a program doesn’t offer training, it risks losing its accreditation. The American Board of Obstetricians and Gynecologists requires training for doctors to be certified to practice.

In emergency situations, there’s a professional duty for a doctor to act, irrespective of state restrictions. The U.S. Department of Health and Human Services has reaffirmed the Emergency Medical Treatment & Labor Act, legally mandating that clinicians provide life-or health-saving abortion services in emergency situations — overriding any state laws.

To be sure, training hospitals in states with restrictive laws may still be able to provide legal abortion care for people with medical, obstetric and psychiatric illness, fetal abnormalities and other qualifying circumstances.

But these cases are so rare that students may not encounter them. And they won’t know how to handle any complications, said Hunt.

If a program fears running afoul of state laws, it must help its doctors travel to another state to receive training.

That’s where Bay Area teams are stepping in. The bold idea at the heart of their effort is to teach out-of-state doctors that abortion is a seamless part of health care for women — something that is essential, not shunned.

UCSF’s Ryan Program aims to help future ob-gyns. How does it work? A training program in a restrictive state asks the program to arrange a slot in California or another pro-abortion rights state. The program finds a match and also irons out all the messy contractual details, such as salary payment, insurance coverage, licensing and even badging and access to computer networks.

An anonymous donor in the San Francisco Bay Area has donated funds to support the program’s training of about 50 Texas resident physicians.

At Stanford Medicine, four students from Georgia and Texas — states hostile to abortion — are now studying with eight Stanford students in the medical school’s two-year Complex Family Planning Fellowship, according to fellowship director Dr. Erica Cahill, clinical assistant professor of obstetrics and gynecology.  The fellowship trains doctors how to treat high-risk women with pregnancies that are abnormal, unwanted or potentially life-threatening.

UCSF’s TEACH program focuses on helping students who want to be family doctors. Partnering with Planned Parenthood clinics and medical centers in San Francisco, Santa Rosa, Salinas and Martinez, it coordinates a reproductive health care “rotation” for about 50 second-year residents and 20 to 25 third-year residents. In addition to teaching hands-on procedures, it trains doctors how to conduct telehealth for medication abortion and help protect patients from prosecution.

“We’re preparing future providers to navigate what is becoming a very complex legal landscape, so that they can provide the best care they can — regardless of where they’re practicing,” said Hunt.

Vadusevan at first planned to return to practice in Texas. “I know my community is there,” she said. But the political realities back home, including Texas’ law that allows individuals to sue anyone who performs or aids an abortion, has made her think twice. She’s planning to stay in California for now. “There’s the risk of like losing not only my job but potentially my medical license if I were to go back to Texas,” she said.

Dr. Jacqueline Moskow is keeping her future options open. Raised and educated in Ohio, the family physician credits California with providing the skills necessary to practice family medicine in Martinez — and perhaps, someday, use them in her home state.

“It became more and more apparent that abortion training would be hard to get up in Ohio,” she said. Through TEACH, “this felt like a much more nurturing environment in which to be trained, rather than one where I always had to be fighting.”

“If I were to go back to Ohio,” she said, “I want what exists here to exist there … and in all 50 states.”