Iowa has an OB-GYN shortage. Is the state’s abortion ban partially to blame? : Shots

Jonna Quinn was initially thrilled when she landed her first job after residency as an OB/GYN in Mason City, Iowa. It was just an hour's drive from her hometown of West Bend, where she grew up on a farm.

But the hospital began limiting some birth control options and fertility treatments based on… his affiliation with the Catholic Church, she said. At the same time, her unit was becoming increasingly short of staff as other obstetricians left and retired.

At one point, Quinn said she was seeing up to 50 patients a day.

“That’s twice as much as a typical OB/GYN will see in a day,” she said. “I knew I was going to miss something because no one can function at that level.”

Last spring, Quinn decided to leave—not just Mason City, but all of Iowa.

At that time the state Supreme Court was on the verge of passing a law banning abortion as early as the sixth week of pregnancy, with very few exceptions.

This was the last straw for Quinn, who got a job in Minnesota and moved her family there. Minnesota has constitutional protection for an abortion.

“I could either stay and destroy myself, my career, my mental health and my relationship with my children, or I could go and continue doing midwifery, which was always my dream,” she said.

A few months after Quinn left, Iowa's abortion ban went into effect on July 29, 2024.

Iowa has a severe shortage of obstetricians

After the Supreme Court overturned Roe v. Wade in 2022, several states, including Iowa, abortion ban came into force — despite already facing a shortage of obstetricians and gynecologists.

The laws have placed doctors under increasing pressure and scrutiny. complicating standard treatments for miscarriage, ectopic pregnancy, premature rupture of membranes and other pregnancy problems. Some doctors fear the laws could push much-needed doctors out of certain states and discourage other OB-GYNs from moving here and opening their practices.

Iowa has the smallest number of obstetricians and gynecologists per capita in the countryaccording to KFF analysis for 2021-2022. federal data from Health resource and service management.

Research shows that poor pregnancy care is associated with low birth weight and increase in infant and maternal mortality.

As doctors leave, more stress for those who remain

Rural hospitals in Iowa are struggling to find more OB-GYNs.

Grinnell Regional Medical CenterThe 49-bed hospital in a rural college town has been trying to hire an obstetrician-gynecologist and a family practice physician with obstetrics training for more than a year.

The hospital saw a sharp jump in the number of births after its neighboring hospital. shuttered its labor and delivery department last year. According to the company, the additional number of births has placed stress on two existing obstetrics physicians. David-Paul Cavazosleader with center.

Previously, when the number of patients was smaller, it was easier for doctors to be on duty on weekends, he said.

“You just had to hang out at home, be on the phone,” he said. But lately, doctors on duty are delivering “five babies on Saturday and six on Sunday,” Cavazos said. “It gets more intense.”

Iowa State Legislature passed the bill The last session that increased Medicaid reimbursement rates for maternity services so that OB/GYNs could be paid more for caring for pregnant patients.

The new law also directs federal funding to a project to create more medical residency positions, including OB/GYN residency positions, in Iowa. Medical residents typically stay and establish a practice in the states where they complete their residency.

These things can help, said Carla SolheimChairman of the Iowa Chapter of the American College of Obstetricians and Gynecologists. But the state's restrictions on abortion are still a red flag for some OB-GYNs when deciding whether to practice in Iowa, she said.

“It's clear they don't want to put their licenses and their livelihoods at risk when it comes to patient care,” Solheim said.

In her previous job in the Quad Cities, Solheim performed an abortion on a patient who had life-threatening complications, she said. This prompted a flurry of phone calls from hospital administrators.

They peppered her with questions about her decision, Solheim recalls: “Did I have enough evidence? Were her blood counts low enough that her life was in danger? Should we have waited for her blood pressure to come down?”

Solheim recently stopped delivering babies to focus on gynecology and outpatient care, saying she was tired of working on Iowa hospital wards where there are not enough obstetricians.

Recent residency application data suggests that state abortion bans could impact the next generation of doctors.

Fewer medical students submit an application into OB/GYN residency programs in states that restrict or ban abortion, according to data analysis from the Association of American Medical Colleges.

For E, a fourth-year medical student from Iowa, the law weighs heavily on her decision about where to apply for an OB/GYN residency and ultimately practice. She worries about how the Iowa law will impact her ability to provide evidence-based care.

E. is her middle initial. She asked to be identified as such because she was concerned that her comments could negatively impact her future career.

“I'm seriously questioning whether Iowa is the state I want to practice in long-term, and it breaks my heart because I know there's a need,” she said.

Research presents a mixed picture

It is not yet clear whether abortion will be banned doctors are being kicked out of the state.

One recent study Idaho found that two years after the state passed a highly restrictive abortion law, 35 percent of the state's 268 obstetricians and gynecologists had stopped practicing obstetrics.

But another studyanalyzing federal data two years after 2022. Dobbs decision, failed to find significant variations in the number of obstetricians and gynecologists from states where abortion is illegal.

“We were surprised and we reduced the data in every possible way,” he said. Becky SteigerAssociate Professor at the University of California Berkeley School of Public Health and lead author of the study.

While the numbers don't indicate a systemic exit, it's possible that some of these OB-GYNs will be able to adapt their practices to stay with their patients, she said.

“We've heard from anecdotal evidence and through qualitative research that they are really very committed to these patients,” Steiger said.

She said the analysis also does not record How do obstetricians-gynecologists feel about this? I work in states with abortion restrictions..

“What we cannot observe is the quality of care that providers can provide, provider job satisfaction and provider safety,” Steiger said.

This story comes from NPR's health reporting partnership with Iowa Public Radio And KFF health news.