I'm absolutely not surprised that doctors are refusing to work in Idaho based on how much the state's laws choose to disrespect women's rights to bodily autonomy and reproductive freedom. 85% of...
I'm absolutely not surprised that doctors are refusing to work in Idaho based on how much the state's laws choose to disrespect women's rights to bodily autonomy and reproductive freedom. 85% of OBGYNs are women. Why does Idaho think female doctors, women, want to live and work in a state that disrespects them so much?
Aside from altruism or solidarity with women patients, there are realistic selfish reasons for an ob to think twice about practicing in an anti abortion state. Abortion is necessary treatment to...
Aside from altruism or solidarity with women patients, there are realistic selfish reasons for an ob to think twice about practicing in an anti abortion state.
Abortion is necessary treatment to save the lives and or fertility of certain pregnant patients with complications.
When medical necessity is structured as an affirmative defense within laws about prosecution for providing abortion, that becomes a huge headache and risk for the doctors.
Any prosecutor can second guess a doctor's choice to terminate a pregnancy and bring charges. The only way to defend the case is to demonstrate to a judge or a jury that your medical choice was correct, after you have been charged, booked, arranged bail etc. I can't imagine that doctors want to deal with the time, cost , stigma and risk of criminal charges as part of standard day to day operating procedure. I don't know whether the cost of a defense attorney would be covered by malpractice insurance. Representation in criminal trials is not cheap. Teaching medical risk benefit analysis with regard to pregnancy complications to a judge or jury without medical training in the context of a trial with your license and freedom at stake is not an attractive option for a doctor.
Another aspect of the OBGYN perspective has to do with residency. My friends who are in their residencies would never have considered anywhere where there are abortion restrictions. Why would they...
Another aspect of the OBGYN perspective has to do with residency. My friends who are in their residencies would never have considered anywhere where there are abortion restrictions. Why would they train somewhere where they are legally unable to train in a critical aspect of their profession. They would be crippling their future prospects for no reason. And without local residents, you will have less people who stay to attend to the wards afterwards.
Also aside from solidarity is that women who are health care providers are still women who need Healthcare. Being an OBGYN who can perform abortions doesn't remove the risk of being a woman who...
Also aside from solidarity is that women who are health care providers are still women who need Healthcare. Being an OBGYN who can perform abortions doesn't remove the risk of being a woman who may need an abortion. On the contrary, having in-depth knowledge about pregnancy care means you're more likely to understand all the the ways that it can go wrong even if you do everything "right". Even if you don't care at all whether or not your patients can access appropriate resources (which I highly doubt is a common attitude), you'll certainly want to be able to access it yourself.
To highlight this: an anti-abortion argument about the death of Savita Halappanavar in Ireland, the case that became a cause célèbre for legalization, was that an abortion was legal in her case...
When medical necessity is structured as an affirmative defense within laws about prosecution for providing abortion, that becomes a huge headache and risk for the doctors.
To highlight this: an anti-abortion argument about the death of Savita Halappanavar in Ireland, the case that became a cause célèbre for legalization, was that an abortion was legal in her case and the doctors were at fault for failing to perform one: the law was not what prevented it. And, considered directly, that was true. But the law also meant that their decision could be second guessed, and came with the potential risk of life imprisonment. And that heavily influenced calculations of risk: the doctors needed to balance the risks to the life of the mother with the risks, in some sense, to their lives.
Ireland did actually reform its abortion ban, before legalization, into what might be seen as a model for how to ban abortion in a medically well-considered way, if one insists on banning it: it involved a panel to consider non-urgent cases where a termination might be medically advisable, and made it so that a doctor's decision that a termination was urgently needed could not be called into question. But current bans in the US seem to be taking to opposite approach, of being as cruel and unsafe as possible.
Idaho ranks at the bottom of all 50 states for its supply of doctors per capita. Even in areas of the state with high population density, such as the Boise area, patients often face months-long wait times to see primary care physicians, even though most providers are already concentrated in the those places.
...
