New research from the Ryan Residency Training Program ffound that ob-gyn residents training in states that restrict abortion feel profound distress at not being able to provide the evidence-based care their patients need. This challenges their core identities as physicians and makes them feel complicit in injustices against the very patients they are meant to serve.

The paper, published in the Journal of Graduate Medical Education, analyzes interviews held after the Supreme Court’s Dobbs decision with ob-gyn residents in states that restrict abortion care. All the residents showed signs of moral distress, a known healthcare workforce phenomenon where providers know the right thing to do, but institutional constraints make it nearly impossible for them to do it. 

“Not only do these abortion bans profoundly harm people who need care,” said Jema Turk, PhD, lead author of the paper, “but it’s also devastating for these residents to devote their lives to improving people’s health and wellbeing and then be forced to do the exact opposite. They really feel they are often putting their patients in danger because of unjust restrictions.”

Three major themes arose in the interviews:

• Residents felt that being unable to do their jobs threatened their core identities as physicians, causing them to reconsider their career choices. Residents had all seen the harmful effects of withholding high-quality care and expressed feelings of powerlessness and failure.  A resident in Texas said, “But we can’t actually care for patients when they need it because we’re not allowed to. And it’s just this complete sense of like a worthlessness ... it’s so hard.”
• Residents felt complicit in denying care to people who needed it, eroding patients’ trust and worsening health inequities. Nearly every resident shared a story about a patient who was unable to get abortion care due to cost, distance, lack of transportation, lack of childcare, or inability to take time off work. They felt responsible for what happened to their patients. A Florida resident shared, “It was kind of like a smack in the face that we told her, initially, yeah, we think that is the right thing to do. And then, we went back and said, ‘Oh, but we can’t do it.’”
• Residents’ distress made them determined to provide and advocate for abortion access. Despite contending with devastating and often confusing restrictions, many residents were resolute in their commitment to abortion care. They were willing to push boundaries wherever possible, even if they had to go above normal expectations. “I feel like I am willing to jump through hoops to help patients get the care that they deserve because I believe so deeply in their right to have that care,” said a resident in South Carolina.

“While these residents are determined to fight for their patients to get abortion care, they’re also questioning whether they can spend their futures in this constant moral tug-of-war,” said Jody Steinauer, MD, PhD, Director of the Ryan Residency Training Program and senior author on the paper. “These abortion bans are drastically reshaping the future of the health care workforce, motivating residents to leave restrictive states and discouraging future residents from applying. That ultimately leaves people in restrictive states without comprehensive reproductive health care.”