[Previous: Failed states]
It’s a bad time to be pregnant in Idaho:
Bonner General Health, the only hospital in Sandpoint, announced Friday that it will no longer provide obstetrical services to the city of more than 9,000 people, meaning patients will have to drive 46 miles for labor and delivery care.
… “The Idaho Legislature continues to introduce and pass bills that criminalize physicians for medical care nationally recognized as the standard of care,” the hospital’s news release said. “Consequences for Idaho physicians providing the standard of care may include civil litigation and criminal prosecution, leading to jail time or fines.”
… The release also said highly respected, talented physicians are leaving the state, and recruiting replacements will be “extraordinarily difficult.”
“Idaho hospital to stop delivering babies. One reason? ‘Bills that criminalize physicians.’” Kelcie Moseley-Morris, Idaho Statesman, 17 March 2023.
The abortion bans springing up across red-state America force physicians into a cruel dilemma. If a pregnant person comes into the emergency room, hemorrhaging or suffering sepsis from a miscarriage or dying from preeclampsia—but the fetus still has a heartbeat—doctors could face criminal charges if they intervene. Their only chance is to hope that the fetus dies before it’s too late to save the mother.
This isn’t a hypothetical scenario. In Oklahoma, a woman with a molar pregnancy—a cancerous, nonviable fetus—sought medical attention, but was told the hospital couldn’t do anything to help her. Staff suggested she wait in the parking lot until she was about to die so that they could act. She gambled on traveling out-of-state instead, and got the care she needed. But it’s only a matter of time until we have an American Savita Halappanavar.
This is an impossible position for doctors and nurses. They either desecrate their professional ethics by standing by and watching someone die whom they could have saved, or else face criminal charges. Understandably, many of them are voting with their feet. They’re leaving these barbarous and backward places in favor of progressive states where they won’t be jailed for practicing medicine.
Sandpoint, Idaho is a case in point. It used to be a medical hub for north Idaho, Montana and Washington, with an ob-gyn ward that delivered hundreds of babies each year—until the fall of Roe and the enactment of abortion bans.
In March, Sandpoint’s obstetrics department completely shut down as doctors fled. Idaho women with high-risk pregnancies now have to travel much further for medical care, like St. Luke’s hospital in Boise. But that one may soon be closed too. It has only six doctors left, most of whom are near the end of their careers. Two younger, recent recruits have already left the state.
Anticipating the likely result, Idaho’s conservative legislature took action. They stopped collecting data on maternal mortality.
Red state brain drain
Red states are suffering brain drain, and not just in Idaho. Doctors are packing up and leaving states like Ohio, Tennessee, West Virginia, and more.
Wyoming has one of the worst physician shortages in the country, with rural hospitals closing their maternity wards. Meanwhile, the state legislature is mulling an abortion ban that will make the problem worse. In South Carolina, more than one-third of counties have no prenatal care at all. In Missouri, rural hospitals are closing in droves.
Texas is an especially sharp example of the problem. Doctors are fleeing the state, worsening a shortage that was already at critical levels:
Almost every provider I spoke with for this story has thought about leaving their practice or leaving Texas in the wake of S.B. 8 and Dobbs. Several have already moved or stopped seeing patients here, at least in large part because of the abortion bans. “If I was ever touch a patient again, it won’t be in the state of Texas,” said Charles Brown, chair of the Texas district of the American College of Obstetricians and Gynecologists (ACOG), who stopped seeing patients last year after decades working as a maternal fetal medicine specialist.
…In 2022, 15 percent of the state’s 254 counties had no doctor, according to data from the state health department, and about two-thirds had no OB-GYN. Texas has one of the most significant physician shortages in the country, with a shortfall that is expected to increase by more than 50 percent over the next decade, according to the state’s projections. The shortage of registered nurses, around 30,000, is expected to nearly double over the same period.
In addition to abortion bans, right-wing persecution of transgender people is worsening the problem. Dell Children’s Hospital in Austin had a world-renowned adolescent health clinic, which treated conditions from eating disorders to menstrual and hormonal problems.
But in May, Texas opened an investigation into the clinic for providing gender-affirming care to trans teenagers. In response, all its doctors quit. The clinic was effectively shuttered, and kids who had been relying on it were left without care.
In another high-profile case, Dr. Jake Kleinmahon, a nationally recognized expert in pediatric transplant surgery, announced in August he was leaving his home state of Louisiana for New York. Dr. Kleinmahon is gay, and he decided that the state’s hostility toward LGBTQ people and families was intolerable:
“Tom and I have discussed at length the benefits of continuing to live in the South, as well as the toll that it takes on our family. Because of this, we are leaving Louisiana. Our children come first. We cannot continue to raise them in this environment,” Kleinmahon wrote.