Policy decisions, like Idaho's strict abortion ban, have had a "chilling effect" on recruitment and retention of the state's already slim body of physicians, the impacts of which are felt beyond the health care industry, says Dr. Edward McEachern, a general internist, pathologist and health services researcher. McEachern retired in January, and now works at Boise State University as a distinguished scholar in residence.
...
The Idaho Physician Well-Being Action Collaborative, which McEachern co-chairs, released a report in February that said 22% of Idaho obstetricians have stopped practicing in the state in the first 15 months since Idaho's abortion ban took effect. [...] The report notes that Idaho had 268 obstetricians in August 2022, and by November 2023, was down to 210 obstetricians, a loss of dozens of obstetricians during a period where only two obstetricians moved into the state to practice. There is now one obstetrician per 8,510 Idahoans.
...
Maternal-fetal medicine doctors, that is, obstetricians who undergo three additional years of training to manage the most complicated and high-risk pregnancies, are also leaving. [...] Of the nine maternal-fetal medicine specialists who practiced in Idaho before the state's abortion ban took effect, only four are left.
...
Since the ban was enacted, three rural hospitals have closed or announced closure of their labor-and-delivery centers, and medical leaders say they're struggling to recruit new staff.
I'm shocked that so many doctors are staying. Practicing under those conditions must be terrifying, and there are plenty of more hospitable places that need doctors. I'm glad that people who can't...
I'm shocked that so many doctors are staying. Practicing under those conditions must be terrifying, and there are plenty of more hospitable places that need doctors. I'm glad that people who can't afford to leave the state are still able to access some level of Healthcare, and while I don't wish for anyone to be without the access they need, I hope the long wait times and associated issues motivate them to pressure the state legislature to reverse these abortion bans.
Keep in mind, it's Idaho (I used to live there). The article doesn't mention, but I'd wager there's a large percentage of the doctors and obstetricians who remain who are fully supportive of the...
Keep in mind, it's Idaho (I used to live there). The article doesn't mention, but I'd wager there's a large percentage of the doctors and obstetricians who remain who are fully supportive of the legislation for religious reasons.
Religion and medical practice are complicated. I've worked with many maternal-fetal medicine specialists, and even some of the most devout among them were vocal about prioritizing the mother's...
Religion and medical practice are complicated. I've worked with many maternal-fetal medicine specialists, and even some of the most devout among them were vocal about prioritizing the mother's life and health. [I'd never before heard a good Christian curse so much as a Texas doctor forced to fill out a death certificate for a 14-week miscarried fetus.]
I know there's a small proportion of doctors who are involved in the most batshit of the pro-life "embryos are people" political activity, but I never met a one. And that's a huge problem for states that want to pursue the laws around life beginning at conception - even if every fellow-believer physician or advanced practitioner moved there, they'll never have enough to support the increasing number of people who'll need specialist medical services due to forced birth policies. Pregnant children are incredibly vulnerable to life-threatening complications, not to mention those with serious health conditions, addictions, extreme socioeconomic stressors, advanced maternal age, multiples, and so on.
I have some experience with the legislative process through a close contact. I was very surprised that the state legislatures enacting anti abortion statutes after the Dobbs decision did not hold...
I have some experience with the legislative process through a close contact. I was very surprised that the state legislatures enacting anti abortion statutes after the Dobbs decision did not hold hearings with expert witnesses testifying about how to craft the laws to best allow doctors to practice effective medicine. The lawmakers without medical training assumed that they knew best and that the courts would sort out any problems.
Even a prolife doctor might not be happy about having to defend a decision that abortion was medically necessary to a random judge or jury.
I recall reading some interviews with republican lawmakers who were being asked about some of these situations with medical complications and rape. Several said that isn't an abortion. I think...
I recall reading some interviews with republican lawmakers who were being asked about some of these situations with medical complications and rape. Several said that isn't an abortion. I think many of these lawmakers truly believe there is a difference, while others play dumb because of religion or politics.
It wouldn't have taken much effort to avoid the truly insane outcomes like where laws forbid abortion in cases of ectopic pregnancy. The lawmakers just didn't take the trouble, didn't acknowledge...
