On Monday morning, a group of obstetrics and gynecology residents dressed in blue scrubs and white coats gathered in an auditorium at the Indiana University School of Medicine. After the usual updates and announcements, Residency Program Director Dr. Nicole Scott addressed the elephant in the room. “Any other abortion care questions?” he asked the trainees.
After a few moments of silence, a resident asked: “How is Dr. Bernard?”
“Bernard’s actually in really good spirits—I mean, relatively,” Scott replied. “He has 24/7 security, his own lawyer.”
They were talking about Dr. Caitlin Barnard, an Indiana OB-GYN who performs abortions and trains residents at University Hospital. Bernard was recently caught in a political whirlwind after he spoke about an abortion he gave to a 10-year-old rape victim from Ohio. Barnard was the target of false accusations on national television by pundits and political leaders, including Indiana’s attorney general.
Doctors interviewed for this article said they were not speaking on behalf of their schools of medicine but rather their personal experiences at a volatile moment that will affect the way they care for their patients.
The vitriol directed by Bernard hit home for this group of residents. He has mentored most of them over the years. Many young doctors were sure they wanted to practice in Indiana after their training. But lately, some are ambivalent about that prospect.
Dr. Beatrice Soderholm, a fourth-year OB-GYN resident, said what Bernard saw was “scary.” “I think that was part of the point for those who put him through it,” Soderholm said. They were trying to “scare other people away from what he does”.
In early August, Governor Eric Holcomb, a Republican, signed a nearly complete abortion ban into law, making Indiana the first state to adopt new restrictions on abortion access since the Supreme Court overturned the ruling. Roe v. Wade In June. When the ban goes into effect Sept. 15, medical providers who violate the law risk losing their licenses or up to six years in prison.
These days, Scott, the residency program director, uses some meeting time with residents to fill in political updates and available mental health services. He reminds them that legal counsel is on call around the clock to help if they are ever unsure about patient care.
“Our residents are devastated,” Scott said, holding back tears. “They signed up to provide comprehensive health care to women, and they’re being told they can’t.”
He hopes it will “profoundly affect” how Indiana hospitals recruit and retain medical professionals.
A 2018 report by the March of Dimes found that 27% of Indiana counties are considered maternity care deserts, with no or limited access to maternity care. The state has one of the highest maternal mortality rates in the country.
Scott said new laws restricting abortion will only worsen those statistics.
Scott shared the results of a recent survey of nearly 1,400 residents and fellows across all specialties at the IU School of Medicine, with nearly 80% of trainees saying they were less likely to stay and practice in Indiana after the abortion ban.
Dr. Wendy Tian, a third-year resident, said she was worried about her safety. Tian grew up going to medical school in Chicago and chose to do his residency in Indiana because the program has a strong family-planning focus. When he finished his training he was open to practice in Indiana.
But that has changed.
“I, for sure, don’t know if I’ll be able to keep up with what’s going on from Indiana Postgraduate,” Tian said.
Still, he feels guilty for “giving up” on Indiana’s most vulnerable patients.
Even earlier Ro By fall, Tian said, Indiana’s climate can be hostile and frustrating for OB-GYNs. Indiana, like other states with abortion restrictions, allows almost all health care providers to opt out of providing care to abortion patients.
“Every day we work with people we encounter other people who oppose what we do,” Tian said. Tian said she and her colleagues had to cancel scheduled procedures because the nurses on call were not comfortable assisting during abortions.
Scott said the IU School of Medicine’s OB-GYN program provides residents with extensive training in abortion care and family planning. Because the abortion is conducted in the same way as a first-trimester abortion, he said, the training gives residents a lot of experience. “What termination procedures allow you to do is understand these types of recurrences and the female anatomy and how to manage the complications that can occur with abortion,” she said.
A ban on abortion dramatically reduces facilities for OB-GYN residents and is a huge concern, she said.
The program is exploring ways to offer training One option is to send residents to study in states without abortion restrictions, but Scott said that would be a logistical nightmare. “It’s not as simple as just going into the office and saying, ‘Can I observe?’ This includes obtaining a medical license for out-of-state trainees. It includes funding for travel and lodging,” Scott said. “It adds a lot to what we already do to educate future OB-GYNs.”
Four out of 10 of all OB-GYN residents in the United States are in states where abortion is prohibited or likely to be prohibited, so the number of residents willing to move out of state to make up for lost training opportunities may increase. The Accreditation Council for Graduate Medical Education, the organization that accredits residency programs, has proposed changes to graduation requirements for OB-GYN residents to account for the changing landscape.
For some Indiana OB-GYN residents — including Dr. Veronica Santana, a first-year resident — these political hurdles are a challenge they’re willing to take on. Santana is Latina, grew up in Seattle, and has been involved in community organizing since she was a teenager. One reason she chose obstetrics and gynecology is how the field intersects with social justice. “It’s political. It always has been, and it continues to be,” he said, “and obviously, especially now.”
after Ro Instead, Santana, along with other residents and advocates, took to the streets of Indianapolis to rally in support of abortion rights.
Indiana may be the perfect battleground for Santana’s advocacy and social activism. But recently, he says, he’s been “very unsure” that it makes sense to stay to practice after a residency in Indiana, because he wants to provide a full range of OB-GYN services.
Soderholm, who grew up in Minnesota, felt a strong connection with the patients at County Hospital in Indianapolis. He was sure he wanted to practice in Indiana. But her family in Minnesota — where abortion is largely protected — recently questioned why she would stay in a state with such a hostile climate for OB-GYNs. “There’s a lot of hesitation,” he said. But patients find it difficult to get out. “Sorry,” she began to cry.
It’s for those patients that Söderholm decided he would likely stay. Other young doctors may make a different decision.
This story is part of a partnership that includes Side Effects Public Media, NPR and KHN.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Along with policy analysis and polling, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is a non-profit organization that provides health information to the nation.
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