Texas’ abortion laws are straining the OB-GYN workforce, new study shows

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Texas’ new abortion laws are stressing the state’s already beleaguered OB-GYN workforce, and threatening the pipeline of new doctors that would help provide relief, a new survey shows.

More than 70% of practicing OB-GYNs in Texas feel the near-total ban has negatively impacted their work, prohibiting them from providing high quality, evidence-based care for their patients, according to survey results released Tuesday.

One in five have considered leaving Texas, and 13% are planning to retire early as a result of the new restrictions. Meanwhile, a majority of OB-GYN medical residents say they’re considering the new abortion laws when deciding whether to stay in Texas after their training concludes.

Manatt Health, a health care consulting firm, surveyed all Texas-based members of the professional association American College of Obstetricians and Gynecologists and received responses from 450 practicing doctors and 47 medical residents.

Dr. Todd Ivey, a Houston OB-GYN and an officer with the Texas division of ACOG, said the survey results raise concerns about the long-term impacts of these laws. The state is expecting a significant shortage of OB-GYNs over the next decade, with some rural areas already unable to find the doctors they need.

Like many of his peers, Ivey considered leaving but decided to stay and provide the best care he could within the limits of the law. But he understands why a new doctor, who hasn’t yet built a practice or a family in Texas, might choose to go somewhere else.

“Not having people coming up is going to impact women’s health greatly,” Ivey said. “I just hope we don't get to the day where women can't get their pap smear screening, they can't get their breast cancer screening, they can't get prenatal care.”

“Patients don’t want a confused doctor”

In summer 2022, after the U.S. Supreme Court overturned Roe v. Wade, Texas made it a crime punishable with up to life in prison to perform an abortion. There is a narrow exception to save the life of the pregnant patient, but dozens of women have come forward in the last two years, saying they were denied medically necessary care because of the law.

Anti-abortion groups and Republican lawmakers say it is clear when doctors can intervene to perform an abortion. Doctors disagree, this survey shows. Almost one-third of OB-GYNs in Texas do not have a clear understanding of the law and how it relates to their medical practice, and 60% are fearful of legal repercussions.

Dr. Anitra Beasley, a Houston OB-GYN, said she and other doctors bring the fear of criminalization into the room with the patient, even when they’re treating a miscarriage or other pregnancy complications.

“It turns it into something that’s about me and my risk instead of being about the patient and their situation,” she said.

In her other role as a researcher with Resound Research for Reproductive Health, Beasley spends a lot of time digging into Texas’ abortion restrictions. But even she remains uncertain about when exactly the law would allow her to intervene to perform an abortion.

The Texas Medical Board has offered some guidance on how a doctor should document a medically necessary abortion and the Texas Supreme Court has ruled that doctors need not wait until there’s an imminent risk of harm to the patient. But beyond that, Beasley said, doctors, hospital administrators and general counsels are navigating these high-stakes legal questions on a case-by-case basis.

“If I’m confused, I can only imagine that other doctors are confused,” she said. “Patients don’t want a confused doctor.”

Despite this confusion and fear, Beasley has decided to stick it out in Texas. She has a whole life in Texas — a family, a job she loves, her research work.

“And I’ve got patients here that depend on us to provide really excellent care,” she said. “I think there's a lot of us who feel like we just can't abandon people. We just can't abandon the patients who need us the most.”

Beasley isn’t alone. Most Texas OB-GYNs say they haven’t thought about leaving the state as a result of the laws, the survey shows, and of those who have considered it, many said they were staying because of family or financial issues. But almost 15% of surveyed doctors said they were planning to retire early, which could accelerate the state’s looming shortage of OB-GYNs.

By 2030, Texas is expected to have 15% fewer OB-GYNs than is needed to keep up with demand. Many rural areas are already beginning to feel the effects of these shortages. More than 45% of Texas counties are considered maternity care deserts, meaning there’s no doctor to see during your pregnancy and nowhere to give birth.

Texas ranks 50th among states and the District of Columbia for women’s health, according to The Commonwealth Fund, which measured health care quality, outcomes, coverage, access and affordability.

Maternal mortality increased in Texas in 2020 and 2021, the most recent data available, before the state banned nearly all abortions, reversing several years of progress. Infant mortality is increasing faster than the national average, which researchers attribute to abortion restrictions.

“We all love to look at pregnancy through this romantic kind of view, and that everything is gorgeous and perfect,” Ivey said. “The reality is it doesn't always work that way, and often we have to deal with some very, very serious consequences.”

“People who have less access [to medical care], that is who is going to suffer,” he said.

The next generation of doctors 

With this retirement wave approaching faster than anticipated, Texas will need to quickly train and retain young OB-GYNs.

Historically, the state has done a lot on this front. Texas trains more medical students than any state other than New York and more residents than any state other than New York or California. About 65% of doctors who come to Texas for residency stay after their program ends, a better retention rate than the national average. In recent years, the state has built new medical schools, expanded residency programs and invested in physician loan repayment programs.

But Texas may be “undermining its own investment,” said Dr. Atul Grover, executive director of the Association of American Medical College’s Research and Action Institute. States that banned abortion saw a 16% drop in applications to OB-GYN residency programs this year, even as the number of applicants ticked up nationally, AAMC found.

There were other changes to the residency application process that muddies the data a bit, but the overall trend is clear, Grover said — medical students hoping to study OB-GYN are shying away from states that have banned abortion.

While some of the hesitation may be about the training they’ll receive or the care they’ll be able to provide, Grover said his group frequently hears another concern: the care these doctors can receive when they become patients.

“If you think about the ages of people who are graduating from med school, they’re 27 to 35,” Grover said. “They are very concerned about their ability to control their own health care or that of somebody close to them.”

The directors of Texas-based residency programs surveyed by Manatt Health said they are not seeing a decline in the quality of applicants and are still able to fill all their residency spots. But whether those doctors will stick around after finishing their program is a different story.

Almost 60% of surveyed residents said they were considering the new laws when deciding whether to stay in Texas after residency, and of that group, half said they were planning to leave as a result.

Ivey was recently talking to a medical student who said, despite the good residency programs in Texas for her chosen speciality, she was “absolutely not” considering staying.

“Texas is traditionally a great place to get your education, to get your training in medicine and to practice medicine,” he said. “We've typically been a very physician-friendly state, and I think these new restrictive laws that have come in the last few years are really changing that for a lot of people. They don't see it in that same manner.”