It wouldn't have taken much effort to avoid the truly insane outcomes like where laws forbid abortion in cases of ectopic pregnancy. The lawmakers just didn't take the trouble, didn't acknowledge that they don't know about edge cases or medical complications. Hell, they didn't even authorize an agency to do rule making or appoint specialist hearing officers. The same judge who spends most of their time ruling on search and seizure issues is expected to suddenly be up to speed on medical necessity.
I think some of the rush and lack of nuance is a blind to avoid the issue of "health" vs "life" clauses. Many republican lawmakers chafed at the courts granting broad interpretation of "to protect...
I think some of the rush and lack of nuance is a blind to avoid the issue of "health" vs "life" clauses.
Many republican lawmakers chafed at the courts granting broad interpretation of "to protect the health of the mother" to include mental health, future fertility, etc. In contrast, courts have interpreted "to protect the life of the mother" very narrowly. So the Republicans want to avoid giving any latitude to doctors or the courts because they truly only want exceptions at the last moment to save the mother from dying.
Which is horrible. And I do think it is on purpose, because they don't want an expertly written law with nuance.
Why would they? Why would a doctor be happy about having to defend anything in court? As an affirmative defense, they have to be in court. On trial. At risk for a verdict against them. It's the...
Why would they? Why would a doctor be happy about having to defend anything in court? As an affirmative defense, they have to be in court. On trial. At risk for a verdict against them. It's the definition of "okay, roll and consult the results chart to see what happens", except in real life rather than at a gaming table.
To get to that point, they've probably been arrested. Who wants to be arrested, no matter how likely it is you'll make out okay? And it's not at all likely they will come through the expensive court case okay.
The doctors who aren't interested in risk move. Even if they don't want to (people hate change, and moving is considered a HUGE change to most people). Some might stay because they hate the change that much. And some might stay out of some sense of empathy; thinking "but if we all leave, the people who live here are fucked."
To that, I would say "fuck them." If you shield people from the consequences of their actions, they don't learn. They don't change their behavior. Goes for the citizens as well as the legislators.
If they have a doctor shortage, and it gets severe enough, sooner or later people start trying to figure out why. If it comes out that it's because of their strident laws in certain subjects that affect doctors, they might at least consider their actions. Beyond the short term political win, the political ability to spike the football and run to the adoring crowd cheering your success.
If they truly enter an actual doctor shortage, will they change? Maybe. Perhaps they might rewrite their restrictive laws to allow for the likely medical realities (not all abortions are elective purely for non-medical reasons), and offer doctors some protection.
I think a lot of people, however they land on either side of the debate, would probably tend towards agreeing that there is a difference between a patient who just decides "I want to terminate; I just do, I don't have a medical reason, I simply don't want to be pregnant" and a patient that has any of the increasingly documented examples of a patient who needs an abortion for a medical reason. An abortion to avoid actual medical harm, actual medical risk; like a tubal pregnancy, or in cases where the fetus is non-viable, has died in utero, and is going to threaten the mother's life as it goes necrotic in utero would some some cases that have come up in the anti-abortion states as real instances where the anti-abortion laws threatened both the patient and the doctor.
One thing's certain, if they don't experience any consequences, why would they change? They won.
You make precisely the points I intended to except that I would expect that politicians might want to avoid needlessly alienating organized professionals with lobbying groups such as health care...
You make precisely the points I intended to except that I would expect that politicians might want to avoid needlessly alienating organized professionals with lobbying groups such as health care providers
One issue Idaho has is that it poorly funds higher education, and places an emphasis on shorter degrees with quick placement in local industry. This means a supply of locally trained doctors that...
One issue Idaho has is that it poorly funds higher education, and places an emphasis on shorter degrees with quick placement in local industry. This means a supply of locally trained doctors that is on the lower end of the spectrum compared to other states.
I was curious as to the exact numbers, so I did some quick Excel work. Idaho has about 145 graduates from their medical schools each year, which translates to about 7 doctors per 100,000 people in the state. Additionally, many of the medical programs are actually multi-state collaborations, like WWAMI, which delivers remote instruction from the University of Washington, with local clinic rotations. The goal of the program is to provide an education focused on rural medicine.
