Louisiana OB-GYN residents train at an abortion clinic. Now where will they go?
Most obstetrics and gynecology medical residents in Louisiana train at a Shreveport abortion clinic. Now, it’s not clear where they will get that surgical instruction when most abortions likely become illegal in Louisiana and the clinic is shut down.
“We are looking to set up another opportunity for this training somewhere, whatever that is or wherever that is,” said Nicole Freehill, who runs the clinical residency program for OB-GYNs at LSU Health Sciences Center in New Orleans.
Even if doctors never intend to perform an elective abortion, they still need the training provided at the clinic because they may have to perform the procedure in an emergency situation, one where a pregnancy can result in death. OB-GYNs also have to use same surgical procedures to manage miscarriages if they become life-threatening, Freehill said.
In all, four of Louisiana’s five OB-GYN residency programs contract with with Hope Medical Group for Women, the abortion clinic in Shreveport, said Kathaleen Pittman, the clinic’s administrator, this week.
Pittman declined to name which four programs worked at the Shreveport clinic, but Tulane University’s OB-GYN residents do not train at the facility, according to a university spokesman.
LSU’s OB-GYN residency programs in New Orleans and Baton Rouge confirmed they send doctors to the clinic. Ochsner Health system, which runs an independent residency program based in New Orleans, and LSU Health Sciences Center in Shreveport did not answer questions about whether their residents trained at the clinic.
Credential standards for medical residency might change
The Accreditation Council for Graduate Medical Education currently requires all OB-GYN residency programs in the country to provide access to abortion training, but the organization is considering adjustments to that rule in light of the recent U.S. Supreme Court decision striking down the constitutional right to an abortion.
Following the court’s decision, it’s estimated that 45% of OB-GYN residents in the United States are now located in states like Louisiana, where abortion is likely to be banned or heavily restricted, according to the Bixby Center for Global Reproductive Health.
The accreditation council might allow OB-GYN programs to send residents out of state for abortion training instead of providing it as part of their in-house education. For those who can’t travel, the residency programs could also turn to simulations that resemble the real-world, clinical experience they would otherwise get, according to draft guidelines the organization released.
LSU Health in New Orleans is considering sending their OB-GYN residents – about six people each year – out of the state for the two-week. training they have typically received at the Shreveport abortion clinic, Freehill said.
The university would have to cover the travel and housing for them while they worked outside the state, said Leslie Capo, an LSU Health spokesperson. Because states surrounding Louisiana are also likely to ban abortion, it could mean sending residents as far as Illinois, Freehill said.
The New Orleans teaching hospitals and facilities that typically work with her residents do not see enough cases that require surgical abortion procedures in order to provide adequate training opportunities, Freehill said.
University Medical Center and Touro Infirmary in New Orleans, where Freehill works, may only see a handful of people every month that need that type of surgical care for a miscarriage or pregnancy gone wrong. At the Shreveport abortion clinic, residents were able to practice those surgical procedures under the eye of an experienced physician several times a week, Freehill said.
“When they go to Shreveport, they get to perform multiple procedures in a row. That teaches them immensely in a very short period of time,” she said. “It’s like doing a gymnastics or a dance routine.”
Residents who object to elective abortion aren’t forced to perform them, Freehill said. They typically sat out the procedures at the clinic but continued to participate in the post-operative care and contraceptive counseling that the clinic also provides.
Criminal consequences could deter doctors
Freehill said the abortion ban may impact LSU’s ability to attract students to their program. OB-GYN residents come from all over the country to do their training in Louisiana, but some might be deterred from trying to match here if they don’t feel they can get the same level of education, she said.
Some Louisiana medical students are already frustrated. Members of a New Orleans chapter of Medical Students for Choice, which supports access to abortion, are among those suing the state over its abortion ban. In a legal filing, the medical students have argued that they have standing to fight the ban because it would interfere with their medical education.
Dr. Rebekah Gee, Louisiana’s former health secretary and an OB-GYN, said she worries residents and fully trained doctors won’t want to practice in Louisiana if there is a threat of criminal penalties hanging over them.
The Orleans Parish Civil District Court is currently blocking the state’s abortion ban with a temporary restraining order, but it could be lifted as soon as July 8. When it goes into effect, the ban contains criminal penalties, including fines and prison sentences, for people who provide illegal abortions, including doctors.
The ban includes a few general exceptions in which abortion would be legal, such as to treat a life-threatening pregnancy. Gee said the circumstances for a legal abortion aren’t spelled out clearly enough in the law. Physicians are worried they could face criminal charges for handling a miscarriage or providing a medically necessary abortion they might think is allowed, she said.
“What if a woman comes in with a miscarriage and she is bleeding heavily? How do we know if she is bleeding enough [to justify an abortion-like procedure]? Will the resident and attending physician be comfortable treating her given the criminal penalties?” Gee said. “Will people want to come here to train if they could go to jail?”
In Louisiana, people are already more likely to die from pregnancy or during childbirth than they are in almost any other part of the country. So the prospect of limiting medical training necessary to treat life-threatening pregnancies and miscarriages is concerning, Freehill said. If doctors aren’t comfortable with certain procedures – or are afraid to administer them – it could exacerbate that state’s already high rate of pregnancy and childbirth death, she said.
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