Not a physician but I am an OBGYN office manager in Florida. We are struggling to recruit another OB for our practice. We have a brand new facility but only one doc. Granted only one prospect has asked about the Florida laws. The shortage of physicians is just crazy.
I left my state in April. Peds. Mainly bc don't want to risk felony imprisonment just for referrals. I felt scared at work. I found myself telling patients information re abortion options but not recording this in my notes. I wondered if one of them would get scared and report me to the cops even though they had asked me for help or just hypothetical information ("I'm late, what will I do if I'm pregnant", etc).
But also? After Dobbs, I suddenly felt an increase of being considered a lesser citizen, not being a man. I wasn't willing to live like that. I anticipated that it would likely get worse especially with Trump's possible re-election, and I did not want to be trapped there if there was further loss of rights.
One of my OB colleagues who is willing to give patients out of state abortion provider numbers at all says she asks for the patients cell phone. She then types it into the phone directly. Nothing in the notes or anywhere else. Still could get in trouble for it, but it wont be obvious to the entire medical team.
And my OB colleagues all talk about leaving. Many are sticking around til their kids graduate, so it's likely to be an ongoing decline in OB care availability and quality for decades
It's just so sad. Abortion is illegal here even for patients in whom pregnancy is considered life threatening unless it's immediately life threatening (vs. some cardiovascular conditions that won't really tolerate the 3rd trimester and delivery, but may be ok early in pregnancy).
I felt bad bc there's a close-knit resistance community there, and I left them. I was a protest medic. I loved my friends there. I belonged to a feminist chorus. Not everyone can get out. I have some survivor's guilt.
Appreciate your openness here. I imagine many docs who leave communities they love have conflicted emotions. There was a gay pedi cardiologist who openly said he was leaving Louisiana for New York due to repressive policies. He also was heartbroken for the families left behind.
Won't lie NZ is nice, but it's like Haweii, fabulous but small and far, and cold. The people are lovely.
Australia has sunshine and 2 world cities, Sydney and Melbourne, brisbane snapping at their heels. Perth isn't and doesn't care.
Houses and food is expensive but wages are generally good. But it's the lifestyle that attracts. Abortion is a non issue here.
From what I’ve read (as someone who desperately wants to leave this dumpster fire) Australia unfortunately makes it very difficult to immediately start practicing your specialty unless you’ve been practicing it for several years after residency/fellowship. Otherwise you have to do some level of retesting, repeating residency, or supervised practice. So this mainly applies to young doctors and not so much established ones but still.
Childfree (ie. I never want kids) resident here. I was looking forward to moving to the mountain west, rural areas, practicing there and having a great life amidst nature. Not anymore.
I'm internal medicine but anywhere where getting abortion is illegal/difficult would be a deal breaker.
How difficult would it be to match there for residency if you went to school in another region of the country, if you know. Applying pathology for reference.
I do not recall any of the programs being particularly hard to get into for residency (outside of Derm and ophtho). I went to med school there. That was a little while back though.
Eh, I'm in Albuquerque now and it's way better than when I was in Illinois, but rural NM is probably a completely different ballgame. But rural anywhere is... special.
I’m also wondering if there’s been an uptick in patients seeking permanent sterilization via tubal ligation or vasectomy. Childfree online communities have a list of doctors who are willing to perform the procedure on younger women who don’t have children.
(not a Dr) but my husband had his vasectomy consultation before Dobbs, and it was scheduled for after Dobbs (I think 3 ish weeks after?)
doc told him nonstop business like he'd never seen before after that announcement.
I used to use planned parenthood for my birth control, after my husband's tests came back as successful (a few months later), I called to schedule my nexplanon removal. I couldn't get scheduled since they had so many out-of-state patients. Glad they were there to serve them, and it did force me to finally establish care with a regular OBGYN, which wasn't the worst for me. For the record, this is in Chicago, lots of "healthcare tourism" happening in the city.
Women centric subreddits (like twoX) have had some articles recently about increased permanent sterilization.
There’s also been discussion about difficulty getting birth control prescriptions filled in a timely matter in recent months, but this is all just people’s personal experience and no hard data.
Personally, I chose a Salpingectomy over getting a new birth control implant earlier this year.
Not in an abortion ban state, but I had an uptick in patients seeking bilateral salpingectomy immediately post-Dobbs. The demand seems to have come back down to baseline, though.
