Demand for abortion training in Minnesota could grow if Roe overturned

ROCHESTER, Minn. — Though an approaching court decision could cause abortion to become illegal in 26 states, OB-GYN residency training experts say that access to abortion training is a required component for the accredited education of doctors who provide reproductive health services.

As a result, they say obstetrics and gynecology training programs in so-called "abortion refugee" states such as Minnesota will be needed to serve an increase of out-of-state physicians seeking training in abortion care as part of an accredited program.

"I think we'll be able to get those who are highly motivated to places where they can get training," said Jema Turk, director of evaluation for the Ryan Residency Training Program . The 23-year-old training initiative, through the University of California San Francisco, helps programs meet the Accreditation Council for Graduate Medical Education mandate for routine abortion training.

"But I also worry about the programs and clinics in safe states. They're going to be completely overwhelmed with women traveling from out of state and people who want to be trained."

Turk is coauthor of a new commentary in the journal Obstetrics and Gynecology which found that a reversal of Roe could greatly diminish the training of physicians in the widely used medical procedure.

"One out of four women need and want this procedure," Turk told Forum News Service in an interview. "So that means even if you don't think you know someone who this connects with, you do. Your cousin or sister or friend — someone you know and love has had to deal with this."

Out of 286 accredited OB-GYN residency programs nationwide, Turk's paper found that 128 or almost 45% "are in states certain or likely to ban abortion if Roe v. Wade is overturned," and almost 44% of all OB-GYN residents are "certain or likely to lack access to in-state abortion training."

It calculated that a reversal of Roe would mean that 2,638 of the nation's 6,007 reproductive health residents would need to be offered training in another state.

Since 1992, all graduate programs in obstetrics and gynecology are required to offer abortion training on an opt-out basis in order to be certified by the national oversight body for medical residencies.

Teaching hospitals do not have to provide the training themselves, but they must provide access for resident physicians. "Opt-in" programs requiring students to take the initiative are considered noncompliant.

Most programs abide by this requirement. Turk cites a 2018 survey showing that of those who responded, about 64% of the nation's OB-GYN programs dedicated time in their schedules for routine abortion training, with just 31% who made it available as an opt-in. Another 5% of the programs were out of compliance altogether.

Participation is high. The survey found 71% of OB-GYN residents became familiar in first trimester aspiration, 66% in medication abortion, and 67% with induction termination, albeit with only 22% in dilation and evacuation, a second trimester procedure also sometimes used for miscarriage.

Complicating questions of access to reproductive health training post-Roe, is the sometimes considerable overlap between abortion care and routine reproductive healthcare. Though physicians may need to be able to know different complications or prep skills, in a general sense, Turk said, "the actual procedure to empty the uterus is the same for whatever reason."

While "residents can still get a lot of training in these skills even if it isn't an induced abortion, if a program only did miscarriage management, there would definitely not be enough volume in most places for every resident to train it with any competence," Turk said.

The American College of Obstetrics and Gynecology calls abortion training "a critical element of women’s reproductive health care," and recommends residency programs "continue efforts to destigmatize and integrate abortion training into medical education."

It also recommends first trimester abortion skills be trained among family practice doctors and advance practice clinicians, a term that encompasses nurse practitioners and physician assistants.

According to the American Medical Association's Residency & Fellowship database, there are just two graduate OB-GYN residencies in Minnesota, at the University of Minnesota and at Mayo Clinic in Rochester. The University of Minnesota is listed as a participant on the website of the Ryan Residency Training Program, while Mayo Clinic is not. There are no programs in North Dakota or South Dakota.

Kat Dodge, media relations manager for the University of Minnesota Medical School, says its program is in compliance with the accreditation requirement.

"The Accreditation Council for Graduate Medical Education requires accredited medical schools to provide obstetrics and gynecology residents training, or access to training, in all forms of contraception," Dodge said in a statement.

"This includes the termination of pregnancy and management of health complications. As per national guidelines, residents who have a religious or moral objection may opt out. The University of Minnesota is fully in compliance with the (accreditation) requirements."

"Mayo Clinic is committed to advancing the training and education of medical students and residents to care for all patients," Kelley Luckstein of Mayo Clinic communications said in a statement.

"This commitment encompasses the full spectrum of medical conditions related to women’s health and care for pregnant patients." Mayo declined to answer further questions about it's OB-GYN training in relation to abortion care.

"I wish that all these hospitals and places that say they want to take care of patients would be honest about the fact that this is a part of health care, and it should be, you know, treated like one," Turk said.

"Programs that don't acknowledge it as part of health care, those doctors...are really missing out on a big portion of their patients' lives," she said.

Turk says her research shows residents who participated in a rotation at family planning clinics, no matter their level of participation, had their understanding changed by the experience.

"What we found is ... maybe they are not going to do it themselves, but they are going to make sure their patients have good referrals to someone who will care for them. Their attitude really changed."