Medical students and residents increasingly come to Dr. Colleen McNicholas with the same concern: will their training in Missouri prepare them to competently care for pregnant patients?
McNicholas, who for years was among the few doctors performing elective abortions in Missouri, said that fear is reflected in a report released in May by the It found Missouri had more than a 25% drop in applicants for OB-GYN medical residencies since 2022, when abortion became illegal in the state.
鈥淲hat does it mean to be an OB-GYN in a state that is telling you how to practice medicine?鈥� asked McNicholas, chief medical officer for Planned Parenthood of the St. Louis Region and Southwest Missouri and Missouri chair of the American College of Obstetricians and Gynecologists.
saw a decrease in OB-GYN residency applications, despite a slight overall increase in physicians applying for OB-GYN residency programs nationally, the study found. Missouri was second only to Arizona for the largest decrease in applicants.
The need for more robust and accessible maternal health care is particularly stark in Missouri, where lawmakers on both sides of the aisle have lamented the state鈥檚 woeful maternal and infant mortality rates 鈥� among the worst in the country 鈥� and lack of maternal health care providers in nearly half of its counties.
McNicholas said legal concerns aside, there are a couple things for doctors to consider when deciding where to do their residency, since historically, most physicians remain in the community where they do their training.
Physicians tend to start families later in life, which means they are inherently at higher risk of having pregnancy complications or needing to use assisted reproductive technology, she said. And which means they need good maternal care if they choose to have a family.
鈥淭he need for more OB-GYNs is going to be at a crisis point here soon,鈥� McNicholas said. 鈥溾�� You cannot even seriously consider how to fix that problem until you address the reality of what a workforce crisis looks like under an abortion ban.鈥�
State Sen. Mary Elizabeth Coleman, an Arnold Republican and a board member for Missouri Stands with Women, a group formed to fight a campaign to legalize abortion in Missouri, doesn鈥檛 think the study鈥檚 conclusions are valid.
She instead pointed to other reasons she sees for declining OB-GYN residency numbers across the country, including a move by some universities to DEI-based admission and population declines, particularly in rural areas.
Coleman accused the medical association of fear-mongering, adding that if physicians choose not to apply to Missouri because of its abortion ban, then they are doctors she鈥檇 prefer to stay away.
鈥淚 wish they would focus on providing rural health care to Missourians,鈥� she said. 鈥淩ather than a love affair with a violent procedure that ends a life.鈥�
Alyssa Lally, a spokeswoman with the University of Missouri-Kansas City, said the school attributes fluctuations in OB-GYN residency applicants over the past several years in part to a change in how residents are now matched.
Over the past few years, the national organization that handles residency applications stopped sending all OB-GYN applicants to all medical schools with the program, and instead started sending the applications of residents only to the schools they showed interest in attending.
Despite this, she said UMKC continues to fill all its residency slots. A spokesperson for the University of Missouri-Columbia鈥檚 medical school said it also has no problem filling their four openings each year.
Lisa Cox, a spokeswoman with the Missouri Department of Health and Senior Services, said the state is working to improve physician retention through its Graduate Medical Education Grant Program, which supports extra residency positions.
鈥淚t is difficult to pinpoint a single cause (of the drop); however, our main takeaway is that Missouri needs more residency spots. Of course, this is an issue nationally,鈥� Cox said in a statement. 鈥� 鈥� Our residency spots, while already low, are routinely filled, and it remains a competitive field, which could deter applicants.鈥�
States with bans are 'reaping what they sow鈥�
Pamela Merritt, the executive director of Medical Students for Choice, said she has a hard time selling medical students on coming to states with abortion bans.
鈥淚 don鈥檛 know anybody who鈥檚 invested close to half a million dollars in their education who wants to walk into a residency program in a state where people with absolutely no background in medicine are drafting regulations that deny your ability to care for your patients,鈥� she said.
The data reflects this due diligence by medical students to research where they want to start a life and start a practice, she said.
And while she said states should be doing all they can to attract top talent, bans often have the opposite effect.
鈥淎ll of the states with bans are reaping what they sow,鈥� Merritt said. 鈥淭he tragedy is that the communities most harmed by this are rural communities and poor communities.鈥�
She guesses public health outcomes will only worsen as a result.
Maternal mortality rates were 62% higher in states with abortion restrictions, according to a 2023 study
A study from the state鈥檚 found that between 2018 and 2020, 210 Missouri women died while pregnant, during childbirth or within a year of birth. The majority were deemed preventable.
