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Abortion doctors’ post-Roe dilemma: Move, stay or straddle state lines

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The Supreme Court’s decision overturning Roe v. Wade and clearing the way for roughly half the states to ban abortion is forcing the nation’s providers to upend their lives and could radically alter the reproductive health care landscape.

One clinic in Alabama, for example, is offering its roughly dozen staff members buyouts to give them a couple months’ cushion if they need to search for jobs in other states.

An abortion provider near Cleveland — a single mom who promised her teenage son he wouldn’t have to change schools again — is switching fields to become an addiction specialist. And a Texas doctor, who felt his job had become untenable, just packed up to relocate to Montana, where abortion remains legal, for now.

The National Abortion Federation has set up an online marketplace where doctors who have been shut down or expect to be can sell their ultrasound machines, speculums and other equipment.

“We’re all grappling with the question of, ‘At what point would I move?’” said Ashley Brant, an OB-GYN at an academic facility in Northwestern Ohio and a fellow with the nonprofit group Physicians for Reproductive Health. “What will be my personal line in the sand?”

Though the number of abortion providers in the nearly two dozen states that have banned or are expected to swiftly ban abortion is small — about 10 percent of the national total, according to the Guttmacher Institute, an abortion-rights think tank — their departure will likely have an outsized impact.

Health experts warn that this potential migration could be devastating for patients, leaving them without access to birth control, prenatal care and other reproductive health services. They also fear no provider will be left in some communities to perform emergency abortions in the life-threatening circumstances exempt from most state bans.

“If you see a fleeing of providers from states that have severely restricted their ability to practice in line with their moral compass and medical ethics, it will be a huge loss to public and community health,” said Jamila Perritt, an abortion provider in Washington, D.C., and the president and CEO of Physicians for Reproductive Health. “We don’t have to guess what’s going to happen. We already see the high rates of maternal mortality and morbidity in places like Louisiana and Mississippi. But we’ll see much more of that as these bans continue to sweep the country.”

Among the providers POLITICO spoke with in states with abortion bans on their books, none said they are willing to offer illegal abortions — aware that doing so risks losing their medical license and, in some states, serving a lengthy jail sentence.

Instead, many are planning to travel across state lines a few days a week or month to provide abortions while keeping a practice in their home state in case the bans are reversed. Some intend to use telemedicine to consult with their patients and prescribe abortion pills in states that allow them. And others — especially those whose current work focuses mainly on abortion instead of the full range of OB-GYN services — are moving to other states.

At the same time, more progressive states fear that as they become abortion destinations for millions of patients, they won’t be able to staff up fast enough, potentially causing delays in care that push people later into their pregnancies. Activists in California and elsewhere are calling on lawmakers to make it easier for doctors to get licensed if they move to other states or travel part-time or provide incentives like student-loan forgiveness to entice more providers.

But that may not be enough to convince a sufficient number of doctors to uproot their lives.

“If I were free to move, there would be a lot of great opportunities right now,” said Zevidah Vickery, the Ohio abortion provider changing fields instead of moving out of concern for her son. “[Abortion] is my professional identity. It’s been my raison d’être for more than 20 years. But I’m also a single mom of a preteen who has been with me every step of the way. So I just cannot relocate. And I can’t describe it any other way than to say I went through a period of mourning making this decision.”

The National Abortion Federation, in addition to its online marketplace for equipment, also recently created a job board.

“We’ve seen an uptick in interest since the Supreme Court decision leaked,” said Melissa Fowler, the chief program officer of the National Abortion Federation. “People had been holding out hope, but after that, they started advancing and accelerating their plans to find work in other states.”

Fowler says that, so far, they’re seeing more doctors, nurses and other front-line health care workers looking for part-time travel work instead of moving permanently.

“People are deeply rooted in their communities, and it’s hard to pick up and move to a totally different region of the country,” she said. “Plus, travel is not unheard of in the health care space. We have lots of traveling nurses already, particularly during Covid. It’s a life that provides a lot of flexibility, and some abortion providers chose it long ago for security reasons.”