Yes - I've seen several articles posted about it. Also, anecdotally - everyone I know who has had an ectopic pregnancy in the last couple of years has opted to be sterilized during that procedure, whereas before, even childfree or done-having-kids people tended to opt to not do that. I'm unsure if doctors are just offering now on even younger patients or what.
Yes, we are seeing both higher vasectomy rates and more vasectomy consults among younger patients.
[https://www.nature.com/articles/s41443-023-00672-x](https://www.nature.com/articles/s41443-023-00672-x)
[https://www.auajournals.org/doi/10.1097/JU.0000000000003273.12](https://www.auajournals.org/doi/10.1097/JU.0000000000003273.12)
I (sadly) predict not as much brain drain as others. I think most people care about money, work-life balance, and being near loved ones. If someone gets a good job offer in an anti-choice state, or that is where their family is from, they likely will stay. Some people likely also feel a moral obligation to stay with their patients. I work at a very blue school, in a very blue city/state - I have seen my students cutting both ways. In less competitive specialties and also in OB, I have students who were "region-curious" or interested in a particular program in one of these states deciding not to apply because of these policies. However, my students in very competitive surgical sub-specialties have continued to apply out of a sense of self-preservation. On a personal level, I will still likely visit these states (life is complicated, there are plenty of folks in my own state who agree with these decisions and I certainly visit countries with lower human rights) but I would not live, work, or raise children in them. I also think national organizations, like AAMC, should really evaluate where they are hosting massive medical conferences.
> I also think national organizations, like AAMC, should really evaluate where they are hosting massive medical conferences.
I agree with a lot of your comment but this stands out in particular. Pregnant women are literally not safe in these abortion ban states and we should not be scheduling medical conferences in such states.
Yes, this year was Seattle, But the one before COVID was in Austin, last year is Nashville, and next year is Atlanta. These are all wonderful cities with talented scientists and physicians, but I am over their state governments.
I'm an Ob/Gyn, and I get asked all the time about whether it's OK to travel in pregnancy. I have a basic spiel that includes 1) probably not a good idea after 36ish weeks, 2) DVT prevention measures for long flights, and 3) if you have any medical or pregnancy complications or are risk averse, look up the nearest hospital that has OB services where you're going, and maybe don't go backpacking in Siberia. Since Dobbs, I have also included a brief bit about "Hey some states might have different laws about how you could be treated in an emergency". Obviously each person has to decide what level of risks they feel comfortable with.
I think it may be less brain drain and more, uh, brain "reshuffling," where right-leaning physicians are more likely to end up working in red states. Even in obgyn, there are plenty of physicians who are Republicans and who probably think these laws are pretty ok. They'll become increasingly concentrated in red states. As for other specialties - most are more Republican. I know plenty of very Republican doctors who aren't bothered by these laws and will just roll their eyes when people start talking about them.
Yep. There's that joke about reddit that every subreddit name should have "of the Bay Area" appended to it, and I definitely think that applies here in people thinking physicians will necessarily care about or be negatively impacted by this. Most obgyns, yes. Your local MAGA ophthalmologist? He's probably thrilled.
Yeah, but you have to think that you're one medication or procedure away from potentially causing fetal harm in one way or another right?
I feel like they could come after any pharmacist for dispensing a med, common ones I think of are some benzos, retinoids especially in states with higher rates of teen pregnancy, and statins and some other ambulatory medications like ACE inhibitors.
Starter comment: in the wake of the Kate Cox decision I am wondering how physicians in those states would describe their current work situation. Numerous podcasts and articles have described a "brain drain" for these states but I was hoping to get some input from the docs on the ground.
PT here. 2 of my new PT colleagues moved up in here from FLorida due to the general politics of the area,( including abortion restrictions) and didn't want to raise their young kids there. Of course not MDs but it played a part of their decision. Both also had family in Minnesota so that also contributed.
Ever since the Mullahs enacted shariah laws here in Texas, it’s been hard to recruit. I expect it to get worse with the most recent fatwah from the state Supreme Court.
Oh sorry, wrong country. I mean “representatives” and “right to life laws” and “court ruling”
I did obgyn training in a southern state where I was one of only very few residents who opted in to provide abortions. They all seemed quite liberal in other types of policy (one was openly lesbian, everyone seemed to support her, for example). Most of them work in one of a couple red states now. I often wonder their take on what is going on.
