Thread by @abbyliberty1

Closing with the session: Collateral Damage: Graduate Medical Education in Post-Dobbs US

#SFP2022

Where you train is where you work. Half of physicians stay in the states where they do their residency, so there is unlikely to be spontaneous sharing of abortion knowledge across communities. Healthcare inequities will continue to rise.

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states.guttmacher.org/policies/

While this panel will focus on medical specialities, including OBGYNS and FM residents who are some of the most diverse subspecialties, there are so many trainees impacted by abortion restrictions including @ACNMmidwives and @GeneticCouns not to mention Pediatric and EM

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OBGYNs are the only speciality which includes abortion training as part of its educational requirements, although these have been weakened in order to accommodate abortion restrictions

bit.ly/3uoGfXx

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Now @yenpdoan from speaking about Navigating the Match in a post-Roe world.

They remind us that abortion restrictions are a significant additional stressor to the match process.

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@yenpdoan: I was forced to decide whether I would train in my home in the South or train where I would get the training I wanted and my patients deserve.

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On top of that distress, the #OBGYNmatch is competitive!

There are 286 OBGYN residency programs, but only 155 in non-restrictive states. Most applicants are applying to 60 programs.

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There is a Reddit spreadsheet that applicants use to get information about sensitive natures, like abortion climate and opportunities. This is moderated, but unregulated.

@ObgynVirtual

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Applicants report the following influence their rank list:
- Geography: 90%
- Goodness of fit: 88%
- Reputation: 85%
- Work/life balance: 76%
- Quality of residency: 75%

Did they ask about abortion? Would that rank?

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The pipeline of physicians who know about abortion care starts in medical school (no required abortion ed). This is exacerbated by residency, wherein abortion care is concentrated among OBGYNs. The knowledge and skills deficit must be addressed EARY in medical training.

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Now Dr. Zite from @univtennessee talking about recruiting applicants to restrictive environments. Although their program was not a Ryan program, they emphasized abortion training opportunities and this allowed them to draw a competitive pool.

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@acgme allows "abortion adjacent" activities to count for some Family Planning education - but this was disingenuous, so the program was honest & got a citation. This allowed the program to create a Family Planning rotation.

Curriculum matters. Honesty matters.

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Horvath et al: Residents were more satisfied when they had routine abortion training. If abortion training unavailable, residents were more likely to be dissatisfied with their training.

bit.ly/3H93pc7

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Hopefully @acgme holds firm in their assertion that abortion training is important. Physicians in training in restrictive settings depend on them.

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Training opportunities are available through @MWAccessProject and the Ryan Program. However, Dr. Nite says she wanted this training earlier in residency because D&C are an important foundational skill that will strength the care provided throughout training.

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Inter-state licensing is an incredible barrier. This prevents, delays and disheartens residents from accessing abortion training.

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For example, @NCMedBoard requires licensees to re-certify their license on their birthday so out of state residents who go to train during their birthday have to re-apply within that month in order to continue their training.

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@EmoryUniversity study: Even non-OBGYN applicants want to avoid ban states. Trainees are often reproductive age and their access to care could be restricted. Ongoing studies will look at the impact abortion bans had on the #Match2023 token system and match rates.

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Some universities have addressed this, such as @VUmedicine which stated loudly and proudly that they would financially support trainees who need reproductive health care across state lines.

bit.ly/3VzEiUe

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The future of training physicians in abortion care needs:
- Universal training license
- Training malpractice insurance valid across states
- Funding solutions for state-funded institutions where care & training are threatened

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Now @TXabortiondoc talking about TX restrictions which have limited Family Medicine educational opportunities, but residents can still focus on:
- Ultrasound skills
- Miscarriage
- Post abortion care

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The @RHEDIFamMed program empowers continuity for Family Medicine residents to get training in abortion care:
rhedi.org/rhedi-programs/

ONLY exist in access-states.

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Post-graduation education opportunities exist through the @RHAP1 group, again, limited to states where abortion access is protected.

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Lastly, Abortion Training has programs (protected states) with training opportunities including radiology and pathology opportunities.

abortiontraining.org

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Training also opens job opportunities, but people can reach out to Clinical Abortion Staffing Solutions for employment possibilities!

prochoice.org/providers/cass/

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The Ryan Program supports integrating abortion education into residency training. Some programs continue to exist in restricted states and they have unique support needs.

ryanprogram.org

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Read more in @JAMANetwork about the the moral distress trainees will face by withholding care due to abortion restrictions:

bit.ly/3gV1gpT

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Abortion restrictions and medical training is not only about training or skills gaps.

Abortion restrictions hurt clinicians directly.

Abortion restrictions cause moral distress, burnout, worsening health inequities.

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*FREE* Didactic materials for those training in areas with abortion restrictions from @IERHatUCSF

bit.ly/3uoKodU

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The Ryan Program stated an out of state training program which required:
- $1,500 stipend for travel/lodging
- >100 hrs staff time
- 5 months for contract negotiations, liability, scheduling

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The @ohsuobgyn and @OHSUWomens were happy to participate and have been nothing but awed but the amazing providers coming from around the country to train for a bit in Oregon

bit.ly/3VTLSbQ

The success of this out of state pilot leaves us asking:
- How can we scale this?
- What does this program mean for Ryan programs in restricted states?

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Informal audience poll:
- 13% already engaged in cross-state education programs
- 20% actively organizing cross- state education

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Audience: How are you ensuring that BIPOC trainees are getting this training?

Panel: This is important. We are working on it. Lots of feedback from the pilot to improve upon this.

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Audience: Many family medicine residents want training and are living/training in Haven spaces. What is SFP going to do to work with this population that has a high chance of making impactful access change?

Panel: YES

#SFP2022 #FMRevolution

Panel: This is not unique to family medicine training programs. Even OBGYN programs in haven states don't always provide abortion training! Access to abortion training is institutional, site-specific as well as related to state laws.

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Audience: Given the legacy of exclusion of BIPOC people from the GME process, for example - discrimination of physicians trained in other counties, how is partnering with GME organizations going to remedy this gross inequity?

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Panel: We need to de-academize abortion care. We don't need letters after our names. We don't need accolades. We need to dismantle systems which haven't worked for us, which we have started to do.

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