[UNLOCKED] Attacking medical school training
Students for Life doesn't want to fix the OB-GYN shortage; they want to capitalize on it.
This post, originally published on October 29, 2023, has been unlocked for all readers.
"Targeting."
"Retaliation."
"Coercion."
These words stir up fears of persecution. Grievances and fears are galvanizing, favorite linguistic tools exploited by authoritarians and demagogues with hyperbolic vigor.— This is exactly what Students for Life is doing in its latest scheme: attacking medical school training to ensure “that no abortions or abortion training happen at all.”
The group’s efforts tell us what we can expect in future litigation and legislation.
Students for Life of America (SFLA) is a powerful anti-abortion group that is sometimes pejoratively referred to as Students for Lies due to its pattern of blatant dishonesty. The group and its zealous leader, Kristan Hawkins, are also known for tastelessly exploiting tragedy and humanitarian concerns to advance their goal: the complete abolition of abortion in every circumstance, for any reason.
It is also worth noting that SFLA seeks to ban the most effective forms of contraception, including the pill, IUDs, the shot, and the implant.
Adding grievance grifting to its resume of lies and exploitation, SFLA recently published a post on its website titled, "One Reason Medical Students May Bypass OB-GYN Specialty & Contribute to Shortage? Opt-Out Abortion Training Requirements." The SFLA post builds on an opinion piece written by the group's Lead Operations Supervisor & Medical/Law Coordinator, Gavin Oxley, published at Real Clear Policy. Both posts make the claim that one of the causes of the OB-GYN shortage in the United States is opt-out abortion training requirements at numerous medical institutions.
Yes, you read that right.— SFLA is blaming the shortage of OB-GYNs on the fact that med school students/residents are given the option of conscientiously opting-out of abortion training.
But in order to fully appreciate the ridiculousness of SFLA's cockamamie claims, we need to briefly review the current shortage of OB-GYNs.
The OB-GYN Shortage and the Post-Dobbs Landscape
There are several factors which have led to the current shortage in OB-GYNs, including a growing patient load and an aging pool of obstetricians. That said, the shortage of OB-GYNs has been exacerbated by the Dobbs decision and the myriad of anti-abortion legislation now restricting doctors' ability to provide evidence-based healthcare in states with abortion bans. As the New York Times observed, "Across the country, in red states like Texas, Oklahoma and Tennessee, obstetricians — including highly skilled doctors who specialize in handling complex and risky pregnancies — are leaving their practices." With a landscape hostile to maternal care, the breath of anti-abortion politicians on the backs of the necks, and the ever-present threat of criminalization hanging over their heads, can you blame them?
Replacing these physicians is proving difficult. Scott Dunn, a family physician with Bonner Health in Idaho, explained, "It turns out, there aren't a lot of people who are dying to come to a state where basically anybody could sue them for care that they perceive as being related to some kind of an abortion or even speaking about abortion."
Meanwhile, the Association of American Medical Colleges (AAMC) has been following the effects that the Dobbs decision has had on medical students.
An April AAMC data snapshot found that the number of U.S. MD senior applicants to programs in states with abortion bans dropped 11% from 2022 to 2023 — twice the decrease in states without restrictions.
“Actual interest in these states could be even lower,” says Atul Grover, MD, PhD, executive director of the AAMC Research and Action Institute and an author of that snapshot. “Students may think, ‘I’d rather match in a restrictive state than risk not matching at all, so I’ll apply more broadly,’ but they ultimately would prefer a program in a less restrictive state.”
Meanwhile, a survey of third- and fourth-year medical students suggests a greater possible post-Dobbs impact. Nearly 60% of respondents said they were unlikely to apply to programs in states that restrict abortion.
In Ohio, "More than 500 students of the health professions attending Ohio universities signed on to a letter" urging voters across the state to vote in support of a reproductive rights amendment that will protect citizens' reproductive health freedom and "keep harsh abortion restrictions from again having the force of law." In the letter, the student warn:
Let us be clear: if an abortion ban goes into effect in Ohio, we may not be able to continue to practice in this state. Abortion bans endanger patients. Many of us have taken, or will take, the Hippocratic Oath to do no harm to our patients. The patient-provider relationship is sacred and built on trust. Should an abortion ban go into effect, we will be unable to live up to the very promise that is the basis for our work as health professionals.
Given the continued media coverage of the OB-GYN shortage and growing maternity care deserts affecting the health and wellbeing of millions of American women, as well as media coverage of the ways in which anti-abortion legislation has upended medical training and is causing OB-GYNs to leave red states, it was only a matter of time before those in the anti-abortion movement would put a self-serving spin on these humanitarian issues.
