Farah Yousry/Side Effects Public Media
Early on a Monday morning, a group of young OB/GYN residents gathered for a daily meeting. The young doctors, dressed in blue scrubs and white coats, sat in the auditorium of Indiana’s largest teaching hospital.
The meeting was an opportunity to share updates and make announcements. But they also had to address the elephant in the room.
“Any more questions about abortion care?” Dr. Nicole Scott, director of the residency program, asked the participants.
One of the residents spoke up after a few harsh moments of silence: “How is Dr. Bernard?”
“Bernard is in a really good mood. I mean, relatively,” Scott replied. “She has 24/7 security, she has her own lawyer.”
They refer to Dr. Caitlin Bernard, an Indiana abortion provider and one of the doctors who trains residents at this teaching hospital. Bernard was recently caught up in a political turmoil after speaking to a reporter about an abortion she performed on a 10-year-old rape victim who crossed the state line from Ohio. The doctor was the target of attacks from pundits and political leaders on national television, including the Indiana attorney general.
Vitriol hit this group of residents. Bernard has been a mentor to most of them for years. Many of these young doctors were sure they wanted to practice in Indiana after training. Lately, some have felt more ambivalent.
“Looking at what [Dr. Bernard] what she went through was terrifying,” said Dr. Beatrice Soderholm, a fourth-year OB/GYN resident and one of Bernard’s trainees. “I think that was part of the point for those who were putting her through it. [It] was to scare other people out of doing the work she does.”
Last week, Republican Indiana Governor Eric Holcomb enacted a near-total ban on abortion, making Indiana the first state to pass new legislation restricting access to abortion since the Supreme Court struck down Roe vs. Wade in June.
Before lawmakers voted, thousands of Indiana providers expressed concern that outcomes would likely worsen for their patients. It is unclear what this will mean for providers as well.
And that’s what the medical residents are worried about: the first doctors to spend four years training to become obstetricians and gynecologists.
Doctors weigh their options
These days, Scott, the director of the residency program, has found that the scope of her work has expanded beyond clinical and academic responsibilities. Her meetings with residents include policy updates and she tells them mental health services are available if they need them.
“I mean, our residents are devastated,” Scott said, fighting back tears. “They signed up to provide comprehensive health care for women. And they’re told they can’t do that.”
She hopes this will “profoundly impact” the way Indiana hospitals recruit and retain medical professionals.
Indiana, like many Republican-led states, has a shortage of providers. A 2018 March of Dimes report found that 27% of Indiana counties are considered maternity care deserts, with limited or no 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 make these statistics worse.
Dr. Wendy Tian, a third-year resident, said she has been scared lately and worried about her safety. Tian grew up and went to school in Chicago and chose to come to Indiana for residency because the program has a strong focus on family planning. She was also open to practicing in Indiana when she completed her training.
But that has changed.
“I always thought I wanted to do family planning. Now I’m thinking of doing something else,” he said. “I know I still want to bring him in. But for sure, I don’t know if I could stay in Indiana after graduation with what’s going on.”
Still, she feels “guilty for giving up” on some of Indiana’s most vulnerable patients.
Even before the Supreme Court struck down Roe vs. WadeTian said the medical climate in Indiana could be hostile and frustrating. Indiana, like other states with abortion restrictions, allows almost all health care providers to opt out of providing care to abortion patients.
“We meet other people we work with on a daily basis who are opposed to what we do,” Tian said.
Tian said that sometimes she and her colleagues have to cancel scheduled procedures because on-call nursing staff don’t feel comfortable helping a patient undergoing an abortion.
“We often have to call the anesthesiologists ahead of time, because there are only certain providers who are willing to provide anesthesia [for abortion patients]”Tian said.
Dangerous abortion training
Still, the OB/GYN program in Indiana has been able to provide residents with comprehensive training, including abortion care and family planning. This is important for more than abortion cases.
“Miscarriages are handled in exactly the same way as first-trimester termination procedures,” Scott said. “But what termination procedures allow you to do is that kind of repetition and that understanding of the female anatomy, and how to manage the complications that can occur with miscarriages.”
Farah Yousry/Side Effects Public Media
And that worries Scott because eliminating abortion dramatically reduces the hands-on experience OB-GYN residents can get at his hospital.
Scott’s show is exploring ways to make up for that. They could send out-of-state residents to learn in places without abortion restrictions. But Scott said this would be a logistical nightmare.
“This is not as simple as showing up at an office and saying, ‘Can I observe?’ This includes obtaining a medical license for out-of-state trainees. This includes funding for travel and lodging,” Scott said. “It adds a lot to what we already do to educate future OB/GYNs.”
Nearly half of all resident OB/GYNs in the US are in states where abortion is prohibited or likely to be prohibited. This means there will be an influx of residents looking to leave the state to make up for lost training opportunities. The Accreditation Council for Graduate Medical Education, the body that accredits residency programs, has proposed modifications to graduation requirements for obstetrics and gynecology residents to account for this changing landscape.
The difficult decision to stay or go
For some residents, like freshman Veronica Santana, these political hurdles are actually a welcome challenge. Santana is Latina, grew up in Seattle, and has been involved in community organizing since she was a teenager. Part of why she chose OB/GYN was because of how the medical field intersects with social justice.
“It’s political. It always has been and still is. And obviously, especially now,” he said.
After Roe was overturned, Santana took to the streets of Indianapolis to participate in demonstrations for abortion rights. So did many of his co-residents and mentors.
Most of them, including the program’s director, have asked not to name the medical school or hospital system they work for because they fear backlash. Some said their employer remains coy about supporting staff when it comes to the abortion debate in Indiana.
In a way, Indiana could be the perfect battlefield to sate Santana’s enthusiasm for advocacy and social activism. But lately, she said she’s “very unsure” whether continuing to practice after residency makes sense as a doctor who wants to provide the full scope of health services.
Soderholm, a fourth-year resident physician, said there is a lot to think about.
Soderholm will complete his training in a few months and will start practicing soon. She grew up in Minnesota, but in recent years has felt a strong connection to patients at the Indianapolis County Hospital. She was so sure that she wanted to practice in Indiana. But lately, her family in Minnesota, where abortion remains largely protected, questioned why she would stay to practice in Indiana’s hostile medical climate.
“There have been many doubts. But women [and] the people of childbearing age that we have cared for, especially in our county hospital, [make it] really hard to leave. I’m sorry,” she said, beginning to cry.
It is because of those patients that Soderholm decided that he will probably stay. The same cannot be said for many other future doctors.
This story comes from a journalistic collaboration that includes the Indianapolis Recorder and Side Effects Public Mediaa public health news initiative based in wfyi in Indianapolis.