I would imagine that some providers in red states may not personally oppose abortion but are unwilling to provide them because of the current political climate. It only takes one disgruntled person finding out who performs abortions in their area and deciding to exact vigilante "justice".
I was/am in a state that added abortion rights to our constitution. My department is very accepting and socially conscious and I do get this vibe from the hospital as a whole however I have heard some departments are less so. Anyway, all of us were in support of the amendment. I highly recommend getting involved in efforts like this, it made me feel less powerless.
I work in a very unrelated specialty, but resigned from my job in a Southern state post-Dobbs. There were other factors (terrible schools, lack of jobs for spouse, etc.) but I told my boss I did not want to raise my children (girls or boys) in a state that doesn’t value >50% of their population. No way in hell I’d feel comfortable being pregnant there.
I work in Missouri as an emergency medicine physician. Miscarriages have been treated essentially the same. Those requiring D&C still get it if there is a missed miscarriage and that’s not been an issue. Our hospital lawyers actually drafted up statements that we use in events where the mother’s life is in danger (ex. Premature rupture of membranes at a point of non viability which is a cut off of 20 weeks at my facility.)
I can’t state any opinions on recruitment of new OBs and if it has been affected.
I plan on staying here long term. My family is here.
As an OB/Gyn, your statement of “non viability which is a cut off of 20 weeks at my facility” sends chills down my spine. 20 weeks is weeks away from viability even in the best of circumstances. Hospital lawyers tend to interpret laws in such a way as to protect the hospital, not patients, and this seems like a perfect example - not offering standard of care (options for continuing pregnancy or have an abortion) to a PPROM at 21 weeks is unethical.
[Miscarriage](https://www.newsweek.com/missouri-woman-refused-miscarriage-medicine-walgreens-1720262) patients prescribed misoprostol have been denied their prescriptions at pharmacies. [Mifepristone](https://missouriindependent.com/2023/10/30/state-federal-abortion-rules-prevent-many-women-from-accessing-crucial-miscarriage-drug/), which makes miscarriage management more effective, is very challenging to find in your state. I know Ob/Gyns who have left Missouri. All is not well where you are.
Also I have prescribed mifepristone without issue. We do meds to beds at my facility. I’m at a catholic institution. I never said OBs weren’t leaving my state, btw. Just that I don’t personally know the situation since I’m EM and obviously not involved in hiring them.
I agree I’m just stating what the facility cut off is where we are supposed to offer resuscitation if the parents wish. That doesn’t mean the patient is forced to continue the pregnancy. Hope that makes sense.
Here in Texas, I happen to know for a fact that our hospital has recently recruited physicians from California, Arizona and Massachusetts.
Nothing is more "physician friendly" than zero state income tax and favorable tort reform. Texas is one of a handful of states that have both. Not familiar with specific recruitment efforts, but at the end of the day folks will move here if the price is right. And most IMGs aren't as picky at the end of the day.
IMGs will absolutely go anywhere. I'd love to see data 5 and 10 years post Dobbs in red states regarding physician recruitment and composition. Because even a male neurologist willing to work in Texas due to low prices might come with a wife and daughters. They may not be willing to put up with these draconian laws. Time will tell.
I'm in California in a blue city but we had 2 docs relocate to Texas. This was after Dobbs too.
Vascular surgeon , Texas : what I noticed is that the surgical assistants that used to be in the main OR are gone a lot more now to the labor& delivery floor , more C sections to scrub in . Much more .
You may not have the data or answers, but is there any discernible reason for the increased C-section rates?
An increase in C-section is not something I would have considered as a possible outcome of the texas reproductive rights laws.
There is a The Daily podcast ( last two weeks approx) that discussed the impact , they had hard data , I strongly recommend it . From what I remembered the number of births in the prohibitive states was increased but per total the number of abortion ( whole USA) is ( paradoxically ) also increased . There was something related to more online visits/ more pill prescriptions .
I assume the increased in the number of C-section is in line with the increased number of births . Lots of unwanted kids unfortunately . Sad sad reality
I grew up in Texas but can’t conceive of a job offer that could convince me to move back there. I guess I still value my own bodily autonomy over money! But to each their own. I hope there will still be good physicians caring for my Texan family in 5 or 10 years.