While this is great, it also means that Idaho is producing few specialists compared to other states. Additionally, some of these doctors will go to other rural states, further shrinking the number of specialists. I think this is important to Idaho's situation because there are many people in Idaho who agree with their laws. But Idaho isn't locally training these folks into specialists at a high rate. Any time you are expecting doctors to deliver care that differs from industry standard guidelines, you better be sure you have a supply pipeline. And Idaho just doesn't. If you compare them to places like West Virginia, which produces 20 medical school graduates per year per 100k people, Idaho has a lot of ground to cover.
https://amp.idahostatesman.com/living/health-fitness/article285521662.html edit: it is only truncated on mobile? Anyhow, if anyone else on mobile was wondering where those excerpts from u/skybrian...
The article has been truncated since it was first published. The original and full article is at
edit: it is only truncated on mobile? Anyhow, if anyone else on mobile was wondering where those excerpts from u/skybrian came from, the alternate URL is complete.
I know this publication would like to blame almost the entirety of the doctor shortage on Idaho's pro-life stance, but the shortage of doctors in rural areas is a big problem everywhere. Rural...
I know this publication would like to blame almost the entirety of the doctor shortage on Idaho's pro-life stance, but the shortage of doctors in rural areas is a big problem everywhere. Rural areas and especially ones that are looking for family medicine doctors are at a big disadvantage and many places are finding they need to provide considerable incentives in order to attract docs who would otherwise be flocking to bigger centers. The fact is that its very difficult to run a clinic with only one doc, you need 2 to 4 for any of them to have any reasonable time off, and family clinic overhead is now so high that many of those docs are paying the bills but not making any headway - their 'gravy' money comes from hours in the a local emergency ward or a specialty clinic. So if those opportunities dont exist most family docs are going to move to bigger centers where they can actually get ahead financially.
I quoted more from that part of the article, but it does talk about the other things going on and doesn’t claim it’s just one thing. The anti-abortion laws seem to be a larger factor for...
I quoted more from that part of the article, but it does talk about the other things going on and doesn’t claim it’s just one thing.
The anti-abortion laws seem to be a larger factor for obstetricians than other specialties, for obvious reasons.
I'm absolutely not surprised that doctors are refusing to work in Idaho based on how much the state's laws choose to disrespect women's rights to bodily autonomy and reproductive freedom. 85% of OBGYNs are women. Why does Idaho think female doctors, women, want to live and work in a state that disrespects them so much?
Aside from altruism or solidarity with women patients, there are realistic selfish reasons for an ob to think twice about practicing in an anti abortion state.
Abortion is necessary treatment to save the lives and or fertility of certain pregnant patients with complications.
When medical necessity is structured as an affirmative defense within laws about prosecution for providing abortion, that becomes a huge headache and risk for the doctors.
Any prosecutor can second guess a doctor's choice to terminate a pregnancy and bring charges. The only way to defend the case is to demonstrate to a judge or a jury that your medical choice was correct, after you have been charged, booked, arranged bail etc. I can't imagine that doctors want to deal with the time, cost , stigma and risk of criminal charges as part of standard day to day operating procedure. I don't know whether the cost of a defense attorney would be covered by malpractice insurance. Representation in criminal trials is not cheap. Teaching medical risk benefit analysis with regard to pregnancy complications to a judge or jury without medical training in the context of a trial with your license and freedom at stake is not an attractive option for a doctor.
Another aspect of the OBGYN perspective has to do with residency. My friends who are in their residencies would never have considered anywhere where there are abortion restrictions. Why would they train somewhere where they are legally unable to train in a critical aspect of their profession. They would be crippling their future prospects for no reason. And without local residents, you will have less people who stay to attend to the wards afterwards.
Also aside from solidarity is that women who are health care providers are still women who need Healthcare. Being an OBGYN who can perform abortions doesn't remove the risk of being a woman who may need an abortion. On the contrary, having in-depth knowledge about pregnancy care means you're more likely to understand all the the ways that it can go wrong even if you do everything "right". Even if you don't care at all whether or not your patients can access appropriate resources (which I highly doubt is a common attitude), you'll certainly want to be able to access it yourself.
