When Roe v. Wade was overruled in 2022, the fallout pouring gasoline on an alarming trend of burnout among obstetrician-gynecologists.
But it also put gynecologists and obstetricians on the front lines of the abortion battle, as the ruling led to a wave of restrictions and near-total abortion bans in about half the country’s states.
As president of the American College of Obstetricians and Gynecologists (ACOG), Stella Dantas wants to try to solve the burnout crisis while supporting doctors’ work to advocate for themselves and their patients.
“Without defending rights, we cannot do what we do. Wherever you live, you are affected by current issues and legislative interference in the practice of medicine,” said Dantas.
For example, doctors in Oregon, where Dantas lives and practices, are trying to fill gaps in care in neighboring Idaho, where abortion is almost completely banned. Patients are leaving the state to get the care they need, but so are doctors who don’t want to work under the threat of criminal sanctions.
Dantas said that in the wake of Dobbs’ decision, obstetricians and gynecologists are speaking out more, especially about their experiences living in states with abortion bans.
“You’re seeing people getting involved in their state medical society. They’re working with ACOG, with the government affairs team. And they are going out to educate their patients,” said Dantas.
One of the most important educational aspects is trying to fit people’s personal experiences into the larger narrative, she said.
If people can’t see their doctor, it may be because low reimbursement rates mean clinics are operating with smaller staff. Or maybe it’s because, after the Dobbs decision, there are fewer doctors in the state.
“If you go upstream, where the problem really is, it opens the eyes of friends, family, voters and people as they think about the issues,” Dantas said. “I think our doctors are feeling like they need to go out there and do this work, which will help them in the long run. And that’s why we see people willing to do whatever is necessary in education, talking to people and getting involved in advocacy work.”
The Supreme Court’s decision in the Dobbs case was years in the making, so Dantas said ACOG could see the writing on the wall and was preparing for it. But it was still a huge blow.
“That reality, I guess I would say, was difficult to face,” she said. “When I was here in Oregon, with this decision, you know, you feel helpless, because you just want to go and help the people in Texas. You want to go and help people in Idaho.”
Doctors in states with severe restrictions just want something better than the current situation, Dantas said.
“Boots on the ground, doctors and clinicians are taking care of patients. They’re seeing patients suffer because they can’t take care of someone at 10 weeks, or they can’t take care of someone at 15 weeks.”
But there is also a long game to consider, and allowing lawmakers to impose restrictions on abortion sets a precedent.
“If you open any door to legislative interference, what does that mean not just for abortion, but what does that mean for contraception? What does this mean for gender-affirming care? What does that mean for anything, you know, in the practice of medicine?” Dantas said.
Dantas works full-time seeing patients at Northwest Permanente in Portland, where she also serves as medical director of graduate and undergraduate medicine.
She has been involved with ACOG for most of her career and said her introduction to advocacy work came when she helped push Oregon to require mandatory licensing of all providers of out-of-hospital birth services, such as midwives.
Advocating for her specialty, she said, gives her a sense of balance.
“As a working doctor, you feel the effects of what happens when someone legislates something in medicine, be it about reimbursement, be it about education, be it about laws that interfere with our practice of medicine,” Dantas said.
“You feel it in a very different way, and being able to do something about it, whether it’s giving a talk or helping with legislation, being at the table of your medical society, just makes you feel like you’re doing something.”
Advocacy for abortion care is especially crucial, Dantas said, but it is also intrinsically linked to the issue of burnout.
Practicing during the COVID-19 pandemic took a toll. But upon emerging from the pandemic, instead of the situation improving, it got worse.
COVID was stressful, “but everyone was working toward a goal, right? And the patients, they forgave. They were banging pots at us. They were supporting us, delivering meals to the hospital. They were all there supporting the doctors and healthcare providers,” Dantas said.
“Now, there is no patience. People want to receive your care. They are tired of the surgical delay. So you have that impatience, and less forgiveness, that affects health care providers.”
And then, most of all, the Supreme Court overturned Roe, ending the constitutional right to abortion that had existed for almost 50 years.
In some cases, patients need to travel hundreds of miles out of state to terminate a pregnancy, 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, and Dantas said this has led not only to an exodus of doctors from states with abortion bans, but also an exodus of practicing obstetricians and gynecologists in general.
“No one goes into medicine to see someone get sick before they can save or help them. This made a lot of people rethink, ‘Is this what I want to do?’ Especially if you are close to retirement age, you can either reduce or not work,” said Dantas.
This worsens the problem of burnout and affects patients. There will be more dropouts from maternity care, increasing the risk of poor outcomes in these areas.
Dantas said the bigger issues, like abortion, won’t be resolved quickly. But to help with burnout, she wants people to look out for each other.
“You stay for the people, you stay for your patients. And at least if we can make it still a positive thing, coming to work every day, maybe we can help people not leave because of all the other threats and pressures and stress that are on us.”
This story originally appeared on thehill.com read the full story