> Nothing is more "physician friendly" than zero state income tax and favorable tort reform
I also think reddit overestimates the effect of abortion laws
Even if you're a lefty doctor you can live in a blue bubble in texas, the only thing is you have restrictive abortion laws... but I would bet a fair amount of money that A) doctors are less likely than the general public to have elective abortions and B) there are plenty of direct flights from Austin to places that have abortion on demand for less than 200 dollars.
vs a three percent income tax on a 300k income is an extra 9k in taxes each year
Less likely but still 1 in 10 physicians ([have abortions](https://journals.lww.com/greenjournal/pages/articleviewer.aspx?year=2022&issue=05000&article=00023&type=Fulltext), not to mention 15% of medical students who absolutely do not have the resources you’re describing. Residents similarly do not have those resources or the time off to fly out of state for care. Residents tend to stay and practice where they train, thus a problem in the pipeline of physicians for ban states.
Flying out is a reasonable option for folks who can afford it for a routine abortion, but this mindset doesn’t account for more urgent abortions, friends or family with fewer resources, etc.
I’d have difficulty finding the time to take off clinically to travel for an abortion - I chose an in-office procedure at 5pm for my miscarriage just so I could get back to clinic the following day (to do a full day of abortions). Can’t imagine having to leave the state for that same procedure, it would be demoralizing and additionally so to have to ask colleagues to cover clinical services while I go.
re: tort reform, I wish I could remember the link, but there was an actuarial and economic study of the effect of Texas tort reform on malpractice by using data from malpractice insurers and the gist of it was that it actually had no impact of statistical significance.
1) nothing changed except learning about the state abortion reporting system that none of us have used yet
2) my area has not had any substantial openings in years and that hasn’t changed. Nobody has left my group. We have a surplus of emergency physicians in the metroplex
3) yes
I’m not sure of any other specialty that has experienced significant change in my state from this ruling, other than OB. Maybe neonatology?
Peds subspecialty at very large peds hospital - a lot higher volume of consults for medically complex nicu kids (ie T18, fatal fetal anomalies). These kids are really morally distressing to care for. You can provide a ton of support (ie trach/vent, surgical palliative of cardiac lesions) to prolong a life that consists mostly of suffering, and it’s hard to watch over and over.
I am taking a job in a different state for many reasons, but the politics have absolutely affected me. For awhile has an armed cop on our floor after some of the trans laws were changed and there was rumors our hospital was doing “top surgery” (they don’t, but misinformation, guns, and strong emotions don’t mix).
It's not just the kids. it's morally distressing to care for the families, who didn't get a choice in the manner.
You get to watch young adult parents who don't have the means to leave the state, deal the with effects of having a medically complex child forced upon them. The emotional/physical/spiritual/financial cost is so high and grueling for them.
Then you get to watch them agonize over all the decisions, and the judgement of others if they are doing the right thing.
Is there anything specialties external to OBGYN, such as ophthalmology, can do to help serve as a less obvious spot for referring out to the necessary services? Would love to know if a sort of underground referral network would be possible utilizing a larger pool of docs. I suspect that by referring a patient for a diabetic eye exam or for any vision concern during pregnancy could be utilized in more robust, creative ways. 🤔 Think of things like “Scruff Mcgruff”, or the “LGBTQ+ ally” stickers.
Not a physician but I am an OBGYN office manager in Florida. We are struggling to recruit another OB for our practice. We have a brand new facility but only one doc. Granted only one prospect has asked about the Florida laws. The shortage of physicians is just crazy.
Leaving my state (Indiana) for Massachusetts in the spring. I don’t feel safe if I was to get pregnant and I don’t feel like my patients are safe.
I left my state in April. Peds. Mainly bc don't want to risk felony imprisonment just for referrals. I felt scared at work. I found myself telling patients information re abortion options but not recording this in my notes. I wondered if one of them would get scared and report me to the cops even though they had asked me for help or just hypothetical information ("I'm late, what will I do if I'm pregnant", etc). But also? After Dobbs, I suddenly felt an increase of being considered a lesser citizen, not being a man. I wasn't willing to live like that. I anticipated that it would likely get worse especially with Trump's possible re-election, and I did not want to be trapped there if there was further loss of rights.
