AUSTIN (KXAN) — Abortion laws in Texas are stressing the state's already overworked women's health care workforce and depleting numbers of doctors entering and staying in the state, according to a study by Manatt Health.
More than 70% of practicing OB-GYNs in Texas feel the near-total ban is prohibiting them from providing high-quality, evidence-based care for patients and negatively impacting their ability to practice, according to the study released in October.
In 2022, after the U.S. Supreme Court overturned Roe v. Wade, Texas banned all abortion from conception, except when the mother's life was in immediate danger. Under the law, a doctor convicted of providing an illegal abortion in Texas can face up to 99 years in prison, a $100,000 fine and lose their medical license.
But some say it remains unclear what constitutes an illegal abortion. Almost a third of OB-GYNs in Texas do not have a clear understanding of the law, and 60% are fearful of legal repercussions, according to the Manatt Health study.
"When we drafted the Heartbeat Law, we did not want to risk confusing medical providers by changing the definition, so we kept the language that had been in Texas law for years — language that physicians and hospitals should be familiar with," said Sen. Bryan Hughes, the author of the Texas Heartbeat Law, in an opinion piece written for the Houston Chronicle.
One in five OB-GYNs have considered leaving the state, and recruiting new talent to take their place is also proving difficult. OB-GYN residency applications in Texas dropped by 16% for last year's admission cycle. Those who are already practicing in OB-GYN residency programs in Texas say that new abortion laws are a major factor when deciding whether to stay in Texas after their programs end.
Liza Meyer, a medical student born and raised in Texas, had never envisioned her life elsewhere. Meyer had always dreamed of being an OB-GYN but says the legislation in the field has her rethinking her future.
"I am scared to want to go into this field," Meyer said. "I just remember that moment of hearing Roe v. Wade was overturned, and I was thinking, 'Oh my God. What am I going to do with my whole future?'" Meyer said.
Meyer said she's considered applying into different specialties for residency but she can't shake her passion for women's health care.
"I love Texas but I also love maternal fetal medicine, and it's becoming a really bad place for that, which sucks," Meyer said. "I want it to be a safe place for everyone."
Another factor that Meyer and other potential OB-GYN residency applicants have to consider is that they may not be receiving the full scope of abortion education through programs in Texas.
"The difficulty with having an obstetric residency or fellowship in Texas is that in order to provide that comprehensive care that the Accreditation Council for Graduate Medical Education requires, programs literally have to send their residents to other states to get the rest of that comprehensive care," said Dr. Emily Briggs, an obstetrician and family physician in New Braunfels.
Briggs said she doesn't think that sending people out-of-state to learn the proper care is feasible for the state in the long run.
"If you're already guaranteeing three plus years of your life to doing something where you're not really paid for it, and you're putting your whole family, your life on hold, why would you then also make it set up that you have to go live somewhere else for a few months and then come back?" Briggs said.
Briggs said she thinks that outside of concerns about practicing within the legislation's limits, this presents an additional logistical loophole for potential OB-GYNs coming to the state.
"It's a really good reason for people to not do an obstetric fellowship or obstetric residency in Texas," she said.
Meyer said she can't wrap her head around why programs in Texas aren't able to teach her the comprehensive care required by the ACGME.
"Why am I being taught this out of state in order to practice it in Texas?" Meyer asked. "I feel like that just doesn't make sense. Why would you teach me to do something in another state so I can be certified to do it in this state, but it doesn't happen here?"
Dr. Anitra Beasley, a Houston OB-GYN and assistant dean of academic and faculty affairs at Baylor College of Medicine, says she worries this training is not enough.
"I think when the residents are going there, they're getting a really good experience, but they're getting a really good experience for three to four weeks, and that does not substitute for the comprehensive, longitudinal experience that they would get if abortion care were available in Texas," Beasley said.
Beasley said that she worries this lapse in education will have an impact on the quality of patient care in the state.
"If we're thinking about the number of procedures that residents are exposed to, when you're thinking about abortion, an experience that includes abortion care and miscarriage management, there just aren't enough," Beasley said.
