Doctors Lack Access to Abortion Medical Training in Texas
Every year, more than 100 new obstetrician-gynecologists graduate from a Texas residency program and enter the medical workforce. Theoretically, all have had the opportunity during their four years of residency to learn about what's called "induced abortion" — named that to distinguish it from a miscarriage. However, the closure of abortion clinics in Texas — more than 20 since 2013 — has made that training increasingly difficult.
The Current State of Residency Programs
Texas has 18 residency programs in the field of obstetrics and gynecology, but the political climate affects how these programs operate. In many cases, this training happens quietly, almost in secret. "Doctors working in these institutions are walking a very delicate line," said Carole Joffe, a medical sociologist at the University of California, San Francisco, who studies doctors who do abortions. This is because academic medical centers in Texas receive tens of millions of dollars a year in state funding. Some institutions are fearful of the other sectors of the university coming down on them and saying, "You're threatening our funding."
The Professional Obligation to Learn
Medical residents can opt out of abortion training for religious or moral reasons, but many feel a professional obligation to learn the procedure. A resident identified as Jane explained her perspective: "This is part of OB-GYN — it's not an optional part, per se. Women can choose if they want an abortion or not, but you as their doctor need to be able to provide them with all the choices available."
During her third year of residency, Jane spent about a month at a family planning clinic. The rotation taught her various skills that will be useful in other practice areas, including:
- Counseling: Learning to counsel patients about abortion, contraception and sexually transmitted diseases.
- Ultrasound Proficiency: Doctors do ultrasounds before abortions in order to date the pregnancy, which helps determine which technique will be used to terminate it. While she might do a few ultrasounds in a typical OB triage area, Jane noted, "here we do 30 ultrasounds in a morning, so it's a lot of good learning."
- Clinical Techniques: Learning techniques for pain management and dilation of the cervix.
Challenges Facing Medical Providers
It's understandable why an OB-GYN resident in Texas might think twice about providing abortions. Doctors who provide the service must navigate a complex landscape of professional and personal risks:
- They must think about security issues for themselves and their staff.
- They have to deal with the scrutiny of state inspectors as well as anti-abortion protesters.
- Surveys and other research show that doctors who do abortions may have fewer job opportunities.
- In Texas, an ultrasound is mandated by state law, adding a layer of legal compliance to medical practice.