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ABORTION | POST ROE LANDSCAPE

OB-GYN residents struggle to receive training after Planned Parenthood halts abortion services in Wisconsin

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With Planned Parenthood halting abortion services throughout the state after the U.S. Supreme Court decision overturning Roe v. Wade, the University of Wisconsin is being forced to revisit how it trains its OB-GYN residents on abortion procedures. 

In order to maintain accreditation from the national Accreditation Council for Graduate Medical Education (ACGME) for its OB-GYN residency programs, the University of Wisconsin Hospitals and Clinics Authority is required to give OB-GYN residents the option to train in abortion care. 

Wisconsin state law, however, says that state funds, including money appropriated to UW Hospital cannot be used to pay a doctor or a facility to perform abortions.

To maintain the option for residents to receive abortion training, UW Hospital has historically worked with Planned Parenthood. The organization paid a stipend for residents to work at its Wisconsin locations, eliminating the use of school funding for abortion services. 

Now that Planned Parenthood has stopped providing abortion procedures in Wisconsin amid uncertainty about whether an 1849 state law banning abortion except to save the mother's life is now in effect, it is unclear how residents will have the option to be trained to perform abortions. 

The rotation was not required, though Dr. Laura Jacques, a doctor with UW Obstetrics and Gynecology, said 95% of OB-GYN residents she surveyed expressed a desire to learn about abortion services.

Though hospitals in Wisconsin may still perform abortions when the life of the pregnant person is at stake, those are likely to be few and far between. Without the Planned Parenthood rotation, residents are lacking the bulk of their training on abortion services. 

New policies and solutions 

With abortions banned in 17 states and likely to be banned in five more, ACGME is looking to change its requirements on abortion training.

Its proposed revisions still require that programs in states that legally restrict abortion training must provide options for OB-GYN residents to learn abortion procedures in other states.

Once regulations are changed, UW Hospitals and Clinics Authority must provide its OB-GYN residents with a method to learn abortion procedures out of state to remain accredited by ACGME.

"While the OB-GYN residents previously had access to clinical training in abortion, that access is now significantly limited," UW Health said in a statement. "It remains too soon to predict what options we will pursue, but we are focused on training OB-GYN physicians to provide the most comprehensive care possible." 

Planned Parenthood Illinois and Planned Parenthood Wisconsin announced a partnership Thursday that allows providers in Wisconsin to perform abortions in Illinois. 

Jennifer Welch, CEO of Planned Parenthood Illinois, said abortions in Illinois have increased tenfold. Wisconsin providers are now traveling to a center in Waukegan to help address that increased need. Planned Parenthood Wisconsin said the majority of the state's abortion providers are travelling to Illinois' Waukegan clinic, but did not say whether UW doctors or residents are among them.

Jacques said OB-GYN residents currently completing a Planned Parenthood rotation remain in Wisconsin and are, for the most part, not learning abortion procedures. 

"Residents on those rotations are available if any patients come in with a post-abortion complication," she said. "The majority are doing simulation training or have been deployed to other clinical spaces."

It is not yet clear how UW Hospital will provide abortion training opportunities to residents in the long term, she said.

Though accredited OB-GYN residency programs are required to provide opportunities for abortion training, students at the University of Wisconsin Medical School interested in obstetrics and gynecology do not have to be offered training in the procedure. Medical residents have graduated from medical school and work for UW Hospital, while medical students are in graduate school. 

Still, some UW medical students have already had trouble studying abortion procedures out of state.

Fourth-year medical student Zoey Shultz said she applied for a family planning rotation at the University of California San Francisco before the Supreme Court ruling. The rotation would have included abortion training.

Medical students are permitted to take part in an "away rotation," where they visit and learn at another school, Shultz said. She was interested in pursuing a family planning rotation away from UW because she wasn’t sure how much practical experience on abortion she would be able to obtain in the state. 

"I want to be an abortion provider one day, and the earlier I am able to get exposure to that kind of care, the more competent I will be, the better a practicing physician I will be and the more ideas I will have for myself and what my career will look like," she said. 

Shultz said she was told the university could not award credit for the rotation or provide her liability insurance for her time away because she would be studying abortion care. That left her unable to complete the rotation.

Though Shultz suspects the university presented the barriers to protect its funding, she said the reasoning behind their policy was never explained to her. She said away rotations do not require school funding. 

"I am disappointed in the medical school for not supporting my career, frustrated that abortion care continues to be othered in the realm of health care and treated as something different when evidence shows it's health care," she said. "If I were applying to any other specialty, this wouldn't be the case."