“Physicians are human beings too”
These departing doctors won’t be easy for red states to replace, if it’s possible at all. A survey of third- and fourth-year medical students—not just OB/GYNs, but other specialties as well—found that more than three-quarters said that abortion restrictions would affect where they choose to live and practice. Almost 60% said they wouldn’t apply to a state that has them.
The decrease for OB-GYN residency applications, 5.2%, was seen in all states, regardless of abortion laws. That percentage dropped by almost double—to a 10.5% decrease—in applications in states with near-total abortion bans.
If the surveys bear out, there could be a serious shortage of OB-GYNs in states with the tightest abortion restrictions. These states already tend to have higher maternal and infant mortality rates.
Another study gives similar numbers:
Our recent study published in the Journal of General Internal Medicine begins to answer this question. In a survey of more than 2,000 current and future physicians on social media, we found that most (82.3%) would prefer to work or train in states with preserved abortion access. In fact, more than three-quarters (76.4%) of respondents would not even apply to states with legal consequences for providing abortion care. The same holds true for states with early or complete bans on abortion or Plan B. In other words, many qualified candidates would no longer even consider working or training in more than half of U.S. states.
…The reasons for physicians’ practice location preferences include, but are not limited to, patient care. While 77.8% of respondents report that their preferences are influenced by patient access to abortion care, others also prioritize preserved access for themselves or their partner (56.1%) or other family members (42.5%). This should not surprise us: physicians are human beings, too, with healthcare needs and personal lives that are not wholly defined by their career choices.
“How Overturning Roe v. Wade Changed Match Day 2023.” Sarah McNeilly, Morgan S. Levy, Simone A. Bernstein, MD, Jessi A. Gold, MD, MS, and Vineet Arora, MD, MAPP. MedPage Today, 20 March 2023.
At the very least, red states will have to pay more to attract and keep medical practitioners. That means taxes and insurance premiums will skyrocket in these states—for everyone. Conservative voters are going to be hit squarely in the pocketbooks by these spiteful, regressive bans they wanted. It’s also likely that wait times will increase and quality of care will decrease, as these states may be forced to take practitioners who can’t get jobs anywhere else.
Heaping more weight on the pile
The U.S. was already facing a shortage of physicians. However, entrenched conservative hostility to science and medicine is making the problem worse.
This began long before the overturning of Roe v. Wade. For years, right-wing refusal to accept Medicaid expansion has been forcing dozens of rural, red-state hospitals to close. Even before abortion bans, large swaths of rural America were maternity care deserts. The South already had the worst maternal mortality and child welfare rates in the country.
Then COVID-19 came along. As the pandemic raged, Republican politicians nurtured a hydra of conspiracy theories. They displayed a bitter resistance to masks, vaccines, lockdowns, and every other policy created by people who were trying to save lives. They loudly proclaimed that “freedom” sanctified their right to get sick, infect their neighbors, and die slow, agonizing deaths. They accused doctors and hospitals of murdering their loved ones.
They paid an awful price for their obstinacy. During the pandemic, conservative voters died at disproportionate rates compared to pro-science Democrats. COVID deaths dragged life expectancy in Missouri down to a four-decade low. So many people died in Alabama that the total population shrank for the first time on record.
Their partisan rejection of science didn’t end with the pandemic, either. It’s spread to become a mistrust of all vaccines. As a result, long-vanquished diseases like measles, whooping cough and polio are making a comeback.
The people who live in red states are confronting a dire scenario of their own creation.
Republican voters are demanding policies that directly harm themselves and their loved ones. In the name of lower taxes, they forced their own hospitals to close. In the name of freedom, they refused vaccines that would have saved their lives during a pandemic. Now, in the name of banning abortion, they’re heaping even more weight on this pile. They’ve passed laws which ensure that their wives, their daughters, and they themselves won’t have medical care in a crisis. Their culture-war victories are purchased at the cost of their own lives.
The people who live in red states—especially white conservatives who live in far-flung, poverty-stricken rural areas—are confronting a dire scenario of their own creation. In the very near future, they’ll have to travel hundreds of miles for routine care, if they can get it at all. The reddest, most impoverished areas will be reduced to medieval conditions. They’ll regularly suffer from outbreaks of disease, dying from conditions that modern medicine could have cured.