Why I Left, and Why It Matters
Author: Joanna Bisgrove, MD
Keywords: abortion, abortion access, abortion rights
A year ago, I left a work situation that mimicked what would happen if Roe fell. My story is a warning about how the SCOTUS ruling on Dobbs v Jackson has forever changed the US healthcare landscape for the worse.
For 14 years, I was a small town family physician in a state with a pre-Roe abortion ban. I took care of everyone who needed to be seen, but the heart and soul of my work centered on women and children. I took care of pregnant mothers, and delivered and cared for their children. I also provided full reproductive health care, including counseling women with unplanned pregnancies on their options. That counseling, by the nature of my work, included the choice of an abortion.
It was this that put me at odds with my place of employment. Our group was bought out by a Catholic healthcare system about nine years ago. Over time, my increasing inability to effectively advocate for the needs of all of my patients frustrated me. Additionally, I could see the landscape of state politics shifting along with the changes in the makeup of the US Supreme Court. I could sense that the end of Roe was coming, and so when a friend told me about a job opening at my medical school, in a state where the right to abortion was protected, I jumped at the opportunity.
Why am I telling my story? Because as a physician and public health expert, it is my job to provide the best care for my patients based on science and the patient’s personal needs. There is no place for anything else, yet outside interests keep trying to force their way in. For years I fought it, but finally I couldn’t anymore and I left. Now, what happened to me and my former colleagues threatens to play out in states across the country, and it could break the healthcare system.
Consider this: As family physicians, I and my partners in Wisconsin took care of well over 6000 people in the region, some traveling from over an hour away to see us. Since I’ve left, others have as well. There is now only one doctor and three physician assistants in the clinic and they cannot take care of everyone, leaving many to travel elsewhere to get care, even when they can’t. It was agonizing leaving people I had developed such deep relationships with, and indeed I put off moving for years because I felt a duty to care for them. However, it got to the point where I knew if I stayed, I would have to choose between providing evidence based care and the law. It was a choice I knew I could not make.
Now multiply this by the thousands of doctors who live in states where abortion is now or about to be banned. A woman’s ability to become pregnant impacts their care across medicine, from cancer care to rheumatology to infectious disease to everything in between, and all of us need the ability to help our patients make the best science and fact-based decisions for their own health. The vast majority of physicians will fight at first, but over time the fight will wear them down. Some will move, some will leave medicine altogether. The result is that people lose their doctors.
Second, the Dobbs decision affects the future of medicine as well. A recent study found that, of study participants, 11% of physicians, physician trainees or their partners previously had at least one abortion, no matter the speciality. Additionally, 15% of medical student participants reported that either they or their partner previously had at least one abortion. Unintended pregnancy can delay and potentially derail years of expensive medical training. It’s a chance many young physicians and physician trainees cannot afford to take. They will therefore be less likely to apply to medical school, apply for residency, or take a job in a state where abortion is banned. As a result, the gaps in access to care for all patients in states where abortion is banned will become significant.
Third, male physicians are affected. As noted above, the study also cited partners of physicians who had abortions. Additionally, the most recent available data on couples matching showed that over 1000 couples participated in the residency couples matching process in 2019, and that number grows every year. That is a not insignificant number of couples who could now also be looking to avoid states where abortion is banned.
To be sure, much of what I am saying is hypothetical. I cannot possibly know what is happening in the minds of doctors in states where abortion is or will be banned. But I can say this: in my previous job, I am by far not the only one who has left. Many of us who did disagreed with the overriding principles espoused by our parent organization. Additionally, the number of physicians who have left, combined with the difficulty in replacing us during a nationwide shortage of doctors, means that the care the organization can provide is impacted. What's happened in my old place of employment is now a very real scenario for healthcare across the country.
We are entering uncharted waters as a country, and a handful of supreme court justices who have no understanding of healthcare just made a decision that impacts the entirety of the profession and the people we serve. People from all walks of life will be affected by this decision, not just women who seek an abortion and related services. The story I have told is but one facet of what is to come, but it is one which cannot be ignored.
About the author: Joanna Turner Bisgrove MD, FAAFP is an assistant professor of family medicine at Rush University Medical Center in Chicago. She has spent over a decade in leadership and advocacy at the local, state, and national level. Dr. Bisgrove’s areas of health policy expertise include reproductive healthcare, disability inclusion, and the health of children and their families. (Twitter: @JoTBizMD; LinkedIn)
