Committee Investigators Spoke with the Doctors Training the Next Generation of Reproductive Health Care Providers Who Warned of the Dangers Facing their Practice and their Patients
Washington, D.C. – Energy and Commerce Committee Ranking Member Frank Pallone, Jr. (D-NJ) released the findings of a 10-month-long Committee investigation into the impact of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization on health care providers and the patients they serve. The report is titled, “It Will Only Get Worse”: How the Supreme Court’s Dobbs Decision Will Decimate Reproductive Health Care for Generations.
In September 2023, Pallone launched an investigation to examine how providers, and by extension their patients, are being impacted by the Dobbs decision. In conducting the investigation, Democratic Committee staff interviewed obstetrician-gynecologists (OBGYN) educators and residents to learn how Dobbs has impacted the study and practice of obstetrics and gynecology.
“I began this investigation to take a hard look at the impact the Dobbs decision is having on reproductive health care providers and their patients across the country,” Pallone said. “What we found was deeply disturbing. The Dobbs decision has created chaos and confusion for OBGYNs and their patients.
“Doctors are overextended and terrified about the risks of criminal prosecution, patients are sicker with greater complications because needed care is delayed, residents are not receiving required training, and many patients are not receiving the information they need to make informed health care decisions. In some restrictive states, reproductive medical training has been practically eliminated or limited to simulations and textbooks, which has forced many residents to travel out-of-state to receive essential training,” Pallone continued.
“I am deeply concerned about the long-term consequences of the Dobbs decision detailed in this report. I fear that over time the stark differences in training between OBGYNs in protective and restrictive states will effectively create two different pools of OBGYNs with entirely different sets of training, knowledge, and ways of caring for their patients,” Pallone concluded. “In no uncertain terms, the Dobbs decision has put the future of doctors and patients in grave peril not in just restricted states but every state in America, and that’s why we must restore access to reproductive health care for all.”
The investigation found a number of alarming effects in the wake of the Dobbs decision on health care providers and their patients, including:
- Providers are seeing sicker patients suffering from greater complications due to delayed care caused by Dobbs;
- The Dobbs decision has harmed the training of OBGYN residents in restrictive states;
- Residency applicants are increasingly concerned about the quality of abortion training that programs can offer in restrictive states;
- Residency directors are finding that restrictions on clinical communication is degrading trust between providers and patients and robbing patients of the ability to make informed decisions about their health;
- The training of OBGYN residents in protective states has been harmed as programs in those states strain their capacity and resources to help train out-of-state residents from restrictive states;
- Restrictive state laws are already leading us to a future with a provider workforce less prepared to provide comprehensive reproductive health care;
- OBGYN residents and program directors are increasingly frustrated, discouraged, and experiencing negative mental health effects in the aftermath of the Dobbs decision;
- Residency program leaders who participated in the report universally agreed that abortion care is integral to other components of reproductive health care and cannot be eliminated or isolated from residency training;
- After Dobbs, OBGYN residency applicants more strongly prefer programs in states that permit abortion access; and,
- A patchwork of state restrictions is leading to disparate systems of reproductive health care, worsening reproductive and maternal health care shortages, and a fractured OBGYN workforce.
Key Excerpts and Quotes from the Report from OBGYN Directors and Residents:
Abortion Restrictions Are Causing Lasting Harm to the Next Generation of Doctors:
“Several providers explained that certain skills learned in abortion training are the same skills required to treat pregnancy complications including premature rupture of membranes, ectopic pregnancy, and miscarriage management. Residents understand that developing these skills will make them more competent doctors and is key to serving patients with pregnancy complications and other routine reproductive health care needs.”
“Several states that allowed access to abortion before Dobbs enacted abortion restrictions after Dobbs that weakened abortion training for residents in those states. In some cases, training has been practically eliminated, and in other cases, it has been limited to simulations and textbooks, forcing residents to travel out-of-state to receive essential training.”
“One resident described her concern about abortion training in a restrictive state as, ‘I’m never going to see it, get to counsel, or learn the standard of care. For other niche procedures, we get simulation, but I don’t think I’m going to ever get to [perform one] on a person and not a dragon fruit.’”
“As one provider shared, the concern is ‘when you don’t do a procedure, you no longer have the skills to pick it up again. It’s not just the future workforce but maintaining [the skills] in the current workforce in the restricted states.’ Another echoed this concern, saying ‘it’s going to look different in 20, 30, 40 years. You don’t want to lose that workforce; you don’t want to lose the gains women had; you don’t want to lose the compassion. It is a hard enough lifestyle and profession to be in that you don’t want to lose the next generation.’”
“A residency director from the Northeast, describing the need for residents to have comprehensive procedural training, said those ‘who didn’t have the opportunity…won’t be able to take care of a patient in an emergency.’”
“One residency program director ominously predicted that, ‘I think we’re just going to have a bunch of untrained providers and they’re going to shy away from [complex family planning] care.’”
