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Roe Reversal Has Unintended Impact on Advanced Practice Training

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Nurse Practitioners (NP), Physician Assistants (PA), and Family Medicine programs nationwide are adapting to restrictions in place after the U.S. Supreme Court overturned Roe v. wade. The decision is expected to limit abortion education opportunities across the country.

Before the fall semester, some programs are quickly trying to adjust their education to new anti-abortion laws, while programs in sanctuary states prepare to take on an influx of interns.

More than half of US states are expected to ban medically unnecessary abortions. Of those states, 13 already have laws in place – trigger bans – that are already in place or will be in place by the end of the month.

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“I suspect abortion education will be seismic,” said Susan Goodman, MD, MPH, clinical professor at the University of California at San Francisco (UCSF) and curriculum director for Early Abortion Education for Comprehensive Care (TEACH). ). The program trains primary care physicians and advanced clinicians in integrated reproductive health.

A recent OB/GYN study by UCLA and UCLA found that canceling Roe’s program would reduce access to abortion education from 92% of programs to 56%.

And while obstetrics and gynecology are critical to women’s comprehensive health care, it’s often family physicians and clinicians with excellence who serve as the primary point of contact for reproductive medicine in many areas, said Rob Stenger, MD, program director of the Western Montana Family Medicine Residency. (FMRVM).

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The NP and PA programs in the Southeast are now considering adapting their teaching. Vanderbilt University has set up a task force to study the effects of university education. As discussions are still ongoing, they are not yet ready to reveal those details, a university spokesperson said via email.

In North Carolina, the future legality of abortion is unclear, but some Duke University faculty told Medscape they are debating what changes might be needed. The NP and PA leadership at Duke declined to comment on the specific changes they are considering.

In California, advanced practice clinicians had the legal right to perform procedural abortions. Now states like Connecticut and Maryland are following suit with new laws allowing midwives, paramedics and nurse practitioners to perform these procedures. In Delaware, midwives and nurses can now prescribe abortion-inducing drugs to women in the first 10 weeks of pregnancy.

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In states where abortion is limited or becoming more limited, there is still ample opportunity for reproductive health education. Goodman says the TEACH curriculum will remain very useful even in programs where procedural learning is limited. “If you are not directly providing abortion services, it is important to know how to refer patients and deal with follow-up issues in the context of your practice,” she said.

In addition to procedural and medical abortions, the curriculum includes instruction on contraceptives, counseling, referrals, and post-abortion care, which are critical to healthcare professionals in every state, she said.

Despite the repeal of the very conservative Rowe and Montana legislature, Stenger does not yet expect changes in FMRWM training. “In Montana, privacy is a protected right under the state constitution. The state Supreme Court recognized abortion as protected under the Montana constitution in the 1990s,” he said.

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Their training partners, three clinics in the region, are expecting an influx of patients from neighboring Wyoming and Idaho. In regards to Idaho’s nursing education program, a ban from 2020 is expected to lead to the end of education. Program coordinators in Idaho did not respond to Medscape’s request for comment.

Abortion education varies by state

Many states will remain largely the same as they were before Roe v. Wade was overturned. In Kentucky, “State law has already prohibited the University of Kentucky from performing abortions except when the mother’s life is in danger,” said Allison Perry, spokesperson for the University of Kentucky and UK HealthCare.

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So, while the administration is actively reviewing the Supreme Court’s decision to determine if the decision will affect training, Rowe’s repeal is likely to have less of an impact on interns in Kentucky.

A report on Southern Hospitals by Columbia University Law School found that access to abortion and abortion education in the Southeast was already limited prior to Row’s cancellation. A large number of large hospital systems in this region are affiliated with Protestant institutions, and therefore abortions were already limited to medically necessary circumstances. Even public institutions are under the influence of a large number of opponents of abortion.

A number of shelters are gearing up to increase their training capacity. Goodman says the TEACH program is sponsoring a bill in California that will expand access to abortion services and educate the future reproductive health workforce by providing educational scholarships, living wage scholarships, and comprehensive services to succeed in achieving their professional goals.

Stenger and Goodman agree that simulation and case-based learning can offer states with disabilities some ways to adapt their learning.

“We [already use] simulations of various types for most of our training,” said Stenger. Montana uses simulations of manual vacuum aspiration, the most common surgical abortion procedure. Most likely, more accurate and high-tech simulations are available, he said. But “we need some clinical [exposure] even if we sped up the simulation.”

The latest version of the TEACH curriculum, released this month, offers more detailed guidance on self-abortion than any previous version. Medical abortions already account for over half of abortions nationwide, and researchers expect to see a surge in self-administered medical abortions with Roe withdrawal. In this case, it is important that healthcare professionals anticipate the intake of these patients. According to a 2020 review article published in the New England Journal of Medicine (NEJM), the majority of these patients will have an identical miscarriage.

While Stenger is confident in the ability of advanced doctors and clinicians to treat spontaneous miscarriages, he is concerned that new laws will force doctors to be wary of treating such patients.

According to the NEJM article, it is largely safer for patients and physicians not to distinguish between spontaneous miscarriage and medical abortion. However, the same researchers say there will also be an increase in the number of self-abortions performed by non-drug methods.

The authors write that clinicians should be prepared to see and offer lifesaving treatment for patients with sepsis, bleeding, pelvic trauma, or toxic exposure.

Goodman said it’s critical for programs to educate interns — and that practitioners will make sure they educate themselves — about their state’s laws so they can safely care for their patients and themselves.

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