Some doctors don’t even want to think about taking jobs in Texas, Wyoming, or other states with strict abortion bans, raising questions about how hospitals will recruit and retain medical staff in a post-Roe country.
Specialists in obstetrics and gynecology—frequent targets of medical malpractice lawsuits—especially are wary of taking jobs in states where the laws could limit their practice, according to recruiters for Merritt Hawkins, AMN Healthcare’s physician recruiting division.
“They are fearful,” said Tom Florence, executive vice president of recruiting for Merritt Hawkins.
And they’re not alone.
Radiologists and physicians with other specialties also have balked at working in the 13 states with trigger bans that took effect after the US Supreme Court ruled there’s no federal right to end a pregnancy, leaving the states broad power to regulate abortion. “Halfway through the recruiter conversation, they’re saying, ‘No, that’s not a state that I want to go to right now,’” Florence said.
Before 2020, the country faced a physician shortage driven by an aging population with more medical needs. Then came the pandemic, and hospitals found that full-time staff were taking jobs with better paying travel services or opting for early retirement.
Now health-care facilities trying to recruit and retain staff have found that the June 24 US Supreme Court decision, and subsequent lawsuits in state courts, have made the task more challenging.
“Hospital administrators have also expressed their concerns about staffing shortages, particularly among nurses and other staff, who may refuse to participate in treating certain patients out of fear that they, too, could be criminalized for the treatment decisions of physicians and others,” Dr. Jennifer Avegno, director of the New Orleans Health Department, wrote in an affidavit to a Louisiana district court.
It’s hard to make hospital staffing plans when court rulings keep changing the status quo, most recently to lift an injunction blocking Louisiana’s near-total abortion ban, Avegno said in an interview.
“I think everyone is just sort of holding their breath,” she said. “Are they going to pick a situation to make an example of and prosecute somebody? When is that going to happen?”
Ohio’s Cleveland Clinic expects to lose doctors who’d rather move than work under a state statute banning abortions once fetal heart activity is detected, usually around six weeks of pregnancy, said Dr. Tristi Muir, chair of the Cleveland Clinic’s Women’s Health Institute. An Ohio Supreme Court order has kept that law in effect pending a legal challenge from abortion providers.
“I think there’ll be divisions in our country that will make people gravitate towards either blue or red states, and physicians will not be an exception to that,” she said. “I think we will lose some physicians.”
The Indiana Hospital Association warned its state lawmakers that a special session called to pass a ban on nearly all abortions was “creating an atmosphere that will be perceived as antagonistic to physicians.”
“As state-level decisions continue to unfold, we caution our public officials from sending signals that could further exacerbate our health care workforce shortage and threaten access to care,” Brian Tabor, the association’s president, said in a July 29 statement.
Indiana went ahead and enacted the first new abortion restrictions since the Supreme Court overturned Roe v. Wade. That law takes effect Sept. 15.
In a lawsuit challenging Louisiana’s near-total abortion ban, doctors filed affidavits detailing their fears that medical students won’t apply to residency programs in the state because abortion training won’t be available. The documents also describe fears of being arrested for prescribing medications that could be unsafe for pregnancy, or for advising chemotherapy that requires ending a pregnancy.
Dr. Valerie Williams had been trying to hire her successor to lead an obstetrics and gynecology training program in New Orleans, only to see the top candidate back out “once she heard that Louisiana had trigger bans with severe penalties for physicians.”
“She said that she could not practice in a state where she could not provide patients with the full spectrum of care,” Williams wrote in one affidavit.
Wyoming’s ban on most abortions was temporarily blocked ahead of a hearing Tuesday before a judge considering whether the law violates the state Constitution’s protections for healthcare access.
“The irony is that in states that pass these anti-abortion laws, there will be fewer OB GYN doctors willing to practice there. But there will be more need for them because there will be more pregnancies going to term,” said Suzanna Sherry, a constitutional law expert at Vanderbilt University Law School.
Most contracts signed and job offers accepted before the Dobbs decision are still being honored in states with strict limits on abortion, and there are things hospitals can do to show candidates their facilities are a good place to live and work, Florence said.
Merritt Hawkins’s clients are being encouraged to boost compensation packages and offer higher salaries, create more opportunities for shift work with less time on-call, and provide doctors with assistants who can transcribe information during clinical visits and enter referrals.
Such incentives would help hospitals offer prospective new hires an appealing lifestyle, Florence said.
“It’s not that it’s impossible or that nobody’s going to relocate to those areas,” he said. “It certainly is making it more challenging, though.”
In Ohio, Cleveland Clinic committed to documenting the impacts of abortion restrictions and providing that research to legislators, Muir said.
Among the data points so far: One urologist’s office is getting up to 60 calls a day from childless men inquiring about vasectomies or mothers asking for IUDs for their daughters long before they expect to be sexually active.
Cleveland Clinic now opens a half-dozen clinics on Saturdays to provide contraception for women. Physicians volunteer for those shifts, and staff in other hospital departments have asked if they can contribute in other ways, such as handing out fliers with the information, Muir said.
“I see it as a really exciting opportunity for our staff, both physicians and nursing staff and front desk, to do something positive in the wake of feeling a little helpless in the decision,” Muir said. “It’s been greeted with a lot of enthusiasm.”