In this video, Jeremy Faust, MD, editor-in-chief of MedPage Today, sits down with Jamila Perritt, MD, MPH, president and CEO of Physicians for Reproductive Health (PRH), and Kristyn Brandi, MD, a fellow at the American College of Obstetricians and Gynecologists (ACOG), to discuss providing ob/gyn care in the post-Roe landscape. Perritt and Brandi talk through concerns, from medical students and physicians who are leaving the profession “en masse,” to the long-term viability of travel-based medicine.
Part 1 of this interview can be viewed here.
The following is a transcript of their remarks:
Faust: Obviously, this new ruling kind of makes everywhere worse, but some places are even worse. There was some discussion about whether people who were training would actually be advised not to go into ob/gyn residencies in states where there just isn’t the ability to provide ethical care. Where do you come down on this?
If you’re a third- or fourth-year medical student thinking of going into ob/gyn, do you tell them, “You know what, I understand you’re from this state, or you want to go there, but that’s just a place where you’re unfortunately not going to be able to train and maybe even be put in situations that are challenging ethically.” Where do you come down on this?
Brandi: Absolutely. I would speak as someone that has just recently left their job in academic medicine and was a mentor and is still a mentor for a lot of medical students and residents. They’re making really tough decisions right now about what to do with their careers, because there’s the very real fact that you’re going to potentially go to a place that you’re not going to get the training that you need in order to take care of patients safely.
There are things that are being done right now to help with that, to help create exchange programs, essentially for folks that are in places that abortion care is restricted, to do rotations in places where they can learn the skills and be able to navigate that. But that’s essentially just putting a Band-Aid on it for right now.
There are opportunities and ways that we can try to build that training, but people are really having to make the tough decisions about, do I even go into this field? I know that ob/gyn had that bad rap to begin with because of litigation and liability around deliveries. But now there’s this additional layer of, if I provide miscarriage care, abortion care, infertility care, potentially contraception care in the future, is that something that’s going to put me at liability in some form?
I’ll also add the layer that not only are people having to think about their careers and how they are training, but they are people too. They are people that could potentially be at risk of pregnancy, that may be wanting to develop families, and going to spaces that may not be safe for them.
So, that’s an additional layer that people are considering as they’re making their decisions about, where do I want to do my medical training? Where do I want to do my residency? Do I want to be a family med doctor or an ob doc or an ER doctor in this crisis that we’re having in healthcare? Those are real questions that people are asking, and we don’t have great answers for them right now, unfortunately.
Perritt: I agree totally. What we’re seeking in this moment are individual-level solutions to systemic problems. Exchange programs and away rotations are individual solutions.
The problem is that there is no equitable, institutional, and systemic access to this human right. The human right to build a family in the way that you know is best for you. If, when, and how you build your family is a human right. Unless we can start talking about it that way, unless we can seek solutions grounded in that framework and in that theory, then these one-off, as Dr. Brandi called them, “Band-Aid solutions” are not going to move the needle in any real way.
We’re actually seeing, in addition to med students that are making these decisions, we’re seeing the same thing with practicing healthcare providers who are leaving medicine en masse — whether they’re leaving medicine and leaving their communities because they’re no longer able to provide the care that they have been trained to do, that they feel called to do morally, or leaving the workforce altogether because it is not a place that has been welcoming or supporting to them. We continue to see these transitions.
The vast majority of folks that we see that are leaving the workforce are providers of color, women, and fems, LGBTQ folks. So, people who are marginalized by these systems more broadly are also feeling the brunt of all of these crises, whether it’s the COVID-19 pandemic that will never end, abortion bans, all of these things.
When we think about who is most directly impacted, it is patients of color, and it is providers of color, many who serve in the communities that we grew up in — the communities that are disproportionately people of color and so are feeling these impacts very deeply.
Brandi: I was going to say also that this is not a right-now problem. This is something that is happening right now, but will have long-term implications for care in the future. We talked about these individual providers leaving communities or these individual trainees not going to communities. We already have abortion deserts, we have prenatal and labor care deserts, and that will only be exacerbated by more and more people drifting out of these communities.
Perritt: Absolutely. The last thing I’ll add to that is just being very explicit in saying that people with resources and money and access and connection will always get care. That is the bottom line, whether it’s legal or not is irrelevant. We saw this pre-Roe in 1973. We’ve seen this post-Roe when folks around the country did not have access to care, and we will see it continuing now.
This is abortion care and, as Dr. Brandi mentioned, it’s infertility care, it’s obstetric care, it’s all of the ways that we continue to operate within this two-tiered system of care, where if you have access to it, if you have money, if you have resources, you get one level of care, and if you don’t, good luck. You can fend for yourself.