SFLA Spins the Narrative
In addition to serving as Students for Life of America's Lead Operations Supervisor & Medical/Law Coordinator, Gavin Oxley also founded Future Medical Professionals for Life (FMPFL) in 2021, "to push back against Med School’s efforts to teach its students how to perform abortions," according to the Jefferson Independent.
Here's says is the solution to the real problem (emphasis mine):
Want to limit the OBGYN shortage we’re facing? Let’s start with easing the pressure on future medical professionals who want to do no harm — one way to do that is by ending opt-out elective abortion training requirements.
Opt-out requirements… place unethical pressures on medical students/residents to violate their conscience in order to not be targeted for their life-affirming beliefs. This isn’t conducive to staying in the field…
Yet, influential medical societies and institutions such as ACOG and the Accreditation Council for Graduate Medical Education (ACGME) continue to press medical education programs to require routine training in elective abortions, where students have to op-out if they wish to preserve their conscience. These requirements include training in both surgical and chemical abortions.
But when considering the decline in the number of people taking on OB-GYN training, it’s more worthwhile to study the way medical school curriculum is exacerbating the problem as it has been structured to encourage students to forsake their conscience for politics.
No one should be put in a situation where they are fearful of retaliation for protecting their Hippocratic values.
The programmatic requirements to attain ACGME accreditation also violate the institutional conscience of religious medical programs.
We must hold medical activist institutions accountable for their role in deteriorating our pool of future medical professionals. No medical student understandably wants to constantly dodge coercive program requirements on the long road to become a full-fledged physician — and neither should they have to.
All of this, of course, is patently absurd. The option to opt-out protects the right of conscience. But SFLA won't let an opportunity to grievance grift go to waste, nor the opportunity to exploit the national OB-GYN shortage to achieve its goal.
SFLA's Spin Strategies
And what exactly is SFLA's goal here? To abolish abortion training altogether. That's right.— SFLA wants to ensure that "no abortions or abortion training happen at all." Several strategies are thus employed to further this goal:
Capture and reframe the narrative
Push for opt-in abortion training, instead of opt-out abortion training
Divorce abortion from obstetrics care
Vilify reputable professional organizations and institutions
First and foremost, SFLA aims to capture and reframe the narrative surrounding the OB-GYN shortage in order to take the heat off of themselves and the anti-abortion movement for the post-Dobbs harms caused by the policies they promote and support. SFLA does not want to solve the OB-GYN shortage; they want to capitalize on it.
Ignoring the factors that are known to have led to the shortage, as well as the ways in which the anti-abortion movement have made matters even worse following the Dobbs decision, SFLA insists that shortage is the big, bad wolves at medical institutions are forcing med students to violate their consciences by allowing them to opt-out of abortion training.
For his part, SFLA's Gavin Oxley has been diligently ramping up the fear-mongering in recent months. In July, for example, he claimed that students lack interest in entering the field of obstetrics due to "concerns about the persecution of pro-life medical students and residents" (emphasis mine). Oh, please! (And can someone please tell Mr. Oxley that, if anti-abortion students are afraid of persecution, it's probably because he's telling them that they are going to be persecuted.)
This is all part of SFLA's effort to capture and reframe the narrative.
Second, SFLA wants opt-out abortion training replaced with opt-in abortion training for all programs, "placing the burden to create a clinical experience on the residents" themselves (ACOG).
Opt-in training also "establishes a culture of marginalization for abortion provision and those who wish to obtain training" (ACOG). This is exactly what SFLA wants. According to Oxley, "opt-in training programs place a necessary negative connotation on providing elective abortions" (emphasis in original).
Third, SFLA seeks to divorce abortion from obstetrics care (and from medical care in general) despite the fact that the ability to empty the uterus is a vital skill in the field.
To this end, Oxley claims that "truly great [OB-GYN] candidates will be the ones who want to save the lives of all their patients, not kill their most innocent ones." (*Note the hierarchy of innocence in Oxley's statement re the provision of treatment. Medical care should never be prioritized for and dolled out to patients based on their supposed level of "innocence." Subjective ideas about innocence should never determine a patient’s worthiness to receive medical treatment.)
“Although medical schools’ curriculums vary, the Accreditation Council for Graduate Medical Education (ACGME) requires OB/GYN residency programs to provide access to abortion training. Residents with moral or religious objections are allowed to opt out. It’s a key component of an OB/GYN’s training, even for doctors who have no plans of becoming abortion providers” (Washington Post). According to ACGME’s Dr. John Combes, "abortion, or evacuating the uterus, is a core procedure for OB-GYN. It’s also used for management of miscarriages and complications of pregnancy like infection and bleeding…So it’s a technique that has to be learned.” There have already been serious concerns raised about a future in which doctors with insufficient education in this area are entrusted with patient care.