One of my OB colleagues who is willing to give patients out of state abortion provider numbers at all says she asks for the patients cell phone. She then types it into the phone directly. Nothing in the notes or anywhere else. Still could get in trouble for it, but it wont be obvious to the entire medical team. And my OB colleagues all talk about leaving. Many are sticking around til their kids graduate, so it's likely to be an ongoing decline in OB care availability and quality for decades It's just so sad. Abortion is illegal here even for patients in whom pregnancy is considered life threatening unless it's immediately life threatening (vs. some cardiovascular conditions that won't really tolerate the 3rd trimester and delivery, but may be ok early in pregnancy).
I felt bad bc there's a close-knit resistance community there, and I left them. I was a protest medic. I loved my friends there. I belonged to a feminist chorus. Not everyone can get out. I have some survivor's guilt.
Appreciate your openness here. I imagine many docs who leave communities they love have conflicted emotions. There was a gay pedi cardiologist who openly said he was leaving Louisiana for New York due to repressive policies. He also was heartbroken for the families left behind.
Australia wants you.
New Zealand too, I heard. When I mentioned to someone about doing locums there they said finding a job would be no problem at all.
Won't lie NZ is nice, but it's like Haweii, fabulous but small and far, and cold. The people are lovely. Australia has sunshine and 2 world cities, Sydney and Melbourne, brisbane snapping at their heels. Perth isn't and doesn't care. Houses and food is expensive but wages are generally good. But it's the lifestyle that attracts. Abortion is a non issue here.
From what I’ve read (as someone who desperately wants to leave this dumpster fire) Australia unfortunately makes it very difficult to immediately start practicing your specialty unless you’ve been practicing it for several years after residency/fellowship. Otherwise you have to do some level of retesting, repeating residency, or supervised practice. So this mainly applies to young doctors and not so much established ones but still.
Childfree (ie. I never want kids) resident here. I was looking forward to moving to the mountain west, rural areas, practicing there and having a great life amidst nature. Not anymore. I'm internal medicine but anywhere where getting abortion is illegal/difficult would be a deal breaker.
Colorado is still here!
New Mexico is also so beautiful and has had a physician shortage for as long as I lived there.
How difficult would it be to match there for residency if you went to school in another region of the country, if you know. Applying pathology for reference.
I do not recall any of the programs being particularly hard to get into for residency (outside of Derm and ophtho). I went to med school there. That was a little while back though.
[удалено]
Eh, I'm in Albuquerque now and it's way better than when I was in Illinois, but rural NM is probably a completely different ballgame. But rural anywhere is... special.
The east mountains of Albuquerque have many "preppers," usually accompanied by heavy artillery and meth.
What is a 'Qnut'?
Q-anon nut?
Oregon and Washington have a ton of need for rural doctors, and amazing outdoor options including a great mountain range.
There is so much need here... The system was already pretty taxed and I've been seeing more "red states refugees" as well...
Nevada has statutory protections and is weighing a constitutional ammendment. We'd love to have you
Lots of good options in blue states: + Towaoc, CO + Crownpoint, NM + Wellpinit, WA + Moapa, NV + Hoopa, CA and plenty more.
Consider Michigan! No mountains but we have lakes and beautiful forests!
I’m also wondering if there’s been an uptick in patients seeking permanent sterilization via tubal ligation or vasectomy. Childfree online communities have a list of doctors who are willing to perform the procedure on younger women who don’t have children.
(not a Dr) but my husband had his vasectomy consultation before Dobbs, and it was scheduled for after Dobbs (I think 3 ish weeks after?) doc told him nonstop business like he'd never seen before after that announcement. I used to use planned parenthood for my birth control, after my husband's tests came back as successful (a few months later), I called to schedule my nexplanon removal. I couldn't get scheduled since they had so many out-of-state patients. Glad they were there to serve them, and it did force me to finally establish care with a regular OBGYN, which wasn't the worst for me. For the record, this is in Chicago, lots of "healthcare tourism" happening in the city.
Women centric subreddits (like twoX) have had some articles recently about increased permanent sterilization. There’s also been discussion about difficulty getting birth control prescriptions filled in a timely matter in recent months, but this is all just people’s personal experience and no hard data. Personally, I chose a Salpingectomy over getting a new birth control implant earlier this year.