Beasley said that on top of a lack of exposure, these restrictions prevent her from teaching proper doctor-patient conversations and decision-making.
She said she is less worried about the drop in application numbers because Texas residency positions typically tend to fill but more about the caliber of the residents themselves.
"Are we going to have more applicants who don't think that comprehensive reproductive health care is important? Are we going to get to the point where we are actually not filling our residency spots because people don't want to come to Texas because they're not getting a comprehensive education?" Beasley said.
In 2024, more than 45% of Texas counties are considered maternity care deserts, meaning there's no doctor to see during pregnancy and no hospitals in which to give birth. As the number of doctors continues to diminish, Texas is expected to have 15% fewer OB-GYNs than is needed to keep up with demand by 2030, according to the Manatt Health study.
Right now, a majority of rural counties struggle to access proper maternal care, according to March of Dimes. As more doctors leave the state, Beasley worries the problem will spread into more urban areas.
"I don't think that this is going to be an issue that is only being seen in rural areas," Beasley said. "If the workforce continues to dwindle, there will be less physicians to take care of patients, period."
This means that doctors may have to take on more patients to satisfy demand in their communities. But, the workforce may not be equipped to handle such an influx.
"I think we're going to have a greater load individually, but we're an aging workforce. I think about half of OB-GYNs are over 55, so we're aging out, and if we don't have young new docs coming to the state, we're going to have a serious crisis," said Dr. John Thoppil, an Austin OB-GYN and former president of the Texas Association of OB-GYNs.
Women's health care in the state is already struggling. Texas ranks 50th among states and the District of Columbia for women's health, according to The Commonwealth Fund which measured health care quality, outcomes, coverage, access and affordability.
From 2019 to 2022, the rate of maternal mortality cases in Texas rose by 56%, compared with just 11% nationwide during the same time period, according to an analysis by the Gender Equity Policy Institute.
Doctors attribute this increase to the fear associated with practicing under the Texas law.
"Practicing medicine in the reproductive health field really is like having someone looking over your shoulder when you are talking to a patient, when you are coming with a plan of care. You really should be thinking about that patient and only that patient. You and the patient should be coming up with a shared plan of care that works for them. We have lost the ability to do that with so many things," Beasley said.
Briggs says she feels like the law prevents her from the full scope of practicing evidence-based care.
"We want to do everything based on what is medically appropriate, but these laws fly in the face of that, because they say that we cannot intervene in a case where it's clearly necessary to anybody who's practiced medicine. We know where we need to intervene and what we need to do to intervene, and we're just not allowed to. Our hands are tied," Briggs said.
A group of 111 other OB-GYNs agree. They sent a letter to elected state leaders in November urging them to change abortion laws that they say have prevented them from providing lifesaving care to pregnant women. Thoppil was one of those doctors.
"I'm honored to have signed on with 110 other courageous OB-GYNS. Our job is to educate because I really do think the law has a lot of unintended consequences and the legislature is somewhat ignorant about some of those consequences. It's our job to help them see that this goes beyond what they think," Thoppil said.
Sen. Hughes said he understands the need to clarify the law but believes that doctors are misinterpreting its intentions. He said the law was never meant to stand in the way of their ability to care for patients.
"More needs to be done to make sure that doctors and the hospitals know the law: When a mother’s life or major bodily function are in jeopardy, doctors are not only allowed to act, but they are legally required to act. The standard of care as well as their moral and ethical duty compel them to act," Hughes wrote in the Houston Chronicle.
Rather than letting the state's alarming numbers deter her, medical student Meyer is motivated.
"I just see potential to make the greatest change here," Meyer said. "Also being from Texas, I would hate for other Texans to not be able to receive care in their own home state. I think that's a concern that Americans shouldn't have to carry."
Doctors hope other students echo her sentiment.
"The women of Texas need you, so don't double punish them by abandoning them just because our legislators have," Thoppil said.
Briggs said she stays for her community — one in which access to women’s health
care is already limited.
"If we are not here, who's going to be here to help the community? There needs to be somebody, and they need to follow evidence-based care," Briggs said. "So please don't leave us. Please, please come back. We are here fighting this fight."