State restrictions are preventing doctors from caring for and endangering the lives of their patients:
“One residency program director in a Southern restrictive state described a case where a pregnant woman was admitted to the hospital with serious pregnancy complications, but her physicians were prohibited from discussing and providing appropriate medical care. Despite requesting an abortion weeks before the fetus’s viability, ‘her doctor couldn’t talk to her about it; couldn’t tell her she could get it in another state.’ The program director said that every resident that participated in this case had cried and was traumatized because the woman would likely die, and the fetus may not survive due to the delay in appropriate care.”
“Another residency program director in a protective Northeastern state agreed that their patients were increasingly delaying care and presenting in the hospital with more complications. These cases would have been easily treated if the necessary care was provided earlier in the pregnancy.”
“A residency program director in a restrictive state noted that laws restricting abortion and preventing communication with patients gives the patient less of a say in their own health care, adding ‘if we stop listening to patients, we’re not treating them well.’”
“One residency program director observed that years of political efforts to isolate abortion care from other obstetric care has reduced access to abortion in many areas of the country because providers do not have the necessary skills to provide comprehensive care. They described the sobering reality that if more patients seek care in areas ‘without a trained person, someone is going to die.’”
Laws in restrictive states are causing harmful spillover effects in protective states:
“[A]nother resident educator said that their ‘colleagues in [nearby protective states] are inundated with patients from [restrictive states] and the workload has tripled…they’re taking care of everyone from multiple states.’ The caseload in protective states can be overwhelming.”
“One residency program director said that taking on extra trainees has required extensive after-hours administrative work with no additional resources or financial compensation and has ‘stretched everyone thin.’”
Restricting doctors from caring for their patients is leading to burnout:
“‘[T]hey see what it should be and then you come back to [a restrictive state] and you’re back in the situation where you can’t and it leads to burnout, frustration…I talk about moral injury all the time. To be back in a place where you have the skills, but you can’t do it.’ Guiding residents through the uncertainty, legal jeopardy, and care limitations imposed after Dobbs has felt like a burden to many educators, with one program director describing it as a ‘black cloud…constantly following you.’”
“One program director said their OBGYN residents and colleagues are ‘terrified’ about risks of criminal prosecution and that ‘we didn’t go to medical school to be lawyers, detectives, or police officers.’”
Pallone Releases New Report on Dobbs Decision’s Harmful Impact on Reproductive Health Care
democrats-energycommerce.house.gov
August 1, 2024 6:34 pm
Committee Investigators Spoke with the Doctors Training the Next Generation of Reproductive Health Care Providers Who Warned of the Dangers Facing their Practice and their Patients
Washington, D.C. – Energy and Commerce Committee Ranking Member Frank Pallone, Jr. (D-NJ) released the findings of a 10-month-long Committee investigation into the impact of the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization on health care providers and the patients they serve. The report is titled, “It Will Only Get Worse”: How the Supreme Court’s Dobbs Decision Will Decimate Reproductive Health Care for Generations.
In September 2023, Pallone launched an investigation to examine how providers, and by extension their patients, are being impacted by the Dobbs decision. In conducting the investigation, Democratic Committee staff interviewed obstetrician-gynecologists (OBGYN) educators and residents to learn how Dobbs has impacted the study and practice of obstetrics and gynecology.
“I began this investigation to take a hard look at the impact the Dobbs decision is having on reproductive health care providers and their patients across the country,” Pallone said. “What we found was deeply disturbing. The Dobbs decision has created chaos and confusion for OBGYNs and their patients.
“Doctors are overextended and terrified about the risks of criminal prosecution, patients are sicker with greater complications because needed care is delayed, residents are not receiving required training, and many patients are not receiving the information they need to make informed health care decisions. In some restrictive states, reproductive medical training has been practically eliminated or limited to simulations and textbooks, which has forced many residents to travel out-of-state to receive essential training,” Pallone continued.
“I am deeply concerned about the long-term consequences of the Dobbs decision detailed in this report. I fear that over time the stark differences in training between OBGYNs in protective and restrictive states will effectively create two different pools of OBGYNs with entirely different sets of training, knowledge, and ways of caring for their patients,” Pallone concluded. “In no uncertain terms, the Dobbs decision has put the future of doctors and patients in grave peril not in just restricted states but every state in America, and that’s why we must restore access to reproductive health care for all.”