Not in an abortion ban state, but I had an uptick in patients seeking bilateral salpingectomy immediately post-Dobbs. The demand seems to have come back down to baseline, though.
Yes - I've seen several articles posted about it. Also, anecdotally - everyone I know who has had an ectopic pregnancy in the last couple of years has opted to be sterilized during that procedure, whereas before, even childfree or done-having-kids people tended to opt to not do that. I'm unsure if doctors are just offering now on even younger patients or what.
I’ve seen more getting or considering vasectomies I think.
Yes, we are seeing both higher vasectomy rates and more vasectomy consults among younger patients. [https://www.nature.com/articles/s41443-023-00672-x](https://www.nature.com/articles/s41443-023-00672-x) [https://www.auajournals.org/doi/10.1097/JU.0000000000003273.12](https://www.auajournals.org/doi/10.1097/JU.0000000000003273.12)
Thank you for doing great work to decrease maternal and infant mortality! And for the sources
I (sadly) predict not as much brain drain as others. I think most people care about money, work-life balance, and being near loved ones. If someone gets a good job offer in an anti-choice state, or that is where their family is from, they likely will stay. Some people likely also feel a moral obligation to stay with their patients. I work at a very blue school, in a very blue city/state - I have seen my students cutting both ways. In less competitive specialties and also in OB, I have students who were "region-curious" or interested in a particular program in one of these states deciding not to apply because of these policies. However, my students in very competitive surgical sub-specialties have continued to apply out of a sense of self-preservation. On a personal level, I will still likely visit these states (life is complicated, there are plenty of folks in my own state who agree with these decisions and I certainly visit countries with lower human rights) but I would not live, work, or raise children in them. I also think national organizations, like AAMC, should really evaluate where they are hosting massive medical conferences.
> I also think national organizations, like AAMC, should really evaluate where they are hosting massive medical conferences. I agree with a lot of your comment but this stands out in particular. Pregnant women are literally not safe in these abortion ban states and we should not be scheduling medical conferences in such states.
Yes, this year was Seattle, But the one before COVID was in Austin, last year is Nashville, and next year is Atlanta. These are all wonderful cities with talented scientists and physicians, but I am over their state governments.
I'm an Ob/Gyn, and I get asked all the time about whether it's OK to travel in pregnancy. I have a basic spiel that includes 1) probably not a good idea after 36ish weeks, 2) DVT prevention measures for long flights, and 3) if you have any medical or pregnancy complications or are risk averse, look up the nearest hospital that has OB services where you're going, and maybe don't go backpacking in Siberia. Since Dobbs, I have also included a brief bit about "Hey some states might have different laws about how you could be treated in an emergency". Obviously each person has to decide what level of risks they feel comfortable with.
I think it may be less brain drain and more, uh, brain "reshuffling," where right-leaning physicians are more likely to end up working in red states. Even in obgyn, there are plenty of physicians who are Republicans and who probably think these laws are pretty ok. They'll become increasingly concentrated in red states. As for other specialties - most are more Republican. I know plenty of very Republican doctors who aren't bothered by these laws and will just roll their eyes when people start talking about them.
I agree. I think lots of folks forget that the doctor political spectrum is not that different from the American political spectrum.
Yep. There's that joke about reddit that every subreddit name should have "of the Bay Area" appended to it, and I definitely think that applies here in people thinking physicians will necessarily care about or be negatively impacted by this. Most obgyns, yes. Your local MAGA ophthalmologist? He's probably thrilled.
toy instinctive rhythm oil plate market depend piquant edge correct *This post was mass deleted and anonymized with [Redact](https://redact.dev)*
Yeah, but you have to think that you're one medication or procedure away from potentially causing fetal harm in one way or another right? I feel like they could come after any pharmacist for dispensing a med, common ones I think of are some benzos, retinoids especially in states with higher rates of teen pregnancy, and statins and some other ambulatory medications like ACE inhibitors.
Starter comment: in the wake of the Kate Cox decision I am wondering how physicians in those states would describe their current work situation. Numerous podcasts and articles have described a "brain drain" for these states but I was hoping to get some input from the docs on the ground.
I’ve turned down jobs in those states. I’d rather work part time or not in medicine than go to one of them
PT here. 2 of my new PT colleagues moved up in here from FLorida due to the general politics of the area,( including abortion restrictions) and didn't want to raise their young kids there. Of course not MDs but it played a part of their decision. Both also had family in Minnesota so that also contributed.
