To Get Abortion Training, Some Medical Students Must Leave Their States — and Come to California

Kelly Mamelson has spent most of her life in Florida, including the last two years as a medical resident specializing in obstetrics and gynecology. But because of the state’s attempts to restrict abortion care, she’ll have to travel out of state to complete her training as an OB-GYN doctor. Like many in her position, she’s not planning to practice in Florida once she finishes — but hasn’t ruled out returning to her home state altogether.

“We feel we are abandoning our patients, but we feel we have no option other than to go out of state to get this training,” Mamelson said Friday at a panel discussion hosted by UCSF’s Bixby Center for Global Reproductive Health.

Doctors on the front lines of reproductive rights debates say these challenges are already having a devastating impact on the profession and on people who seek care. Experts on Friday’s panel said that many medical students are traveling to California, which has been investing in building its abortion training programs, or to other states that support abortion rights, like Maryland and New York, where Mamelson is heading to continue her education.

“Many learners that we support don’t find that the amount of abortion training they’re getting is enough” in states with bans and restrictions, said Flor Hunt, executive director of TEACH (Training in Early Abortion for Comprehensive Healthcare), a program that promotes abortion training for family physicians. Unlike OB-GYN doctors, family physicians are not mandated to learn how to empty a uterus. But reproductive rights advocates say that increasing understanding and training across family medicine is necessary to provide a fuller spectrum of health services. “That means oftentimes traveling to another state or perhaps to another city where there is a higher volume of abortion cases and where they can do a rotation and get a lot more abortion experience.”

In June 2022, the U.S. Supreme Court overturned the historic Roe v. Wade decision that previously upheld the constitutional right to abortion.

Today, abortions are mostly banned in 14 states, including Idaho, Texas, Oklahoma, Alabama, Tennessee, Kentucky, Wisconsin, North Dakota and South Dakota. Other states, like Arizona and Montana, have moved to ban abortion outright but those attempts have been either blocked or limited to a specific gestation period.

Across the rest of the country, abortion remains legal. California, in particular, has positioned itself as a so-called abortion sanctuary. The state enshrined the right to an abortion in the state’s constitution, and has set up resources like a state website for people seeking abortions to find travel and medical support. Hunt’s organization also helped shepherd a package of 16 bills through the California state Legislature last year that aim to create more opportunities for abortion education by increasing funding for training programs and other life-saving reproductive procedures.

But for prospective OB-GYN doctors in states that have restricted access, education and training have become much more difficult.

About a quarter of all medical degree-granting institutions are in states with the most restrictive policies around abortion, and 18.5% of accredited OB-GYN programs are in those states, according to data from the Accreditation Council for Graduate Medical Education.

“Around 30,000 students are being educated to become doctors in those states,” said Dr. Jody Steinauer, director of the Bixby Center as well as the Ryan Residency Training Program, which helps send OB-GYN residents out of anti-abortion states for training and which hosted the panel in San Francisco. “We are worried these doctors will finish their training without abortion care training.”

An estimated 43.9% of current OB-GYN residents are now expected to lack access to in-state abortion training, according to an August 2022 paper Steinauer co-authored.

Dr. Tony Ogburn, a general OB-GYN in South Texas, said that even before Roe was overturned, there were barriers to accessing abortion in Texas and Florida, where he previously lived and studied medicine, but things “dramatically changed with the trigger law that outlawed abortions in Texas,” he said.

“For patients that need a higher level of care, it has caused increased challenges to accomplish that care and for some patients it’s just not available,” he said. “Sometimes they are not able to travel. There is a moral distress around care.”

Mamelson echoed many of the challenges Ogburn cited. In Florida, an attempt to ban abortions after six weeks of pregnancy was signed into law — but can’t go into effect unless the state’s existing 15-week ban is upheld by the courts, which is currently making its way through legal challenges. The two policies have created confusion among both practitioners and patients. In most cases, the only exceptions are if doctors can prove that the pregnancy is life-threatening.

“There is still a lot of hesitation among colleagues when we make that call, and I’ve seen in practice delays in care because of this,” she said. “I received a transfer of someone with a cervical ectopic pregnancy, which is considered life-threatening, but the hospital couldn’t treat them because there was a heartbeat on that pregnancy, which is a ticking time bomb for that patient.”

While education and training on abortion care was not easy in some places even before Roe was overturned, the changing landscape has fueled fear and confusion among patients and practitioners, Mamelson said.

“There are many, many, many people out there who don’t know that they have that choice [to get an abortion] here in the state of Florida,” she said. “We take an oath in medical school that we won’t cause any harm, but I think this change in the law has caused a lot of harm. It is extremely distressing to have patients come in and request services that we cannot provide them.”

But, “we aren’t giving up,” said Mamelson. “That’s for certain.”