Missouri also scored a D- grade for preterm births in a 2023 .
鈥淢issouri already has indefensible maternal mortality rates,鈥� Merritt said. 鈥淢issouri struggles to keep Black children who are born in the state alive for the first year after birth, and we have far too many young people who are living in poverty and are food insecure.
鈥淲e鈥檙e failing children and failing families and women and this ban not only puts the health of people in Missouri who can experience pregnancy at risk, but it now is putting the health of everybody in the state at risk when you become repulsive to doctors, that鈥檚 very dangerous.鈥�
More than , meaning there are no maternity care providers or birthing facilities. Missouri鈥檚 rate is higher than the national rate of 32%, according to a separate 2023 report from the March of Dimes. Across the state, 10% of women do not live within 30 minutes of a birthing hospital.
In the last decade, 19 hospitals across Missouri have closed, according to the
The state鈥檚 board of healing arts, which licenses physicians, reports there are 1,041 licensed OB-GYNs working in Missouri. estimates that in 2022, there were 1.1 million women of childbearing age, which means there is approximately one OB-GYN for about every 1,050 of childbearing age in the state.
Attempts to further limit training in abortion
earlier this year, state Rep. Emily Weber, a Democrat from Kansas City, said she鈥檚 heard about doctors first consulting attorneys before helping women in need of emergency abortions.
Under the state鈥檚 鈥渢rigger law,鈥� health care providers who perform abortions not necessary to save the woman鈥檚 life can be charged with a class B felony, which means up to 15 years in prison. Their medical license can also be suspended or revoked as a result.
The only exception is in cases of medical emergencies when a pregnant person鈥檚 life is at risk or when 鈥渁 delay will create a serious risk of substantial and irreversible physical impairment of a major bodily function.鈥�
鈥淲e鈥檙e losing physicians and doctors,鈥� Weber said. 鈥淭hey鈥檙e leaving the state of Missouri because they can鈥檛 perform their actual duties that they had extensive education on and got their degree in.鈥�
House Minority Leader Crystal Quade pointed to some bills filed this year that didn鈥檛 pass, but that put Missouri on the national stage for 鈥渆xtremism,鈥� likely to impact physicians鈥� decisions on whether or not to move to the state or out of it.
This included a bill from state Rep. Justin Sparks, a Republican from Wildwood, that would have prohibited public and private medical schools from providing any 鈥渁bortion-specific training,鈥� ; and a bill filed by state Sen. Mike Moon, a Republican from Ash Grove, proposed to with murder.
鈥淚t鈥檚 a perfect storm situation where we are continuing to lose access to care, particularly for maternal care,鈥� said Quade, who is seeking the Democratic nomination for governor.
Quade has spoken with women who said they were sent home during a miscarriage because their life wasn鈥檛 yet in enough danger to get an abortion, and she鈥檚 spoken with providers who were unsure whether to stay in Missouri, weighing a moral dilemma between their duty to their patients and their fears of legal prosecution if they perform an abortion the state deems unnecessary.
She, too, fears this decrease in interest in Missouri as a place for providers not just to learn, but to establish roots, will only continue.
鈥淲hat that means is not only potential shortages,鈥� Quade said. 鈥淏ut also that we鈥檙e not getting the best of the best anymore.鈥�
Sparks said his legislation wasn鈥檛 meant to target OB-GYNs, but rather was written based on conversations with Missouri physicians. He hoped to instead end 鈥渁bortion fellowships鈥� where doctors are sent across state lines to perform abortions.
Those conversations, he said, included doctors at Washington University in St. Louis who said their students went out of state in order to 鈥渂ecome really good at abortions, and then come back to Missouri to perform them in the cases where they鈥檙e legal.鈥�
Sparks said this argument doesn鈥檛 hold water for him, since universities already teach a standard of care for emergency abortions that he finds to be sufficient.
鈥淭o say that we just have to do abortions in order to maintain that level of care is disingenuous,鈥� he said, adding that physicians going out of state for training contributes to 鈥渁 generation of folks who won鈥檛 exist.鈥�
He thinks it鈥檚 a stretch to correlate the decrease in OB-GYN applicants with abortion bans, but added that Missouri would not be an appealing state for physicians wanting to go into the 鈥渁bortion industry.鈥�
This story was originally published by The Missouri Independent, part of the States Newsroom.