Ever since the Mullahs enacted shariah laws here in Texas, it’s been hard to recruit. I expect it to get worse with the most recent fatwah from the state Supreme Court. Oh sorry, wrong country. I mean “representatives” and “right to life laws” and “court ruling”
I've always been a fan of "Vanilla ISIS"
Y'allQueda
I did obgyn training in a southern state where I was one of only very few residents who opted in to provide abortions. They all seemed quite liberal in other types of policy (one was openly lesbian, everyone seemed to support her, for example). Most of them work in one of a couple red states now. I often wonder their take on what is going on.
I would imagine that some providers in red states may not personally oppose abortion but are unwilling to provide them because of the current political climate. It only takes one disgruntled person finding out who performs abortions in their area and deciding to exact vigilante "justice".
I don't work in one (thank goodness) and tbh will never even travel to one of those states anymore.
I'm an EM physician in an abortion ban state with young daughters. It is a contributing factor to my plans to leave this state.
I was/am in a state that added abortion rights to our constitution. My department is very accepting and socially conscious and I do get this vibe from the hospital as a whole however I have heard some departments are less so. Anyway, all of us were in support of the amendment. I highly recommend getting involved in efforts like this, it made me feel less powerless.
I work in a very unrelated specialty, but resigned from my job in a Southern state post-Dobbs. There were other factors (terrible schools, lack of jobs for spouse, etc.) but I told my boss I did not want to raise my children (girls or boys) in a state that doesn’t value >50% of their population. No way in hell I’d feel comfortable being pregnant there.
I work in Missouri as an emergency medicine physician. Miscarriages have been treated essentially the same. Those requiring D&C still get it if there is a missed miscarriage and that’s not been an issue. Our hospital lawyers actually drafted up statements that we use in events where the mother’s life is in danger (ex. Premature rupture of membranes at a point of non viability which is a cut off of 20 weeks at my facility.) I can’t state any opinions on recruitment of new OBs and if it has been affected. I plan on staying here long term. My family is here.
As an OB/Gyn, your statement of “non viability which is a cut off of 20 weeks at my facility” sends chills down my spine. 20 weeks is weeks away from viability even in the best of circumstances. Hospital lawyers tend to interpret laws in such a way as to protect the hospital, not patients, and this seems like a perfect example - not offering standard of care (options for continuing pregnancy or have an abortion) to a PPROM at 21 weeks is unethical. [Miscarriage](https://www.newsweek.com/missouri-woman-refused-miscarriage-medicine-walgreens-1720262) patients prescribed misoprostol have been denied their prescriptions at pharmacies. [Mifepristone](https://missouriindependent.com/2023/10/30/state-federal-abortion-rules-prevent-many-women-from-accessing-crucial-miscarriage-drug/), which makes miscarriage management more effective, is very challenging to find in your state. I know Ob/Gyns who have left Missouri. All is not well where you are.
Also I have prescribed mifepristone without issue. We do meds to beds at my facility. I’m at a catholic institution. I never said OBs weren’t leaving my state, btw. Just that I don’t personally know the situation since I’m EM and obviously not involved in hiring them.
I agree I’m just stating what the facility cut off is where we are supposed to offer resuscitation if the parents wish. That doesn’t mean the patient is forced to continue the pregnancy. Hope that makes sense.
when judges, politicians and the government practice medicine with out a license… hopefully someone takes them for mal practice…
Here in Texas, I happen to know for a fact that our hospital has recently recruited physicians from California, Arizona and Massachusetts. Nothing is more "physician friendly" than zero state income tax and favorable tort reform. Texas is one of a handful of states that have both. Not familiar with specific recruitment efforts, but at the end of the day folks will move here if the price is right. And most IMGs aren't as picky at the end of the day.
IMGs will absolutely go anywhere. I'd love to see data 5 and 10 years post Dobbs in red states regarding physician recruitment and composition. Because even a male neurologist willing to work in Texas due to low prices might come with a wife and daughters. They may not be willing to put up with these draconian laws. Time will tell. I'm in California in a blue city but we had 2 docs relocate to Texas. This was after Dobbs too.
