How 5 med students said the abortion ruling could affect their paths to becoming physicians

For five decades, most U.S. medical students have learned about abortion. For those specializing in obstetrics/gynecology, access to training in how to perform the procedure was a must.

Such training is no longer guaranteed following a U.S. Supreme Court ruling that voided the constitutional right to an abortion.

Close to half of ob/gyn residency programs are in states that have restricted abortion or are expected to do so, according to a study published in Obstetrics & Gynecology — meaning that trainees in those programs will no longer learn how to offer the full spectrum of care for their patients.

Even if those states continue to allow abortion in some instances, such as when the pregnant person’s life is at stake, the laws will sharply reduce the chances for students to learn the procedure. Longtime practitioners warn the restrictions also may lead to patient harm by reducing opportunities for students to learn related treatments, such as how to manage miscarriages and excessive uterine bleeding.

In the future, more programs could have to take the approach of a program in Texas that moved to using a small watermelon in place of a uterus to teach dilation and evacuation — a procedure used in both miscarriages and abortions — because state-level restrictions had left residents with too few cases to practice on.

Officials at the American Association of Medical Colleges said they “strongly oppose” the court ruling and were evaluating the implications for medical education and patients.

The Inquirer spoke to five current medical students about how they think the court ruling may affect their medical education, where they choose to practice their profession, and how they anticipate this ruling will change health care as a whole.

They include Devyn Rigsby and Theresa Christensen, both members of an international abortion rights advocacy group, Medical Students for Choice, at the University of Pennsylvania’s Perelman School of Medicine; Amiti Jain and Martinique Ogle, who belong to the same group at Thomas Jefferson University’s Kimmel Medical College; and John Carzon, a member of the Catholic Medical Association at Lake Erie College of Osteopathic Medicine (LECOM) in northwestern Pennsylvania.

All shared their views as individuals, not as representatives of their institutions.

“I would, unfortunately, have to restrict the places that I practice to places where I feel comfortable that I can actually practice to the fullest extent of my training,” said Rigsby, a third-year student at Penn. “I would feel very uncomfortable being in a situation where there is someone in front of me who is requesting a standard of practice, and I can’t provide that to her.”

“For a lot of people, that desire to be close to people that they love and their desire to provide this care are going to be pitted at odds with each other. And that’s a really hard decision to make,” said Christensen, a fourth-year student at Penn.

“Being able to access my own health care as well as being able to adequately or appropriately refer or perform appropriate medicine on the patients that I work with would impact where where I choose to live,” said Ogle, a second-year student at Jefferson.

Carzon, on the other hand, said the restrictions would not affect where he chooses to practice.

“Because I am pro-life, I wouldn’t be performing abortions. I don’t think it would have much of an effect on any future practice I would have,” said Carzon, a second-year medical student at LECOM. “It would just be limiting the scope of people who want to perform abortions in a particular state.”

The medical students all predicted the ruling would change how they will interact with patients.

Carzon says the impact could be positive, citing a personal story involving his mother. During a difficult birth, he said her ob/gyn recommended an abortion, which went against her beliefs.

“So, in her mind, the doctor just suggested, ‘Do you want to kill your child?’ I would guess anyone in that similar situation, there would be a big disconnect between the patient and the doctor. And there would be less trust on the patient’s side of the equation.”

The others worry about eroding trust in the medical profession if politics and legal restrictions are limiting care options.

“There are a lot of people and communities in our country, who for a long time, have mistrusted medical professionals,” Christensen said. “I think this is only going to further exacerbate that and expand that issue in our country.”

“Relationships are built on trust and transparency, and I want to support women and my patients in achieving their goals, but I also don’t want to break the law,” Rigsby said. “It’s very difficult if I’m constantly worrying about the things that I’m saying about the options that I’m offering.”

Rigsby added that she worries about legal implications putting doctors in a bind.

“I can’t really be fully present with my patients and what they need. And on the other hand, my patients often might be worried about the things that they feel comfortable saying to me, worrying that I might have to report them.”

Jain, a second-year student at Jefferson, noted discussion about abortion regulations has been missing from her first-year medical school curriculum.

“We had no conversations about how legislation that could affect our ability to practice,” Jain said. “I think that’s an important conversation to have because it doesn’t just affect people who are ob/gyn. It also affects a series of specialties in medicine.”

For example, abortion restrictions are expected to affect the practice of emergency medicine, if more people try to end pregnancies on their own, the AAMC says.

“I’m more motivated than ever to train as an ob/gyn,” Christensen said. “I know how many people who are trained in this field and want to provide this care in other parts of the country now will not be able to.”

She cited estimates by the Guttmacher Institute, which studies reproductive health and advocates for abortion rights, that restrictions on the procedure in neighboring states will lead to an increase in patients in Philadelphia and Pennsylvania, where abortion remains legal until 24 weeks. “I think [for] people who care about reproductive health in parts of the country where abortion care is still legal and accessible, it’s more important than ever for us to train in those fields,” Christensen said.

“I’m the only person in my family who does anything health care related,” Ogle said. “If I become one of the first people that someone comes to with a question, I want to be able to answer that question in a way that they understand. I think that is an important role to take in the social networks that we do engage in and the relationships that we already have as well as relationships that will hold going forward.”

“People who are pro-life want to have the discussions and talk about the issues. It’s not just they want to oppress people and there shouldn’t be any interaction or exchange. The more the discussion is open, respectful, and understanding in different points of view, you can only find more common ground on the other side,” said Carzon.

No matter their views on the legal debate, the students all saw the ruling as having a profound effect on the delivery of health care.

“Abortion care is health care,” Rigsby said. “It’s lifesaving in many situations. But no matter what the reason, we provide all of the information and [the] woman and their partners, whoever they wish to involve in the decision, is the one making the choice for herself. That that’s the bottom line.”

Christensen framed the debate in the cascade of other health issues that patients may face as a result of any decisions about abortion.

“Abortion care is critical for millions of relatively healthy people who want to be able to go to school, advance their careers, not stay with abusive partners, support kids they have at home, save money to support the kids they hope to have in the future,” Christensen said. “Those folks will now have to face the very real health consequences of being pregnant. Pregnancy can take a healthy person and cause them to have hypertension, diabetes, anemia, obesity, depression, even death. Like so many structural inequities in health care, this disproportionately affects people who are already at risk in our society.”

Staff writer Tom Avril contributed to this article.