SYLVIE DOUGLIS, BYLINE: NPR.
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WAILIN WONG, HOST:
This is THE INDICATOR FROM PLANET MONEY. I'm Wailin Wong. Who could have predicted that the Supreme Court's overturn of the nationwide right to abortion would turn into a story about the nation's labor supply? But that's exactly what seems to be happening. Joining me today to unpack it all is Julie Rovner, who's been following the story. Hi, Julie.
JULIE ROVNER: Hi, Wailin. Nice to be here.
WONG: Great to have you. Julie is the chief Washington correspondent with KFF Health News. She also hosts its podcast "What The Health?"
ROVNER: That's right. And of late, I've been talking to graduating medical students who are shying away from applying for medical residencies in states with abortion restrictions. And this isn't just happening with OB-GYNs. Applications are down for all kinds of trainee doctors, including pediatricians.
WONG: Yeah. This was something that people were speculating could happen if Roe was overturned, but now we have actual data backing that up.
ASH PANAKAM: Ultimately, the schools that I ranked higher had safeguards for abortion access.
ROVNER: That's Ash Panakam. She's part of this trend of medical students who are saying no when it comes to training as a doctor in states that ban or significantly restrict abortion.
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WONG: Today on the show, we measure the exodus of medical students from states with strict abortion bans. We look at how it's disrupting the labor market for doctors around the U.S. and how it could make the doctor shortage in these states get even worse.
Ash Panakam graduated from Harvard Medical School this spring. She'd always planned on returning to her home state of Georgia to train as an OB-GYN. She knows that doctors there, particularly OB-GYNs, are in short supply compared to the rest of the country, and they are badly needed.
PANAKAM: As many people know, the South has very high rates of maternal mortality and, in general, just worse obstetrical outcomes.
ROVNER: Yet this summer, she's starting residency at the Magee-Womens Hospital at the University of Pittsburgh. Why Pennsylvania and not Georgia?
PANAKAM: For me personally and for a lot of applicants, access to abortion training and whether the next couple of years it seemed like that training might be in jeopardy was definitely an important factor.
WONG: Ash is part of a growing and troubling trend, according to statistics from the Association of American Medical Colleges. Atul Grover oversees its program that keeps track of where graduating doctors go for residency.
ATUL GROVER: What they're doing, it appears, is selectively avoiding those states in which abortion is either completely banned or severely restricted.
ROVNER: Residency applications in those states were down around 4% compared to other states, and Atul says where residents train is a big deal. It helps determine the ultimate distribution of doctors around the U.S.
GROVER: About half of people who train in a state will end up staying there to practice.
WONG: Now, we should say these training slots are getting filled. We did a whole episode on the residency match last year. And the U.S., along with foreign medical schools, are graduating way more students than there are residency slots here to train them. It's like a giant game of musical chairs, and not everyone gets a seat when the music stops.
ROVNER: Exactly. But the concern is that hospitals in states with abortion bans are no longer getting the students they most want. Here's how Atul put it.
GROVER: People who might have been applying if the laws were different, who happened to be a better match for your program, for your specialty and your community aren't choosing to apply there. Yes, you can fill it but maybe not with the ideal candidate. And I think that's going to affect patients and populations and local communities in the years to come.
WONG: And he says that can affect what kind of care people in those states will be able to get. Julie, as you said earlier, you've talked to a bunch of people over the last few months about this. You've talked to medical students, doctors, residency coordinators. What are they telling you?
ROVNER: Well, several things. One is that they're worried about getting the training they feel they need to become good doctors. OB-GYNs are required to learn basic abortion techniques. They're the same ones used for miscarriage and for some other pregnancy complications. But in states with bans and restrictions, doctors in training have to travel out of state for that instruction. That means it's not an everyday part of learning. Ash from Georgia, who we heard from earlier, said that factored into her decision.
