Do you know where your obstetrician gynecologist trained?

The midterms have been a major win for abortion rights and medical students are paying attention.

Students looking to specialize in obstetrics and gynecology are currently interviewing at residency training programs across the country. Once hired, they will spend the next four years as resident-physicians learning the skills necessary to become obstetrician gynecologists.

State policies on abortion access directly impact the training these residents will get, training that will ultimately affect the care you or someone you love might receive someday.

It is the professional obligation of an obstetrician gynecologist to know how to treat a patient with any kind of pregnancy outcome. Because the Dobbs v. Jackson Women’s Health Organization decision overruled Roe v. Wade, nearly half of ob-gyn residency programs are in states that have passed uninformed restrictions on when and how this can be done—or likely will as soon as they get the chance. Twelve states have a near complete abortion ban. In others, abortion ping-pongs between being lawful and illegal as various judges block, suspend, and reinstate archaic laws.

With only four years to learn every potential health issue during a woman’s reproductive life, from birth control to childbirth to menopause, our country’s more than 6,000 residents don’t have time to wait on the sidelines while politicians play games with women’s lives. Like their patients who must leave home to get basic care, many are crossing state lines to places like California, Illinois, and New York to learn the evidence-based medicine their lawmakers have decided they don’t need.

Training in abortion is critical. One in four women will have an abortion in their lifetime and nearly all obstetrician gynecologists will encounter a patient in their career who needs abortion care. Abortion is used to manage miscarriages and ectopic pregnancies. Abortion is needed for nonviable pregnancies and pregnancies with fetal abnormalities. Abortion is needed by women who suffer pregnancy complications and by patients whose pregnancies put their lives at risk. Abortion is needed by women who desperately want to be pregnant, and by women who desperately don’t. Regardless of the reason, the procedures are the same — and they are getting increasingly harder to learn.

The Accreditation Council for Graduate Medical Education (ACGME) has made that clear. They have mandated routine abortion training as a core educational requirement for ob-gyn training programs. Following the Dobbs decision, the ACGME revised their mandate to require programs in states where abortion is unlawful to provide access to training in a state where the procedure remains legal. But making that happen for thousands of residents across the country is no small task.

After SB8 effectively eliminated abortion in Texas, our team at the Ryan Residency Training Program — a national initiative to integrate and enhance family planning training for ob-gyn residents — has been assisting Texas residents to secure out-of-state training. The process of finding a training site and completing the required contracts, agreements, and state training licenses took nearly six-months before a single resident could leave the state to train. This administrative lift becomes overwhelming when you multiply it by the 2,638 ob-gyn residents who have already lost or are likely to lose access to in-state abortion training.

Not every ob-gyn residency program will overcome the logistic and financial hurdles necessary to send their residents across state lines, and not every resident can leave their home and family to train hundreds of miles away for weeks at a time. Programs that can’t meet the requirement may lose their ACGME accreditation. Residents unable to travel may start their careers with skills gleaned from online modules, or simulations using fruit and plastic milk jugs, not the hands-on patient care you might expect.

When abortion care isn’t protected, hospitals in restrictive states — many receiving taxpayer money — are hesitant to offer the full scope of abortion care. Hospital legal departments are arriving at wildly different interpretations of what constitutes an emergency, a threat to the life of the pregnant person, and critically, when their doctors can intervene. Interpretations can vary between hospitals in the same state, between lawyers reading the same state laws. If interventions that could treat a patient the most safely, effectively, and conveniently aren’t available to patients, they aren’t available to train ob-gyn residents. As a result, how a resident learns to treat or provide information to a patient has more to do with legal counsel than with evidence-based medicine.

Residents are now receiving vastly different training in the two Americas the Dobbsdecision has created. Ob-gyn training in states that protect abortion care is becoming hyper-competitive as medical students vie for limited spots in programs that offer the full scope of reproductive health care. As with any skill, the more you do, the better you will be. Ob-gyn residents need as much abortion care experience with as many different patients, procedures, and settings as possible to prepare them to practice anywhere.

Politicians at every level must heed the message from voters and deliver on promises to protect and expand abortion access. Without bold action, we can’t ensure that every obstetrician gynecologist will know what to do when a pregnant person in distress comes through their door. If you are this person, or this is someone you care about, you will want a doctor that received the training necessary to provide the best care possible.

Emily Claymore is the Assistant Director of Programs at the Ryan Residency Training Program.