New abortion restrictions are changing where future obstetrician-gynecologists are trained. 

Residency programs in states that have restricted abortion since the Supreme Court removed constitutional protection for the procedure said they are making contingency plans for their doctors to train in other states. Some medical students said they are limiting their searches to residency programs in states that allow abortion. And programs in states that offer clinical experience conducting abortions said they expect a surge in demand that far exceeds the spots available.

Maria Valle Coto, a fourth-year medical student at the University of Illinois College of Medicine at Chicago, said she is using a color-coded map of abortion laws by state to decide where to apply for training. A dean for career advising told her she might need to consider another specialty because competition for OB-GYN slots is so high in states that allow abortion, she said.

Maria Valle Coto. Photo: Maria Valle Coto

“I’ve already gone so far into this career that it would be disheartening to do a different specialty,” she said.

The Accreditation Council for Graduate Medical Education, which certifies physician-training programs, requires that OB-GYN programs provide abortion training for residents who don’t opt out. The council said in September that programs in states where abortion is restricted must help residents get training in another state. 

“This is a core procedure that has to be learned and experienced by residents,” said Dr. John Combes, the council’s public-policy officer. He said the council would work with programs that can’t meet the requirement.

In Wisconsin, where abortions were halted after the Supreme Court’s June decision, the UW School of Medicine and Public Health is exploring partnerships with medical schools and clinics outside the state to meet the training requirements, said Dr. Ellen Hartenbach, chair of the department of obstetrics and gynecology.

“We’re concerned about how it may impact the training program. And we’re concerned about how it will impact the decision of our residency graduates to stay in practice in Wisconsin,” she said of changes in abortion law and practice.

Lynne Johnson, executive director of Midwest Access Project, which works with 11 programs that provide abortion training to residents and other medical providers, said that before the Supreme Court decision the group accepted about half of applicants. This year far more people than usual have applied, she said. 

“We had to end our application cycle early because we couldn’t handle the number we were getting,” she said.

Residency programs that use state funding in places that have restricted abortion are navigating financial and legal constraints on where and how their doctors conduct abortion training, said Stephanie Toti, senior counsel and project director at the Lawyering Project, a group that advocates for abortion access. 

Jessica Mecklosky. Photo: Dr. Katherine Jolin

Jessica Mecklosky, a fourth-year student at Tulane University School of Medicine, in Louisiana, said she was inspired to apply to pediatric residency programs after treating children and teens with pregnancies, many of whom have been sexually abused. She said she had planned to train in the South but now is focused on states including Massachusetts and Pennsylvania that wouldn’t restrict her ability to counsel patients on abortion.

“I wouldn’t feel like a competent physician,” she said.

Some OB-GYNs who oppose abortion said residents get enough exposure to the procedure away from abortion clinics. The procedure is used to remove fetal tissue after a miscarriage or when a woman’s life is threatened from hemorrhage or infection, they said.

“The only thing specific abortion training gives is how to end a viable pregnancy,” said Christina Francis, an OB-GYN in Fort Wayne, Ind., who opposes abortion.

David Eisenberg, an OB-GYN and professor at Washington University School of Medicine in St. Louis, said residents need abortion training to learn how to evacuate a uterus under any circumstance.  

“When a pregnancy goes sideways, you want your health provider to not hesitate,” he said. “It should be as second-nature as putting on your scrubs.”

He said he is working on ways for his students to get the training outside of Missouri, which banned abortions in June except to save a pregnant person’s life. 

Washington University said it would find a way to meet accreditation requirements without breaking the law.