PANAKAM: Although a lot of institutions have made partnerships to ensure that their trainees are able to get this exposure, whether in another state or with another academic institution. I think that the exposure is more limited to a discrete block of time, whereas if you are practicing in a state where there are no restrictions, you would be providing abortion care on a very regular basis.
ROVNER: Reason number two for the exodus is it adds stress to an already stressful experience. I spoke to Beverly Gray. She's an OB-GYN at Duke Health in North Carolina. She says residency is hard enough without the added worry about new restrictions. Because North Carolina now has limits on abortion, she spends part of her time in neighboring Virginia where, well, she says things are just easier.
BEVERLY GRAY: In Virginia, I can go there, and I can just be a doctor. When I'm in North Carolina, I have to go through all of these, like, administrative hurdles to be a doctor.
ROVNER: Beverly says she's willing to fight for her patients' well-being when she's home in North Carolina.
GRAY: But it's hard to expect all medical students and trainees coming in to also have that fight in them when they just need to learn, you know, the basics, right? Like, they're starting off. They need to learn how to do procedures. They need to learn how to practice medicine. And it's hard to expect everyone to want to be in the fight, too.
WONG: And these state laws are making how medicine is practiced very different for residents and for trained doctors. And this is the third reason that residents are not moving to states with these new laws.
ROVNER: Right. Many doctors feel like politicians are looking over their shoulders while they're trying to make complex medical decisions. Atul Grover, with the Association of American Medical Colleges, talked about this. He says vague laws leave doctors second-guessing their decisions.
GROVER: And as much as doctors hate getting sued, we really don't want to be indicted.
ROVNER: Even more stressful is that the laws are constantly changing. Take the U.S. Supreme Court decision just last week. It ruled that doctors in Idaho should follow federal law, which allows abortion in health-threatening emergencies. But that decision is just for now. The case goes back to the lower court, where the policy could change yet again.
WONG: Either way, doctors' desire to avoid legal jeopardy and actual jail time has put women in perilous circumstances. One patient in Oklahoma was told to go wait in the hospital parking lot until she was sick enough to justify the abortion that was threatening her life. A bleeding and miscarrying woman in Louisiana was turned away from two separate emergency rooms during her medical crisis.
ROVNER: These types of stories are tied to the final reason medical students don't want to go to these states. They're worried about their own health. And that's not just med students going into OB-GYN but students applying for residencies in other specialties, too, from pediatrics to family practice.
WONG: Atul says that's because graduating medical students are mostly at the age where they're thinking about starting or growing their own families.
GROVER: And I think they want to have control over their own lives and their own healthcare and make sure that all services are available to them and their families if they need it. And I think even if it's not relevant to you as an individual, it probably is relevant to your spouse or partner or somebody else in your family, and I think that makes a huge difference when people make these choices.
WONG: And these choices have real consequences. For example, if OB-GYNs don't train or settle in those states, it won't just affect women who want abortions or have miscarriages. It will also affect women who want to get pregnant and have children.
ROVNER: That's exactly the conundrum Ash, our OB-GYN in training, is facing. She says she really wants to return to Georgia when she finishes her residency in Pittsburgh. It's her home and where her family is.
PANAKAM: But there's a lot of moral distress that comes from practicing in an area where your medical and scientific knowledge is not valued and also is constantly under attack. And having to say, no, I'm sorry, I can't help you to a patient, not because you don't have the skills or because you don't know what is the best thing to do in this circumstance, but because your hands are tied. It's really heavy, and there's a toll that adds up over time.
WONG: This impact on Ash and others in her position appears to be an unintended consequence of the Supreme Court's overturn of Roe v. Wade.
ROVNER: Yes, I'm confident that the Court had no idea how much this decision would cause ripples throughout the entire medical ecosystem, and it's not over yet.
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WONG: Julie Rovner, thanks so much for coming on and sharing this story with us.
ROVNER: Thanks for having me.
WONG: This episode was produced by Julia Ritchey, with engineering by Josh Newell. It was fact-checked by Sierra Juarez. Kate Concannon is our editor, and THE INDICATOR's a production of NPR.
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