The investigation found a number of alarming effects in the wake of the Dobbs decision on health care providers and their patients, including:
- Providers are seeing sicker patients suffering from greater complications due to delayed care caused by Dobbs;
- The Dobbs decision has harmed the training of OBGYN residents in restrictive states;
- Residency applicants are increasingly concerned about the quality of abortion training that programs can offer in restrictive states;
- Residency directors are finding that restrictions on clinical communication is degrading trust between providers and patients and robbing patients of the ability to make informed decisions about their health;
- The training of OBGYN residents in protective states has been harmed as programs in those states strain their capacity and resources to help train out-of-state residents from restrictive states;
- Restrictive state laws are already leading us to a future with a provider workforce less prepared to provide comprehensive reproductive health care;
- OBGYN residents and program directors are increasingly frustrated, discouraged, and experiencing negative mental health effects in the aftermath of the Dobbs decision;
- Residency program leaders who participated in the report universally agreed that abortion care is integral to other components of reproductive health care and cannot be eliminated or isolated from residency training;
- After Dobbs, OBGYN residency applicants more strongly prefer programs in states that permit abortion access; and,
- A patchwork of state restrictions is leading to disparate systems of reproductive health care, worsening reproductive and maternal health care shortages, and a fractured OBGYN workforce.
Key Excerpts and Quotes from the Report from OBGYN Directors and Residents:
Abortion Restrictions Are Causing Lasting Harm to the Next Generation of Doctors:
“Several providers explained that certain skills learned in abortion training are the same skills required to treat pregnancy complications including premature rupture of membranes, ectopic pregnancy, and miscarriage management. Residents understand that developing these skills will make them more competent doctors and is key to serving patients with pregnancy complications and other routine reproductive health care needs.”
“Several states that allowed access to abortion before Dobbs enacted abortion restrictions after Dobbs that weakened abortion training for residents in those states. In some cases, training has been practically eliminated, and in other cases, it has been limited to simulations and textbooks, forcing residents to travel out-of-state to receive essential training.”
“One resident described her concern about abortion training in a restrictive state as, ‘I’m never going to see it, get to counsel, or learn the standard of care. For other niche procedures, we get simulation, but I don’t think I’m going to ever get to [perform one] on a person and not a dragon fruit.’”
“As one provider shared, the concern is ‘when you don’t do a procedure, you no longer have the skills to pick it up again. It’s not just the future workforce but maintaining [the skills] in the current workforce in the restricted states.’ Another echoed this concern, saying ‘it’s going to look different in 20, 30, 40 years. You don’t want to lose that workforce; you don’t want to lose the gains women had; you don’t want to lose the compassion. It is a hard enough lifestyle and profession to be in that you don’t want to lose the next generation.’”
“A residency director from the Northeast, describing the need for residents to have comprehensive procedural training, said those ‘who didn’t have the opportunity…won’t be able to take care of a patient in an emergency.’”
“One residency program director ominously predicted that, ‘I think we’re just going to have a bunch of untrained providers and they’re going to shy away from [complex family planning] care.’”
State restrictions are preventing doctors from caring for and endangering the lives of their patients:
“One residency program director in a Southern restrictive state described a case where a pregnant woman was admitted to the hospital with serious pregnancy complications, but her physicians were prohibited from discussing and providing appropriate medical care. Despite requesting an abortion weeks before the fetus’s viability, ‘her doctor couldn’t talk to her about it; couldn’t tell her she could get it in another state.’ The program director said that every resident that participated in this case had cried and was traumatized because the woman would likely die, and the fetus may not survive due to the delay in appropriate care.”
“Another residency program director in a protective Northeastern state agreed that their patients were increasingly delaying care and presenting in the hospital with more complications. These cases would have been easily treated if the necessary care was provided earlier in the pregnancy.”
“A residency program director in a restrictive state noted that laws restricting abortion and preventing communication with patients gives the patient less of a say in their own health care, adding ‘if we stop listening to patients, we’re not treating them well.’”
“One residency program director observed that years of political efforts to isolate abortion care from other obstetric care has reduced access to abortion in many areas of the country because providers do not have the necessary skills to provide comprehensive care. They described the sobering reality that if more patients seek care in areas ‘without a trained person, someone is going to die.’”
Laws in restrictive states are causing harmful spillover effects in protective states:
“[A]nother resident educator said that their ‘colleagues in [nearby protective states] are inundated with patients from [restrictive states] and the workload has tripled…they’re taking care of everyone from multiple states.’ The caseload in protective states can be overwhelming.”
“One residency program director said that taking on extra trainees has required extensive after-hours administrative work with no additional resources or financial compensation and has ‘stretched everyone thin.’”
Restricting doctors from caring for their patients is leading to burnout:
“‘[T]hey see what it should be and then you come back to [a restrictive state] and you’re back in the situation where you can’t and it leads to burnout, frustration…I talk about moral injury all the time. To be back in a place where you have the skills, but you can’t do it.’ Guiding residents through the uncertainty, legal jeopardy, and care limitations imposed after Dobbs has felt like a burden to many educators, with one program director describing it as a ‘black cloud…constantly following you.’”
“One program director said their OBGYN residents and colleagues are ‘terrified’ about risks of criminal prosecution and that ‘we didn’t go to medical school to be lawyers, detectives, or police officers.’”