House Republicans want to start a fight over how doctors are trained to provide abortions, reopening an issue that had been settled for nearly three decades.
Hidden in a House GOP funding bill is a new rider that would ban federal funding from going to hospitals that follow abortion training requirements for residents and fellows from the Accreditation Council for Graduate Medical Education. Since 1996, the accreditation body has required residency programs in obstetrics and gynecology to offer abortion training, with an option for residents to opt out if they had moral or religious objections.
The opt-out option was not enough for anti-abortion advocates, who have long sought to limit access to abortion training.
Instead, they want trainees to have to opt-in — with the goal of forcing the accrediting body to rethink how OB-GYNs are trained.
“This is where the problem with accrediting boards has occurred. A lot of them have gone unchecked in their authority,” Rep. Greg Murphy, co-chair of the GOP Doctors Caucus, told NOTUS. “They’re pushing political opinions in medicine.”
The funding bill would make it so that hospitals or “any other program of training in the health professions” would lose access to federal money if they provide abortion training “without the participant first voluntarily electing to opt in to undergo such training.”
Critics of the change say it would further restrict abortion access, decreasing the number of doctors trained to conduct procedures that 1 in 4 women of reproductive age in the U.S. are expected to access in their lifetime, and hindering physicians’ preparedness for handling miscarriages and other complications.
Congress already prohibits entities that receive federal funds from discriminating against health care workers who refuse to undergo abortion training as part of the 1996 Coats-Snowe Amendment, which was proposed after the Accreditation Council for Graduate Medical Education began to require abortion training for OB-GYN residency programs. In direct response to the Coats-Snowe Amendment, the accreditation body amended its requirements to allow residents to opt out.
The American Association of Pro-Life OB-GYNs, an anti-abortion medical organization, has been leading the charge on abortion training reform. Susan Bane, vice-chair for the group’s board of directors, said the group started meeting with Republicans on the issue “a few years ago.”
“There’s been a normalization of abortion as health care,” Bane told NOTUS. “It really violates conscious protection rights when you think about the coercive nature of it, and we’ve heard from students and residents how difficult it is to actually opt out.”
Murphy said the group met with his caucus, telling NOTUS that “they’re absolutely justified in their concerns.”
“This goes back to political correctness in classrooms, where professors are abusing their position of authority onto students and to residents,” he added.
Rep. Robert Aderholt, chair of the appropriations subcommittee that led the bill, called the matter “common sense.”
“We had a lot of people that were advocating,” Aderholt told NOTUS. “Doctors that were being trained and they’re like, you know, ‘We don’t support this and we don’t want to have to be involved in this.’”
The Accreditation Council for Graduate Medical Education declined to comment on this story. A spokesperson said the organization “doesn’t comment on pending legislation but is aware of the bill you referenced and is monitoring its status.”
The accreditation council’s OB-GYN program requirements state that abortion training “equips residents with the skills and knowledge necessary for providing care in other reproductive health care contexts, including but not limited to, the ability to safely evacuate the uterus in the first and second trimesters in various clinical scenarios, such as spontaneous abortion (miscarriage) and its complications.”
“Emptying a uterus is a foundational skill to the practice of obstetrics and gynecology. This is something OB-GYNs must be able to do in order to be able to provide evidence-based medical care,” Rachel Gandell Tetlow, vice president of government and political affairs for the American College of Obstetricians and Gynecologists, told NOTUS in a statement.
The accreditation council’s opt-out system “has proven to strike the appropriate balance between ensuring comprehensive training is the standard while respecting the fact that some residents may have objections,” Tetlow added.
Even before the overturning of Roe v. Wade, abortion training was difficult to access, but that was exacerbated when states began to enact abortion bans. For Democrats, the funding bill provision is just another way to restrict access to abortion, without explicitly calling for a ban.
“Their harmful rider would strip funding from hospitals and training programs that teach future doctors how to provide abortion care — a basic, essential part of reproductive health care,” said Rep. Ayanna Pressley, co-chair of the Reproductive Freedom Caucus.
Many residents from states that ban abortion go to blue states to receive their training, putting those states’ hospitals at risk.
Democratic Women’s Caucus Chair Teresa Leger Fernández said hospitals in her state of New Mexico, where abortion is protected, “rely on federal funding.”
“Every single chance they get, Republicans are putting restrictions into federal law to limit access for women in every state,” Leger Fernández added.
Aderholt railed against those accusations.
“I don’t care if it’s a red or blue state,” Aderholt told NOTUS. He added that people who “don’t agree with abortion” should not be “put on the spot.”
Studies have shown that access to abortion training led to more clinical experience, with some residents who have opted out of the training saying they wanted additional training to treat pregnancy complications.
Dr. Sam Dickman, the chief medical officer for Planned Parenthood for Montana, told NOTUS that abortion training “is a core competency” and having residents opt in to this training rather than doing it automatically “makes no sense.”
“I’m not familiar with any medical specialty where a core competency is allowed to be marginalized in this way,” he said. “This change will end up leading to fewer providers who are able to manage some incredibly common and life-threatening conditions, as well as providers who want to make sure that their patients are able to end a pregnancy when they don’t want to be pregnant.”
The Association of American Medical Colleges found that the number of applicants for medical residency programs in states with abortion bans have continued to decrease, and the number of applicants for OB-GYN programs is lower in states with bans than in those without. Having residents nationwide have to opt in to the training might steer doctors away from the practice, Dickman said.
“Sure, you can sign on the dotted line and say you want to opt in, but that’s going to involve an immense amount of logistical challenges,” Dickman said. “Residency is already such a challenging time.”