Farah Yousry/Side Effects Public Media
Early Monday morning, a group of young obstetrics and gynecology professionals gathered for a daily meeting. The young doctors, dressed in blue robes and white coats, sat in the auditorium of Indiana’s largest teaching hospital.
The meeting was an opportunity to share updates and make announcements. But they also had to address the elephant in the room.
“Any more questions about abortion care?” Dr. Nicole Scott, residency program director, asked the interns.
One of the residents spoke up after several rough minutes of silence, “How’s Dr. Bernard?”
“Bernard is actually in a very good mood. I mean, relatively,” Scott replied. “She has round-the-clock security, she has her own lawyer.
They mean Dr. Caitlin Bernard, an abortion provider in Indiana and one of the doctors who train residents at this university hospital. Bernard was recently caught in a political whirlwind after she spoke to a reporter about an abortion she performed on a 10-year-old rape victim who crossed the state line from Ohio. The doctor was attacked by pundits and political leaders on national television, including Indiana’s attorney general.
The vitriol hit home for this group of residents. Bernard has mentored most of them for years. Many of these young doctors were sure they wanted to practice in Indiana after training. Lately, some have been feeling more ambivalent.
“Look what [Dr. Bernard] it was scary,” said Dr. Beatrice Soderholm, a fourth-year obstetrician and gynecologist and one of Bernard’s mentees. “I think that was part of the point of those who put her through it. [It] was to scare other people away from doing the work she was doing.”
Last week, Indiana Republican Gov. Eric Holcomb signed into law a near-total abortion ban, making Indiana the first state to pass new legislation restricting access to abortion after the Supreme Court struck down Roe v. Wade in June.
Before lawmakers voted, thousands of Indiana providers expressed concern that outcomes would likely worsen for their patients. It’s not clear what this will mean for suppliers either.
And that worries doctors — early-career doctors who spend four years studying to become OB-GYNs.
Doctors are weighing their options
These days, Scott, the director of the residency program, has found that the scope of her work has expanded beyond clinical and academic responsibilities. Her meetings with residents include political updates, and she tells them that mental health services are available if they need them.
“I mean, our residents are devastated,” Scott said, fighting back tears. “They signed up to provide comprehensive healthcare to women. And they’re told they can’t do that.”
She expects it will “profoundly affect” how Indiana hospitals recruit and retain medical professionals.
Indiana, like many Republican-led states, has a shortage of providers. A 2018 report from the March of Dimes found that 27 percent of Indiana counties are considered maternity deserts, with no or limited access to maternity care. The state has one of the highest maternal mortality rates in the country.
Scott said new laws restricting abortion will only worsen those statistics.
Dr. Wendy Tian, a third-year resident, said she has been scared lately and worried about her safety. Tian grew up and went to school in Chicago and chose to come to Indiana for residency because the program has a strong focus on family planning. She was also open to practice in Indiana when she completed her studies.
But that has changed.
“I always thought I wanted to do family planning. Now I’m thinking of doing something else,” she said. “I know I still want to turn it on. But I certainly don’t know if I could stay in graduate school at Indiana with what’s going on.”
Still, she feels “guilty about turning away” from some of Indiana’s most vulnerable patients.
Even before the Supreme Court struck it down Roe v. Wade, Tian said the medical climate in Indiana can be hostile and frustrating. Indiana, like other states with abortion restrictions, allows nearly all health care providers to opt out of providing care to abortion patients.
“We run into other people we work with on a daily basis who oppose what we’re doing,” Tian said.
Tian said she and her colleagues sometimes have to cancel scheduled procedures because the on-call medical staff do not feel comfortable helping a patient having an abortion.
“We often have to call for anesthesia ahead of time because there are only certain providers willing to provide anesthesia [for abortion patients]Tian said.
Abortion training at risk
Still, Indiana’s obstetrics and gynecology program was able to provide residents with comprehensive training that included abortion care and family planning. This is important not only in cases of abortion.
“Miscarriages are managed exactly the same as first-trimester termination procedures,” Scott said. “But what termination procedures allow you to do is that kind of repetition and that understanding of the female anatomy and how to manage the complications that can occur with miscarriages.”
Farah Yousry/Side Effects Public Media
And that worries Scott, because eliminating abortion dramatically reduces the hands-on experience an OB-GYN can get at her hospital.
Scott’s program is exploring ways to compensate for this. They could send out-of-state residents to study in places without abortion restrictions. But Scott said that would be a logistical nightmare.
“It’s not as simple as just showing up at an office and saying, ‘Can I observe?’ This includes funding for travel and accommodation,” Scott said. “It adds a lot to what we’re already doing to educate future OB-GYNs.”
Almost half of all U.S. OB-GYN residents are in states where abortion is prohibited or likely to be prohibited. That means there will be an influx of residents looking to go out of state to make up for missed educational opportunities. The Accreditation Council for Graduate Medical Education, the body that accredits residency programs, has proposed modifications to the graduation requirements for OB/GYN residents to account for this changing landscape.
The hard choice to stay or leave
For some residents, like freshman Veronica Santana, these political hurdles are actually a welcome challenge. Santana is Latina, grew up in Seattle, and has been involved in community organizing since she was a teenager. Part of the reason she chose obstetrics and gynecology is because of how the field of medicine intersects with social justice.
“It’s political. It always has been and it continues to be. And obviously, especially now,” she said.
After Roe was struck down, Santana took to the streets of Indianapolis to participate in abortion rights rallies. So did many of her fellow residents and mentors.
Most of them, including the program director, asked not to name the medical school or hospital system they work for for fear of backlash. Some said their employer remains timid in supporting staff when it comes to the abortion debate in Indiana.
In a way, Indiana could be the perfect battleground to quench Santana’s desire for advocacy and social activism. But recently, she said she’s “very unsure” whether staying to practice after residency makes sense as a doctor who wants to provide the full range of health care services.
Soderholm, a fourth-year resident, said there’s a lot to think about.
Söderholm will finish his studies in a few months and will start training soon. She grew up in Minnesota, but over the past few years has felt a strong connection to the patients at Indianapolis County Hospital. She was so sure she wanted to train in Indiana. But recently, her family in Minnesota — where abortion remains largely protected — questioned why she would stay to practice in a hostile medical climate like Indiana’s.
“There was a lot of hesitation. But the women [and] the birthing people we have cared for, especially at our county hospital, [make it] really hard to leave. I’m sorry, she said and started to cry.
It was for these patients that Söderholm decided he was likely to stay. The same cannot be said for many other future doctors.
This story comes from a reporting collaboration that includes the Indianapolis Recorder and Side effects Social mediapublic health news initiative based on WFYI in Indianapolis.