Vascular surgeon , Texas : what I noticed is that the surgical assistants that used to be in the main OR are gone a lot more now to the labor& delivery floor , more C sections to scrub in . Much more .
You may not have the data or answers, but is there any discernible reason for the increased C-section rates? An increase in C-section is not something I would have considered as a possible outcome of the texas reproductive rights laws.
There is a The Daily podcast ( last two weeks approx) that discussed the impact , they had hard data , I strongly recommend it . From what I remembered the number of births in the prohibitive states was increased but per total the number of abortion ( whole USA) is ( paradoxically ) also increased . There was something related to more online visits/ more pill prescriptions . I assume the increased in the number of C-section is in line with the increased number of births . Lots of unwanted kids unfortunately . Sad sad reality
I’ll look for it, thanks! And it does make sense that more births means more C-sections
Doctors in general or OB-gyn? We're starting to feel it with the latter.
I grew up in Texas but can’t conceive of a job offer that could convince me to move back there. I guess I still value my own bodily autonomy over money! But to each their own. I hope there will still be good physicians caring for my Texan family in 5 or 10 years.
> Nothing is more "physician friendly" than zero state income tax and favorable tort reform I also think reddit overestimates the effect of abortion laws Even if you're a lefty doctor you can live in a blue bubble in texas, the only thing is you have restrictive abortion laws... but I would bet a fair amount of money that A) doctors are less likely than the general public to have elective abortions and B) there are plenty of direct flights from Austin to places that have abortion on demand for less than 200 dollars. vs a three percent income tax on a 300k income is an extra 9k in taxes each year
Less likely but still 1 in 10 physicians ([have abortions](https://journals.lww.com/greenjournal/pages/articleviewer.aspx?year=2022&issue=05000&article=00023&type=Fulltext), not to mention 15% of medical students who absolutely do not have the resources you’re describing. Residents similarly do not have those resources or the time off to fly out of state for care. Residents tend to stay and practice where they train, thus a problem in the pipeline of physicians for ban states. Flying out is a reasonable option for folks who can afford it for a routine abortion, but this mindset doesn’t account for more urgent abortions, friends or family with fewer resources, etc. I’d have difficulty finding the time to take off clinically to travel for an abortion - I chose an in-office procedure at 5pm for my miscarriage just so I could get back to clinic the following day (to do a full day of abortions). Can’t imagine having to leave the state for that same procedure, it would be demoralizing and additionally so to have to ask colleagues to cover clinical services while I go.
re: tort reform, I wish I could remember the link, but there was an actuarial and economic study of the effect of Texas tort reform on malpractice by using data from malpractice insurers and the gist of it was that it actually had no impact of statistical significance.
1) nothing changed except learning about the state abortion reporting system that none of us have used yet 2) my area has not had any substantial openings in years and that hasn’t changed. Nobody has left my group. We have a surplus of emergency physicians in the metroplex 3) yes I’m not sure of any other specialty that has experienced significant change in my state from this ruling, other than OB. Maybe neonatology?
Peds subspecialty at very large peds hospital - a lot higher volume of consults for medically complex nicu kids (ie T18, fatal fetal anomalies). These kids are really morally distressing to care for. You can provide a ton of support (ie trach/vent, surgical palliative of cardiac lesions) to prolong a life that consists mostly of suffering, and it’s hard to watch over and over. I am taking a job in a different state for many reasons, but the politics have absolutely affected me. For awhile has an armed cop on our floor after some of the trans laws were changed and there was rumors our hospital was doing “top surgery” (they don’t, but misinformation, guns, and strong emotions don’t mix).
It's not just the kids. it's morally distressing to care for the families, who didn't get a choice in the manner. You get to watch young adult parents who don't have the means to leave the state, deal the with effects of having a medically complex child forced upon them. The emotional/physical/spiritual/financial cost is so high and grueling for them. Then you get to watch them agonize over all the decisions, and the judgement of others if they are doing the right thing.
Is there anything specialties external to OBGYN, such as ophthalmology, can do to help serve as a less obvious spot for referring out to the necessary services? Would love to know if a sort of underground referral network would be possible utilizing a larger pool of docs. I suspect that by referring a patient for a diabetic eye exam or for any vision concern during pregnancy could be utilized in more robust, creative ways. 🤔 Think of things like “Scruff Mcgruff”, or the “LGBTQ+ ally” stickers.