The June 2022 US Supreme Court ruling in Dobbs v. Jackson Women’s Health Organization revoked the federal right to abortion granted in 1973’s Roe v. Wade decision. In the Featured Plenary “Roe v. Wade and the Future of Graduate Medical Education,” health and legal experts discussed the ruling’s ramifications on graduate medical education (GME).
With the court ruling, specific requirements in the Program Requirements for Obstetrics and Gynecology immediately became illegal in some states, a first for the ACGME, said ACGME Senior Vice President, Accreditation Mary Klingensmith, MD, who moderated the panel.
The Review Committee for Obstetrics and Gynecology first conveyed to the specialty community that programs in these restrictive states would not be cited for non-compliance with the requirements at odds with state law. The Review Committee then continued to meet and discuss what changes needed to be made so that programs in restrictive states could be in compliance with both the Program Requirements and state law. Ultimately, ACGME-accredited programs must still teach residents abortion care in a clinical setting.
“Our duty is to train our graduating residents to be able to practice anywhere,” said panelist and Review Committee Chair Gabriella Gosman, MD, explaining the rationale behind the Program Requirements.
For programs in restrictive states, such as Texas or Missouri, residents must travel to another state to obtain that education and training. As in the previous iteration of the Program Requirements, individual residents may opt out of abortion care education and training on religious or moral grounds.
“The organizations have been really working together, pedal to the metal, to make this a possibility, to build a structure where residents can get education in [abortion care],” Dr. Grossman said.
Gynecologic oncologist and professor Dineo Khabele, MD said her program at Washington University in St. Louis established partnerships with institutions in Illinois to ensure residents received clinical experience in abortion in a state where such care is legal, but that was only the first step.
“This is requiring us to do so much more as physicians,” she said. “We have to understand the laws of our states so much more than we used to.”
Dr. Khabele said her program is working to educate physicians in other programs and departments about the law and terminology. They are also having to assure other physicians that they can continue caring for pregnant individuals, as fear of legal ramifications and confusion over the statutes could bar pregnant patients from receiving other necessary care unrelated to abortion or the pregnancy.
“There is a lot of fear and it’s understandable,” Dr. Khabele said,” but we don’t want there to be a spillover effect where this affects other aspects of health care.”
For example, Dr. Khabele said, a pregnant patient with appendicitis may need surgery, and the surgeons should feel comfortable and empowered to perform that operation without fear of legal or criminal ramifications should an adverse event occur.
“Whatever the law, physicians must fulfill their calling to help,” she said. “There are [still] ways to take care of patients in restrictive states and we have to continue to do that.”
The Dobbs ruling isn’t the only case that could have far-reaching impact on GME and the medical community, said Beth Brinkmann, JD, a leading national appellate litigator who has argued 26 cases before the US Supreme Court.
One case coming through the court system in West Virginia argues that the US Food and Drug Administration (FDA) mailing mifepristone, one of two medications used in medical abortion, to patients violates state law. In Texas, another lawsuit claims mifepristone was unlawfully approved by the FDA. Mifepristone was first approved in 2000 under the brand name Mifeprex; the generic version was approved in 2019.
The case being made questions the process by which the FDA approves all medications, Brinkman said. “That certainly could have wide ramifications.”
One of those potential ramifications is an effect on recruitment, the panel said. While Dr. Khabele said it’s possible residents will be concerned about their own access to care, she’s also seeing learners recommitted to providing excellent health care to their patients, many of whom cannot afford to travel.
“It’s been a way for those learners and their supervising faculty [members] to rally around the importance of providing evidence-based care as they are able, and [to] focus on those positives, on the physician-patient relationship,” she said.
Visit Learn at ACGME to watch the “Roe v. Wade and the Future of Graduate Medical Education” plenary and other featured sessions from the 2023 Annual Educational Conference.