To highlight this: an anti-abortion argument about the death of Savita Halappanavar in Ireland, the case that became a cause célèbre for legalization, was that an abortion was legal in her case and the doctors were at fault for failing to perform one: the law was not what prevented it. And, considered directly, that was true. But the law also meant that their decision could be second guessed, and came with the potential risk of life imprisonment. And that heavily influenced calculations of risk: the doctors needed to balance the risks to the life of the mother with the risks, in some sense, to their lives.
Ireland did actually reform its abortion ban, before legalization, into what might be seen as a model for how to ban abortion in a medically well-considered way, if one insists on banning it: it involved a panel to consider non-urgent cases where a termination might be medically advisable, and made it so that a doctor's decision that a termination was urgently needed could not be called into question. But current bans in the US seem to be taking to opposite approach, of being as cruel and unsafe as possible.
From the article:
...
...
...
...
I'm shocked that so many doctors are staying. Practicing under those conditions must be terrifying, and there are plenty of more hospitable places that need doctors. I'm glad that people who can't afford to leave the state are still able to access some level of Healthcare, and while I don't wish for anyone to be without the access they need, I hope the long wait times and associated issues motivate them to pressure the state legislature to reverse these abortion bans.
Keep in mind, it's Idaho (I used to live there). The article doesn't mention, but I'd wager there's a large percentage of the doctors and obstetricians who remain who are fully supportive of the legislation for religious reasons.
Religion and medical practice are complicated. I've worked with many maternal-fetal medicine specialists, and even some of the most devout among them were vocal about prioritizing the mother's life and health. [I'd never before heard a good Christian curse so much as a Texas doctor forced to fill out a death certificate for a 14-week miscarried fetus.]
I know there's a small proportion of doctors who are involved in the most batshit of the pro-life "embryos are people" political activity, but I never met a one. And that's a huge problem for states that want to pursue the laws around life beginning at conception - even if every fellow-believer physician or advanced practitioner moved there, they'll never have enough to support the increasing number of people who'll need specialist medical services due to forced birth policies. Pregnant children are incredibly vulnerable to life-threatening complications, not to mention those with serious health conditions, addictions, extreme socioeconomic stressors, advanced maternal age, multiples, and so on.
I have some experience with the legislative process through a close contact. I was very surprised that the state legislatures enacting anti abortion statutes after the Dobbs decision did not hold hearings with expert witnesses testifying about how to craft the laws to best allow doctors to practice effective medicine. The lawmakers without medical training assumed that they knew best and that the courts would sort out any problems.
Even a prolife doctor might not be happy about having to defend a decision that abortion was medically necessary to a random judge or jury.
I recall reading some interviews with republican lawmakers who were being asked about some of these situations with medical complications and rape. Several said that isn't an abortion. I think many of these lawmakers truly believe there is a difference, while others play dumb because of religion or politics.
It's a truly amazing feat of dissonance.
It wouldn't have taken much effort to avoid the truly insane outcomes like where laws forbid abortion in cases of ectopic pregnancy. The lawmakers just didn't take the trouble, didn't acknowledge that they don't know about edge cases or medical complications. Hell, they didn't even authorize an agency to do rule making or appoint specialist hearing officers. The same judge who spends most of their time ruling on search and seizure issues is expected to suddenly be up to speed on medical necessity.
I think some of the rush and lack of nuance is a blind to avoid the issue of "health" vs "life" clauses.
Many republican lawmakers chafed at the courts granting broad interpretation of "to protect the health of the mother" to include mental health, future fertility, etc. In contrast, courts have interpreted "to protect the life of the mother" very narrowly. So the Republicans want to avoid giving any latitude to doctors or the courts because they truly only want exceptions at the last moment to save the mother from dying.
Which is horrible. And I do think it is on purpose, because they don't want an expertly written law with nuance.
Why would they? Why would a doctor be happy about having to defend anything in court? As an affirmative defense, they have to be in court. On trial. At risk for a verdict against them. It's the definition of "okay, roll and consult the results chart to see what happens", except in real life rather than at a gaming table.
