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Ky. OB-GYN shortage could worsen as med students consider leaving state

obgyn
Jess Clark
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When you ask University of Louisville medical student Blair Wooten why she wants to be an OB-GYN, she talks about her mother, who became pregnant in college, and ended up dropping out.

“She always says she went to college until she couldn’t fit in the desk anymore because she was so pregnant,” Wooten said, sitting in a study room at the U of L medical school library.

Wooten’s mother made it clear to her children that she doesn’t regret having them. But she wanted her daughter to know having kids that young meant giving up some of her dreams.

“My mom told me that story for as long as I can remember. And she emphasized to me, especially because I’m a woman, that it is imperative that I’m able to do the things that I want to do,” Wooten said.

Providing abortion care is one of those things. Wooten wants to make sure her patients can decide for themselves when to have children.

But since the recent fall of federal protections for abortion, Wooten is among many medical students grappling with tough decisions amid a new restrictive landscape for would-be OB-GYNs.

Narrowing the net

The fourth and last year of medical school is a stressful time — and a career-defining moment. It’s when students undertake the competitive process of applying to residency. For OB-GYNs, that’s four years of required on-the-job training at a teaching hospital. Doctors have to go through the program to learn their specialty and become licensed to practice. Failing to get into a residency can derail a career, so students usually cast a wide net.

“But now, I don’t want to cast a wide net,” Wooten said. “I want my net to be kind of small.”

Since the U.S. Supreme Court overturned Roe v. Wade last month, nearly half of OB-GYN residencies are now in states with laws that ban or severely restrict abortion. Kentucky is one of them, though enforcement of those restrictions is currently on hold due to ongoing litigation.

Another state that severely restricts abortion is Texas, where Wooten had once planned to apply so she could be near her brother.

But Wooten doesn’t want to practice as an OB-GYN in a state where lawmakers have outlawed most abortions. Both Kentucky and Texas have criminal penalties, including jail time, for doctors who provide abortion care, except in cases where the life of the pregnant person is threatened. Even with the exemption, doctors say the law can delay life-saving care while physicians and lawyers consider the legal implications for providing treatment.

“Even though we all took an oath to do no harm, it doesn’t matter to these lawmakers, it doesn’t matter in the eyes of the law,” she said. “I don’t know if I could work in that kind of environment.”

For Wooten, abortion care isn’t just about saving someone’s life medically — it’s also about saving the lives people imagine for themselves.

“I’ve heard women say, you know, ‘maybe my life wasn’t overtly threatened, but I was in college…and that is my life,’” she said. “Just like for my mom…it changes your options for the rest of your life.”

A catch-22

Wooten’s classmate Savanna Holland is also hesitant to apply to residency in states with abortion bans, even if it means being farther from family and friends.

Holland said ideally she’d apply to programs in Kentucky, and in her home state of Arkansas. But she wants to go somewhere she can be sure to get abortion training. An April study published in Obstetrics & Gynecology found that without Roe v. Wade, 44% of OB-GYN residents are “certain or likely to lack access to in-state abortion training.”

“Knowing that, if I go to either [Kentucky or Arkansas] I potentially won’t get the full health care training that I need, is scary. And it grossly narrows the amount of places that I can apply to,” Holland said.

If Holland and Wooten apply to fewer programs, there’s a greater risk they won’t get into residency at all, delaying their careers and leaving them on the hook for hundreds of thousands of dollars in student debt. The average medical student graduates with about $200,000 in student loans to pay off.

Protesters at an abortion rights rally in downtown Louisville following the U.S. Supreme Court decision that undercut abortion rights across the country.

Then there’s the moral dilemma. Holland worries about what will happen if doctors who want to provide abortions start leaving states like Kentucky.

“You don’t want all these people that are pro-choice leaving these states — leaving these women, and trans men, and pretty much anyone with a cervix and a uterus and a vagina, just out to dry. So it’s really conflicting,” Holland said. “And I’m still trying to figure out what I’m going to do, to be honest.”

“It’s kind of a catch-22,” Wooten said.

Even before federal justices overturned Roe, many Kentucky communities were already suffering from a lack of reproductive health care providers.

Meanwhile, some medical students have decided they’ll try to stay in state, abortion restrictions or no.

Luke Archer is another fourth-year U of L medical student who wants to be an OB-GYN. He’s planning to apply to residency at U of L, in large part so he can stay near his family and his girlfriend.

But he also wants to stay to advocate against the state’s abortion restrictions.

“I think that injustices like this have to have some pushback or else they don’t change,” Archer said.

Not coming home

As news was breaking that the U.S. Supreme Court ruled sided with the state of Mississippi in Dobbs v. Jackson Women’s Health Organization, OB-GYN resident Emma Trawick was in Chicago, performing an abortion procedure.

Trawick, a Louisville native, is in the last year of her residency at Northwestern Memorial Hospital, and wants to specialize in high-risk obstetrics. Many of her patients end up needing to terminate their pregnancies to save their lives.

“It feels pretty incongruent to me to diagnose people with fetal anomalies or life-threatening conditions and not be able to offer them termination,” she said.

Trawick once considered coming back to Kentucky to practice. She wanted to be near her parents as they age and relished the thought of being near friends who had already returned home.

But as state lawmakers passed restriction after restriction on abortion, Trawick’s plans changed.

“I can’t really see a place there for me anymore,” she said. “I just have never felt like I would be able to take care of my patients in a way that is important to me if I was working and training in a state that didn’t allow abortion.”

That doesn’t mean Trawick won’t be seeing patients from her home state. Even under Roe, the limited availability of abortion care in Kentucky forced many patients up to Chicago.

Soon, clinics in Illinois may soon be the closest options for Kentuckians.

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