Several abortion providers in Texas, Ohio, Indiana and other states that have banned or are poised to enact bans told POLITICO they don’t plan to move for many of those same reasons — even if it means they have to stop work that’s important to them.

“I’m just going to keep on keeping on, providing abortions until the last day I can,” Brant said. “I could be looking for jobs elsewhere. But a sliver of me remains optimistic that people will be so outraged that the pendulum will swing back.”

A court on Friday allowed Ohio’s six-week abortion ban to take effect, and lawmakers expect to take up a total ban in November or December.

Brant is one of the hundreds of providers now weighing how best to serve their patients in states where their work is or could soon become illegal. Under Ohio’s six-week ban, she could face a felony conviction and up to a year in jail for “knowingly and purposefully” performing the procedure, even in cases of rape or incest.

Still, Brant said, she wants to stay to help manage the post-Roe fallout.

There’s going to be a need for aftercare for people who have managed their abortion outside the health care system,” using pills ordered online or more risky methods, she explained. “And we’re still hoping that there will be exemptions for threats to the health of the mother. If someone has an emergency at 20 weeks, there are not a lot of people who know how to quickly end the pregnancy. So I want to be here for that.”

But Brant remains worried the skills she spent years developing will “atrophy” under a ban, so she’s talking to clinics in Michigan and Illinois and up and down the East Coast and debating whether to start the complicated and expensive process of applying to get licensed elsewhere so she can pursue part-time travel work.

Other red-state doctors are wrestling with similar dilemmas, afraid of criminal charges but also afraid to leave their patients behind.

Caitlin Bernard, an abortion provider and professor at Indiana University’s School of Medicine, noted that while providers may have the resources and savvy to hop across state lines to practice, many low-income patients do not.

“For a lot of people in Indiana, if I tell them to go out of state, I might as well tell them to go to the moon,” she said. “They have to pay for the care at the clinic, the time away from their children, the time away from their jobs. Gas prices are also increasing.”

In Texas, which banned all abortions after six weeks of pregnancy last fall and threatens violators with up to life in prison, providers have had more time to grapple with their future. But that hasn’t made the decision any easier.

“It was incredibly heartbreaking. Every day I was seeing patients, I had to turn some away because they were too far along in their pregnancy,” said Sam Dickman, the San Antonio abortion provider who recently moved to Montana. “I also watched my patients collapse with relief when I told them, during their ultrasound, that they got in to see me early enough to get an abortion in Texas instead of having to travel to New Mexico.”

Others in the state, including Lauren Thaxton, an abortion provider and assistant professor of women’s health at the University of Texas, plan to stay even if abortion is entirely banned. Enforcement of Texas’ pre-Roe ban has been temporarily blocked by a court and the state’s trigger law hasn’t yet taken effect.

She knows, however, that many of her fellow physicians will move, and is anxious about the impact on patients in Texas who already struggle to access reproductive health services like contraception, prenatal care and miscarriage management.

“We are few in number already,” she said. “And because Texas is such a big place, whenever a person leaves their community, they may be the only person with that training for hundreds of miles.”

Medical experts are not only worried about the immediate loss of health services in red states when bans take effect, but also the longer-term effects of a generation of OB-GYNs avoiding those states in the future.

“The people graduating medical school now, where will they be looking for residencies? Not in a state that doesn’t allow them to practice freely,” warned Tracey Wilkinson, an assistant professor of pediatrics at Indiana University School of Medicine and a board member at Physicians for Reproductive Health. “Anecdotally, we’re already hearing residents who are currently here say they do not want to stay in Indiana. We already have multiple counties without OB-GYN care, and this is going to have downstream effects.”

The blue-state clinics that are already seeing a patient surge and expect to depend more heavily in the future on a workforce from red states are also on edge.

“We’re hearing from doctors who aren’t necessarily looking to move because they know they’re still going to be needed in their communities for contraception and family planning, but who may do rotations with us because we’ll be getting an influx of patients,” said Jodi Hicks, the president of Planned Parenthood of California. “But we’re concerned about a generation of doctors who are in training in those states not actually being trained on abortion.”

Megan Messerly contributed to this report.

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