To get to that point, they've probably been arrested. Who wants to be arrested, no matter how likely it is you'll make out okay? And it's not at all likely they will come through the expensive court case okay.
The doctors who aren't interested in risk move. Even if they don't want to (people hate change, and moving is considered a HUGE change to most people). Some might stay because they hate the change that much. And some might stay out of some sense of empathy; thinking "but if we all leave, the people who live here are fucked."
To that, I would say "fuck them." If you shield people from the consequences of their actions, they don't learn. They don't change their behavior. Goes for the citizens as well as the legislators.
If they have a doctor shortage, and it gets severe enough, sooner or later people start trying to figure out why. If it comes out that it's because of their strident laws in certain subjects that affect doctors, they might at least consider their actions. Beyond the short term political win, the political ability to spike the football and run to the adoring crowd cheering your success.
If they truly enter an actual doctor shortage, will they change? Maybe. Perhaps they might rewrite their restrictive laws to allow for the likely medical realities (not all abortions are elective purely for non-medical reasons), and offer doctors some protection.
I think a lot of people, however they land on either side of the debate, would probably tend towards agreeing that there is a difference between a patient who just decides "I want to terminate; I just do, I don't have a medical reason, I simply don't want to be pregnant" and a patient that has any of the increasingly documented examples of a patient who needs an abortion for a medical reason. An abortion to avoid actual medical harm, actual medical risk; like a tubal pregnancy, or in cases where the fetus is non-viable, has died in utero, and is going to threaten the mother's life as it goes necrotic in utero would some some cases that have come up in the anti-abortion states as real instances where the anti-abortion laws threatened both the patient and the doctor.
One thing's certain, if they don't experience any consequences, why would they change? They won.
You make precisely the points I intended to except that I would expect that politicians might want to avoid needlessly alienating organized professionals with lobbying groups such as health care providers
One issue Idaho has is that it poorly funds higher education, and places an emphasis on shorter degrees with quick placement in local industry. This means a supply of locally trained doctors that is on the lower end of the spectrum compared to other states.
I was curious as to the exact numbers, so I did some quick Excel work. Idaho has about 145 graduates from their medical schools each year, which translates to about 7 doctors per 100,000 people in the state. Additionally, many of the medical programs are actually multi-state collaborations, like WWAMI, which delivers remote instruction from the University of Washington, with local clinic rotations. The goal of the program is to provide an education focused on rural medicine.
While this is great, it also means that Idaho is producing few specialists compared to other states. Additionally, some of these doctors will go to other rural states, further shrinking the number of specialists. I think this is important to Idaho's situation because there are many people in Idaho who agree with their laws. But Idaho isn't locally training these folks into specialists at a high rate. Any time you are expecting doctors to deliver care that differs from industry standard guidelines, you better be sure you have a supply pipeline. And Idaho just doesn't. If you compare them to places like West Virginia, which produces 20 medical school graduates per year per 100k people, Idaho has a lot of ground to cover.
Edit: paste bin of the data
The article has been truncated since it was first published. The original and full article is athttps://amp.idahostatesman.com/living/health-fitness/article285521662.html
Maybe someone can edit the url?edit: it is only truncated on mobile? Anyhow, if anyone else on mobile was wondering where those excerpts from u/skybrian came from, the alternate URL is complete.
I know this publication would like to blame almost the entirety of the doctor shortage on Idaho's pro-life stance, but the shortage of doctors in rural areas is a big problem everywhere. Rural areas and especially ones that are looking for family medicine doctors are at a big disadvantage and many places are finding they need to provide considerable incentives in order to attract docs who would otherwise be flocking to bigger centers. The fact is that its very difficult to run a clinic with only one doc, you need 2 to 4 for any of them to have any reasonable time off, and family clinic overhead is now so high that many of those docs are paying the bills but not making any headway - their 'gravy' money comes from hours in the a local emergency ward or a specialty clinic. So if those opportunities dont exist most family docs are going to move to bigger centers where they can actually get ahead financially.
I quoted more from that part of the article, but it does talk about the other things going on and doesn’t claim it’s just one thing.
The anti-abortion laws seem to be a larger factor for obstetricians than other specialties, for obvious reasons.