On the front lines with gynecologists in the post-Dobbs world

When Roe v. Wade was overturned in 2022, the aftermath created an alarming trend of burnout among gynecologists.

But it also put gynecologists on the front lines of the abortion fight, as the decision led to a wave of restrictions and a near-complete ban on abortion in about half the country's states.

As president of the American College of Obstetricians and Gynecologists (ACOG), Stella Dantas wants to help solve the burnout crisis while supporting the work of physicians who advocate for themselves and their patients.

“Without advocacy, we can't do what we do. No matter where you live, you are affected by current issues and legislative interference in the practice of medicine,” Dantas said.

For example, doctors in Oregon, where Dantas lives and works, are trying to fill gaps in health care in neighboring Idaho, where abortion is almost completely illegal. Patients are leaving the state to get needed care, but so are doctors who won’t work under threat of criminal penalties.

Dantas said that after the Dobbs ruling, gynecologists are speaking out more, especially about their experiences in states where abortion is banned.

“You're seeing people getting involved with maybe their state medical association. They're working with ACOG, with the government affairs team. And they're educating their patients,” Dantas said.

One of the most important educational aspects is to fit people's personal experiences into the bigger picture, she said.

If people can’t see their doctors, it could be because clinics are running with fewer staff due to low reimbursements. Or maybe it’s because there are fewer doctors in the state after the Dobbs ruling.

“When you go upstream, where that problem actually is, it opens the eyes of friends, family, constituents and people who are thinking about the issues,” Dantas said. “I think our clinicians feel like they need to go out and do this work themselves, which is going to help them in the long run. And that's why you see people who are willing to do whatever it takes in education, talking to people and getting involved in advocacy work.”

The Supreme Court’s decision in Dobbs was years in the making, so Dantas said ACOG saw the handwriting on the wall and was preparing for it. But it was still a huge blow.

“That reality, I think, was hard to face,” she said. “When I was sitting here in Oregon, with that decision, you know, you felt powerless, because you just wanted to help people in Texas. You want to help people in Idaho.”

According to Dantas, doctors in states with severe restrictions simply want something better than the current situation.

“Boots on the ground, doctors and clinicians are taking care of patients. They see patients suffering because they can’t take care of someone who’s 10 weeks old, or they can’t take care of someone who’s 15 weeks old.”

But there is also a long-term perspective. By allowing lawmakers to impose restrictions on abortion, a precedent is set.

“If you open the door to legislative interference, what does that mean not just for abortion, but for contraception? What does that mean for gender-affirming care? What does that mean for everything, you know, in the practice of medicine?” Dantas said.

Dantas works full-time at Northwest Permanente in Portland, where she treats patients and is the medical director of the undergraduate and graduate medical schools there.

She has been involved with ACOG for most of her career and said her first exposure to advocacy came when she pushed Oregon to require licensing for all providers who deliver babies outside of hospitals, such as midwives.

She said it gives her a sense of balance when she dedicates herself to her specialty.

“As a working physician, you feel the effects of what happens when someone introduces legislation into medicine, whether it has to do with reimbursement, whether it has to do with education, whether it has to do with laws that impede our practice of medicine,” Dantas said.

“You experience it in a completely different way, and if you can do something about it, whether it's giving a lecture or helping with legislation or sitting at the table with your medical association, then you just feel like you're doing something.”

According to Dantas, advocating abortion care is vital, but it is also inextricably linked to the problem of burnout.

Practicing during the COVID-19 pandemic took its toll. But after the pandemic, the situation didn’t get better, it got worse.

COVID was stressful, “but everyone was working toward one goal, right? And patients, they were forgiving. They banged on pots and pans for us. They supported us, delivered meals to the hospital. They were all there to support the caregivers and the caregivers,” Dantas said.

“Now there's no patience anymore. People want to take their care. They're fed up with the surgical backlog. So you have that impatience and that less forgivingness, it takes its toll on healthcare providers.”

And then the Supreme Court made Roe even worse, ending the constitutional right to abortion that had existed for nearly 50 years.

In some cases, patients must travel hundreds of miles out of state to terminate pregnancies, even if their health is at risk. In other cases, including in Idaho, hospitals transport patients who need abortions because doctors fear what will happen if they break the law.

Doctors are confused and scared. According to Dantas, this has led not only to an exodus of doctors from states where abortion is illegal, but also to an exodus of practicing gynecologists in general.

“No one goes into medicine to see someone get sicker before you can save them or help them. That’s left a lot of people asking, ‘Is this what I want to do?’ Especially if you’re close to retirement, or if you’re able to work less or not at all,” Dantas said.

This will make the burnout problem worse and it will have consequences for patients. There will be more deserts in maternity care, increasing the risk of poor outcomes in those areas.

Dantas said the bigger issues, like abortion, won't be solved anytime soon. But to help burnout, she wants people to take care of each other.

“You stay for the people, you stay for your patients. And if we can at least still make that a positive thing, to come to work every day, maybe we can help people not leave because of all the other threats and pressures and stresses that come our way.”

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