Faust: Right. We know that these kinds of bans affect everyone, but there’s a disproportionate effect on BIPOC people, LGBTQ people, and those who don’t have resources in general, like low-income people. How can clinicians who want to help on the ground help those communities get the care they need?
I’ll fold into it this question of: are people starting to travel for the care they need? How can clinicians help all communities, but those communities in particular? And particularly I’m interested in whether and how travel-based medicine is sort of beginning to address some of these problems, albeit I’m sure not optimally.
Perritt: Yeah. I’d say, one, for folks who are tuned in, BIPOC means Black, Indigenous, and other People of Color. It’s an acronym that many folks use that maybe you aren’t aware of.
But what I’ll say is that you’re absolutely right. Abortion access affects everybody, but some communities bear the brunt of these bans more than others. And it’s not easy to say that there’s just one reason why, right? Why do Black women have higher rates of abortion? It’s tied to decreased access to culturally responsive care, decreased access to insurance coverage, increased pregnancies that are mistimed or unintended or unwanted. All of these complicated issues culminate in needing to access abortion care to a different degree than some other communities do.
So, it’s critical for us to keep in mind as we’re thinking about the kind of future that we want, the kind of care model that we want to build in the reproductive healthcare space, if we prioritize those folks that are on the margins of care, people that are often forgotten, often left out, often ignored in our decision making, then if we prioritize them and put them at the center of our planning, everybody else will benefit. That’s a Black feminist organizing principle, right? Organize from the margins in.
In terms of traveling, I’ll say quickly that traveling for abortion care, traveling to seek abortions and provide abortions is not a new thing. It is not something that occurred immediately post-Dobbs. People have been traveling for decades, since abortion was legal, because access to abortion is often limited in many folks’ communities. I don’t believe that it is a solution, because the reality is that you can only take good care of your community if you are in your community. Right?
The travel providers and traveling for care is what we have now, and absolutely it’s a necessity and we should continue it, but the best way to take care of people is to actually be embedded in that community, to know what’s happening, to know the relationship of people in that community to the institution you’re working at, to know the context of the care that’s been provided in your community.
So, traveling for care, either for patients or providers, is not a solution that I advocate for, but it is a temporary stop-gap measure for this moment in time.
Brandi: I guess I’ll add that, I think, again, we’re doing a whole lot of Band-Aid solutions right now to try to piece together care because patients need care right now.
But I would echo that fact that we need to center these communities and recognize that these are not individual-independent issues, that people that are traveling are having difficulty traveling because they’re low-income, or because maybe they’re an undocumented patient or patient that doesn’t want to travel through checkpoints, or has a disability that makes it difficult to travel, or are incarcerated. These individual issues don’t stand alone.
We need to start tackling all of these systemic injustices as one of the many ways that we need to tackle this issue around making sure people have access to care. There’s so much work we need to do.
Perritt: If you take nothing else from this Live today, I want to say very clearly that there is no mandate to report anyone that you suspect of managing their own abortion. That is not underneath the realm of mandatory reporting. And, in fact, we know that it is a violation of HIPAA laws and you may be prosecuted as a provider.
So, really being clear about what our role is, how we can interrupt the risk of criminalization and punishment for our patients, and also make sure that we’re standing in our own values and doing what we believe is the right thing while mitigating and minimizing harm for our communities.
Faust: Alright, this conversation is extremely informative and rich. I appreciate you both being here. Tell us where to follow you and find you on social media.
Perritt: You can follow PRH at @prhdocs on Instagram, on Twitter, on Facebook. You can follow me at @Reprorightsdoc on Twitter and @jamilaperritt on Instagram. Check out PRH’s website. We have a lot of information, especially if you’re a healthcare provider.
If you’re new to conversations about abortion, we have primers on how to talk about it while decreasing stigma or not contributing to stigma around abortion in all kinds of ways. So check out our resources if you’re a healthcare provider, if you’re a patient, if you’re a reporter. We have tons of resources on our website. Please reach out to us.
If you happen to be a legislator that’s writing these laws and you’re looking for a physician to talk with about the real-world implications, we are your go-to folks. We are happy to support and to make sure that you have the context that you need to do good work.
Brandi: As for me, if you’re interested in learning more about ACOG, you can follow us on Twitter at @acog. We are at @acog_org for Instagram. Mine is @DrKBrandi on Twitter and Instagram.
On our website, acog.org, there’s a lot of information for patients that are looking for evidence-based care, for providers that are learning more about how you can get involved in providing this care, what are the current regimens, and what the current policy looks like.
And again, if you are a politician, feel free to reach out to us and we’re happy to provide you with what the evidence is about the care that you’re talking about in the laws that you’re writing.
Faust: Alright. Thank you both for your advocacy and your expertise. Thank you for sharing it with the MedPage Today audience, and I look forward to learning more from you both in the future. Thanks for joining us.
Source: MedicalNewsToday.com
