In the wake of the Supreme Court ruling in Dobbs v. Jackson, which overturned Roe v. Wade, state restrictions are colliding with clinical judgment in ways unfamiliar to many medical professionals. Physicians and other healthcare providers are facing confusion and concern about how recent legal shifts affect them and their patients.
In this volatile legal landscape, The Doctors Company has gathered experts to present frontline clinician perspectives and to discuss approaches to medical providers’ shared dilemmas. During a recent discussion with three prominent OB/GYNs about the pressure that the Dobbs decision has placed on clinicians, five top concerns emerged:
- Telemedicine, Patient Access, and Legal Issues
Daniel Grossman, MD, of the University of California, San Francisco, proposes that in states where prescribing for medication abortions via telemedicine has become a standard of care, offering telemedicine appointments to the appropriate patients could increase clinic capacity to serve patients who must travel for care. Sheila Dejbakhsh, MD, MPH, speaking from Orange Coast Women’s Medical Group in Southern California, made a similar point, noting that offering telemedicine preprocedure and postprocedure consultations for some patients helps those patients minimize time away from work and family and also frees up clinic capacity for patients who have traveled for care.
Read more of these experts’ telemedicine insights
- Healthcare Access Inequities
Increasingly, patients who travel for care must cover enormous distances. A patient in Houston, Texas, who needs access to a first-trimester abortion is now looking at a 700-mile drive, roughly nine-and-a-half hours each way, to Wichita, Kansas, as their closest care option. If that clinic is booked, then the next-closest option is 800-plus miles away. These vast distances impose cost and time burdens, the brunt of which will be borne by patients who are already economically struggling.
Though we sometimes turn to telehealth to overcome physical distance, Ghazaleh Moayedi, DO, MPH, speaking from Pegasus Health Justice Center in Texas, points out that even when telehealth is an appropriate option, it may be the most marginalized patients who have least access to it. Thus, the abortion bans now imposed in many states exacerbate existing stark inequities in healthcare.
Read more about how the Dobbs decision is exacerbating healthcare access inequities—and how medical professionals and organizations can help
- A Critical Shortage of Training Venues
“I work at a training institution,” Dr. Grossman says, “and I’m really concerned about, particularly, the OB/GYN residents, for whom abortion training is mandatory.” Many trainees in other specialties, he says, such as family medicine, would also like to obtain this training—evacuating the uterus is an intervention used in variety of situations, including miscarriages, other obstetric complications, and even the diagnosis of cancer. However, training venues are in increasingly short supply, and are wildly insufficient for OB/GYN trainees already. Soon, it may be that only roughly half of OB/GYN residents have access to this required training.
Find out more about obstacles blocking access to this training—and physicians’ ideas about how to remove them
- Emergencies and the Risks of Delayed Care
All healthcare providers know that, as Dr. Moayedi says, “Nobody’s body read the textbook.” There is no standard medical definition of “emergency.” Yet laws restricting abortion access may not reflect this complex reality, and can seem to expect people’s bodies to follow a simple course. For pregnant patients with complications, Dr. Moayedi says, very often, “They’re OK, OK, OK—and then they decompensate into the worst that you could possibly imagine.”
Find out how to plan ahead for certain predictable, high-stakes urgent situations, such as ectopic pregnancies and preeclampsia
- Finding the Physician Voice
All panelists recognized that clinicians are generally snowed under by their daily work with patients. Still, during this high-stakes period, as organizational conversations unfold at institutions around the country, Dr. Dejbakhsh says, “It is very important that we take a more active role in stepping up.” Along those lines, Dr. Moayedi emphasizes the clinical expertise that physicians bring to institutional planning. She calls on colleagues to step confidently into the role of advocate: “Be open that this moment is one that calls on us to not only serve our patients in the exam room, but to serve them outside the exam room, too.”
Learn more about how clinicians can ensure that the voice of frontline patient care is central to institutional planning
You can hear the full discussion between Dr. Grossman, Dr. Dejbakhsh, and Dr. Moayedi in the on-demand webinar Navigating Healthcare in a Post-Roe World.
As clinicians and organizations adapt to rapidly changing healthcare laws, please continue to visit our Reproductive Healthcare: Post-Roe Resource Center.