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Illinois hospitals brace for a flood of out-of-state doctors seeking abortion training

Crain's Chicago Business

Tuesday, June 21, 2022  |  Column  |  Elyssa Cherney

Some are already getting requests from medical residents in states expected to ban abortion if the Supreme Court overrules Roe.

If the landmark abortion rights case Roe v. Wade is struck down this summer, Illinois won’t only become a so-called “oasis” for women across the Midwest looking to terminate pregnancies. It’s also likely to serve as a massive training ground for early-career OB-GYNs who must learn to perform abortions. 

Hospitals or clinics that offer residency programs in obstetrics and gynecology are required to provide physicians with direct procedural training in abortion—or “access” to abortion training if the institution itself has moral or religious objections. That standard, established by the national accrediting agency for graduate medical education, isn’t expected to change, even as the U.S. Supreme Court moves closer to overturning the federal right to abortion.

 

But with as many as 26 states poised to ban or severely limit abortion after Roe falls, scores of OB-GYN residency programs around the country will have to secure training elsewhere. As a result, programs in states like Illinois, where abortion access remains protected, are already seeing a surge in training requests from outside institutions. Programs here will be especially burdened because Illinois is the only state in the region that guarantees the right to elective abortions, making it a logical choice for neighboring programs to send their residents. 

 

The situation creates logistical, financial and ethical challenges for Illinois residency sites, which must train their own doctors before extending resources to others. External residents can train at Illinois hospitals through temporary rotations that last several weeks, but there won’t be enough room for everyone. Those who don’t come in person could potentially receive remote training. 

 

“It’s a really complicated issue and already something that programs throughout the state of Illinois are discussing,” says Dr. Cassing Hammond, an associate professor of obstetrics and gynecology at Northwestern University. “We can’t absorb all the residents from all the other states. We don’t have the capacity.” 

 

Hammond says requests to train out-of-state residents are flowing in, often through informal conversations between friends or former colleagues. Because of the constraints, Hammond advocates prioritizing residents who are more likely to perform the procedure throughout their careers.

 

“There isn’t any kind of systematic approach that everyone has agreed upon,” he says. “I think there needs to be some sort of central clearing system that can do this in a thoughtful and conscious way.”   

 

Spots in Illinois will be limited. Illinois residents make up under 5% of 6,007 total obstetrics and gynecology residents across the country, data from the accrediting agency and the American Medical Association shows. There are 276 approved residency positions in the state’s 13 accredited programs. Northwestern University's McGaw Medical Center has the largest program, with 48 slots.  

 

A recent analysis published in the Obstetrics & Gynecology medical journal estimates that 43.9% of all OB-GYN residents train in states where abortion access will change—about 2,300 in states that have trigger laws or bans that predate Roe and 332 in states expected to enact new restrictions.    

 

The Accreditation Council for Graduate Medical Education, which is based in Chicago, reiterated in a statement that it continues to require OB-GYN residencies to provide “experiential training in the complications of abortions and the opportunity for direct procedural training in terminations of pregnancy.”  

 

“Should it become illegal in some states to perform aspects of family planning, the ACGME is exploring alternative pathways for completing this training,” the statement says.  

 

The University of Illinois College of Medicine at Chicago and Rush University Medical Center say they’re among the Illinois programs receiving training requests from out-of-state institutions. UIC already provides a four-week abortion training rotation to residents from Loyola University Chicago. Individual residents with religious or moral objections may opt out of abortion training.  

 

Setting up traveling training rotations, however, is an arduous process. Completing all the necessary administrative steps—especially at such a large scale—creates barriers that could decrease participation.  

 

The situation in Texas, which bans abortion after about six weeks of pregnancy, demonstrates the challenges. 

 

Since Texas’ law took effect in September, a national initiative called the Ryan Program offered to help programs there partner with out-of-state institutions for abortion education.  

 

Kristin Simonson, director of programs and operations at the Ryan Program, says it took four to six months to complete the paperwork, credentialing and liability agreements between the partnering hospitals. Seven of the 23 OB-GYN residency programs in Texas asked the Ryan Program to help facilitate partnerships, but only six found partners. That resulted in a total of 38 doctors receiving abortion training out of state, Simonson said. 

 

“This was kind of an interesting pilot project to see what the options are for out of state training,” she says. “The first obstacle is the cost of training—the travel, the lodging, all of those things. The second obstacle is setting up all the agreements.”   

 

INCREASED COMPETITION

 

Experts say another consequence will be increased competition for residency sites where abortion is legal. Residents may prefer to attend programs where abortion training is available to avoid the demands of extra travel and because they want a comprehensive education. That means Illinois sites could see a spike in applications.  

 

“Illinois’ medical schools and residency programs may become more highly sought after if our counterparts in surrounding states are limited in the type of education and clinical care they can legally provide trainees,” Dr. Vineet Arora, the dean for medical education at the University of Chicago, said in an email.  

 

Residency programs in Illinois are competitive already. UIC’s OB-GYN program got 1,200 applications for just seven first-year slots, according to director Dr. Tamika Alexander. 

 

“It's really unfortunate,” she says. “There are a lot of really qualified students who miss out purely by the numbers because there's just not enough spaces.” 

 

The number of residents allotted to an institution is determined by both Medicare funding, which pays for resident salaries, and the number of specific procedures performed by the hospital. To increase their allotments, programs need to petition their local graduate medical education offices for authorization, a difficult process that doctors say shouldn’t be relied upon to substantially expand capacity.

Dr. Lisa Harris, a professor of obstetrics and gynecology at the University of Michigan, says the OB-GYN residency program in Ann Arbor will have to look at outside training opportunities—most likely in Illinois—if Michigan outlaws abortion. 

 

She says abortion training is crucial to prepare residents for the rare but serious situation when the procedure becomes a lifesaving measure, such as when a woman becomes septic from an infection or is hemorrhaging due to a placental abruption.

 

“There are multiple times where I have been called in the middle of the night because someone needs an emergency, second-trimester abortion procedure because they're dying,” she says. “We can do that because we’ve developed those skills outside of emergency settings. It will only take a generation, probably less, for loss of that skill set.”