Yet, SFLA's post insists, "No, this training is not needed in order to provide miscarriage care" (emphasis in the original). To back up their false assertion, SFLA quotes the According to the Association of American Pro-Life Obstetricians and Gynecologists (AAPLOG).
The AAPLOG is an anti-abortion lobbying group that "uses its members’ medical certifications to push medically inaccurate information in support of anti-abortion policy" (Pro-Lies). (Members, however, are not required to be medical professionals. Anyone can join.) The group's ideologically-driven doctors have rightfully been called "dangerous." The AAPLOG is a key player in divorcing abortion from obstetrics, using euphemisms to push the lie that abortion is never medically necessary.
In their post, SFLA furthers this lie, stating, "According to the Association of American Pro-Life Obstetricians and Gynecologists (AAPLOG), medical professionals don’t need to be trained on what is known as 'direct' or 'elective' abortion to manage life-affirming care for mothers and preborn babies experiencing miscarriage." (*Note: Pay attention to the word "direct." This is a Roman Catholic term that is important to recognize and understand. You can learn about it in my recent newsletter on Catholic anti-abortion dogma, "Abortion debate: Recognize 'double-effect' language when you see it.") SFLA pushes this lie on their website, in podcasts, and through social media over and over again.
Oxley’s and SFLA’s efforts to divorce abortion from medical care, elevating anti-abortion students (and the AAPLOG) as being the only ones who are "truly great," also serves their next strategy well.
Fourth, SFLA aims to discredit reputable professional organizations and institutions by positioning them as politically-driven persecutors of "truly great," "life-affirming" medical students/residents and religious institutions.
Gavin Oxley and SFLA would have you believe that the American College of Obstetricians and Gynecologists (ACOG), the Accreditation Council for Graduate Medical Education (ACGME), and ACGME accredited programs are more dedicated to pushing abortion than to providing quality healthcare to patients or to creating a healthy learning environment for medical students; that these black-hearted villains, disguised as professional organizations, are dedicated to achieving their wicked political aims through coercion and targeting, mercilessly forcing others to violate their consciences on the altar of abortion. Positioned as the heroes of this story are the students and religious institutions who bravely refuse to bow down to this political agenda in the face of such adversity— along with the heroic Students for Life of America, courageously stepping up to "hold medical activist institutions accountable for their role in deteriorating our pool of future medical professionals," as Oxley tells it.
This is all preposterous, of course. Nevertheless, grievances and fears are galvanizing means of gaining the power and force necessary to achieve one's ideological ends. Turning professional organizations and programs into comic book villains makes it easier to gain support for changing medical program curriculum, which SFLA's Gavin Oxley claims is "exacerbating" the OB-GYN shortage.
What to Watch for in the Future
The anti-abortion movement is both litigious and legislatively aggressive. As such, we can expect to see more than just propaganda and pressure campaigns in the future. Watch for legislation and litigation. Watch for religious freedom/conscience claims.
Expect to see efforts to chip away at institutional autonomy and authority. In states with bans, for example, we may see efforts to impede programs from coordinating out of state training for their students. We may see attempts to prioritize the hiring of anti-abortion doctors and professors. We may see legislation ostensibly aimed at protecting conscience rights. We may see efforts to change curriculum. We could even see attempts to create parallel institutions or accreditation organizations.
There are many, many different ways that state and federal legislatures, as well as governors, can encroach upon and even hijack medical/academic boards and institutions. Just look at what Governor Ron DeSantis has done to the New College of Florida.
Expect litigation, especially under the guise of conscience/religious freedom. Unfortunately, some (not all) attempts at securing religious freedom for certain individuals/groups are actually intended to control the actions and policies of third parties.
Consider Zubik v. Burwell. In that case, religious groups sued the Obama administration over the Affordable Care Act's (ACA) birth control insurance coverage mandate. Under the ACA, an accommodation was provided for religious organizations to opt-out of paying for their employees' contraception. All these groups had to do was fill out a form. That's it! Yet, "dozens of evangelical Christian and Catholic religious nonprofits — schools, hospitals, nursing homes, and the like — decided that the Obama administration's accommodation wasn't good enough for them. They argued that even just filling out the form makes them complicit in 'sin,' because it 'triggers' or 'facilitates' access to birth control" (Vox). And unfortunately, the Supreme Court failed to resolve the matter. This has implications for opt-out abortion training at public universities.
If there is an available avenue for suing accreditation and educational institutions regarding abortion training, board certifications, employment, etc., you can bet your bottom dollar that those in the anti-abortion movement will do so.
The crusader cause of "saving babies" is an intoxicating drug. For those dedicated to the cause, medical training is an acceptable sacrifice on the road to abortion abolition— the health and wellbeing of the pregnant patient be damned.