Medical students at the University of Wisconsin School of Medicine and Public Health do not receive clinical training in abortion procedures, nor do they receive course credit for training at other institutions, the medical school said in a statement to the Wisconsin State Journal. 

That approach has been in place for some time, and is not a consequence of the recent Supreme Court ruling, the school said.

Sarah Walkenhorst Barber, an attorney with the Wisconsin Legislative Reference Bureau, said the legality of out-of-state abortion training is still unclear because public funds are not allowed to be used in abortion training.

"We do not currently have sufficient information on what arrangements might be available to UW Health residents out of state or the funding involved to provide an opinion on the interaction of any potential arrangement with the Wisconsin statute," she said. 

OB-GYN shortage 

OB-GYN

Prairie Clinic OB-GYN Suzanne Welsch talks with Lodi resident Kimberly Lehr during an appointment in 2017 at Sauk Prairie Hospital. Some worry Wisconsin's abortion ban could worsen the state's rural OB-GYN shortage.

Some local medical leaders speculate that changes in training opportunities for OB-GYN medical residents will worsen the obstetrics and gynecology shortage in Wisconsin.

In 2018, one in every three counties in the state did not have an OB-GYN, said Dr. Ellen Hartenbach, who will become chair of the school’s Department of Obstetrics and Gynecology in September. The American College of Obstetricians and Gynecologists found Wisconsin had 2.38 OB-GYNs for every 10,000 women in 2014.

"There are no specific projections yet, but a worsening OB-GYN shortage is something we are concerned about," said Tanya Atkinson, CEO of Planned Parenthood Wisconsin. "We have certainly heard anecdotally from some folks that are less inclined to want to practice in Wisconsin … in a lot of rural parts of Wisconsin access to physicians and health care is already challenging, and people have to travel hours and hours."

Jacques said she expects OB-GYN residents and doctors to leave the state. 

"There is no question that people will consider the law in Wisconsin and that people will leave," Jacques said. "It's a very different time to be practicing. We have to worry about if we can really provide the best care for the patient or if we might be compromised. It's very draining."

OB-GYN

Prairie Clinic OB-GYN Suzanne Welsch talks with Lodi resident Kimberly Lehr during an appointment in 2017 at Sauk Prairie Hospital. Some worry Wisconsin's abortion ban could worsen the state's rural OB-GYN shortage.

The consequences of a worsening OB-GYN shortage could be severe, Jacques said. She already sees patients who travel an hour or more to get to her clinic in DeForest, using gas money and time off work to do so. 

She added that, as an adviser for medical students, every OB-GYN student she knows is considering the legality of abortion where they are applying for residency. 

"Ninety-five percent of our OB-GYN students want to learn abortion care in some capacity," she said. "They are really motivated to learn about abortion. If they are not able to learn it here, they will go elsewhere. They won't learn those skills and return to Wisconsin not to practice them." 

Shultz said she was born and raised in Wisconsin but is grappling with whether she wants to do her OB-GYN residency in a state where abortion is not legal. 

"I have a column in my list of OB-GYN residency programs titled 'Is abortion legal or not?,’" Shultz said. "That is factoring into where I'm applying, and I know that's the case for some of my peers as well. We want to provide this care."

It's almost certain that if residency programs in the state of Wisconsin are unable to provide adequate abortion training, prospective students will be less inclined to apply, she said.

Eventually, these changes will decrease the number of doctors in the state, since it's common for doctors to live where they complete their training, Schultz said.

"That could be a big problem for states like Wisconsin," she said. "There's going to be a brain drain of physicians who want to provide this care. I'm from Wisconsin, I grew up here and I consider myself having a professional duty to the patients of Wisconsin. But I also really want to provide this care in my practice."

Editor's note: This story has been updated to clarify in several instances that "residents" refers to OB-GYN residents, and that state funds cannot be used to pay a doctor or a facility to perform an abortion. Some references to "the university" have been changed to "UW Hospital." Additional context has been provided to clarify the distinction between students and residents. And the title of Dr. Ellen Hartenbach has been corrected.

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"I'm mad," one 26-year-old demonstrator remarked. "I'm very, very mad. We shouldn't be in this situation in 2022." 

"I am disappointed in the medical school for not supporting my career, frustrated that abortion care continues to be othered in the realm of health care and treated as something different when evidence shows it's health care. If I were applying to any other specialty, this wouldn't be the case."

Zoey Shultz, fourth-years medical student

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