Abortion Training for Medical Students and Residents

Abortion Training for Medical Students and Residents

INSIGHTi

Abortion Training for Medical Students
and Residents
September 7, 2022
The U.S. Supreme Court’s Dobbs v. Jackson Women’s Health Organization decision gives states greater
discretion to restrict abortion, and a number of states have subsequently done so. This change has
implications for medical training both for medical students attending medical school and for medical
residents undertaking graduate medical education (GME) training in states with restrictive abortion
policies. To be licensed to practice independently as a physician, one must complete medical school and a
minimum of three years of GME. Though abortion training is optional for medical students, obstetrics and
gynecology (OB/GYN) GME programs must offer this training. Residents with religious or moral
objections may elect not to participate. Residents in other medical specialties, such as family medicine,
may also seek abortion training, though programs are not required to provide this training.
Changes to the availability of abortion training may have broader effects beyond the availability of
abortion services. For example, experts note that abortion training may also be useful in training providers
in general obstetrical skills, such as how to manage miscarriages, and note that the loss of abortion
training may have broader effects on the preparedness of future physicians and where they choose to
locate after they complete their training.
In the wake of the Dobbs decision, students and residents in states with restrictions may seek training in
states where abortion is permitted. In addition, the Accreditation Council for Graduate Medical Education
(ACGME), the entity that accredits GME programs, has revised its training requirements for OB/GYN
training programs to require that all programs, regardless of location, provide residents with access to
abortion training in jurisdictions where there are no legal restrictions on abortion. This may create a
scenario where students and residents may elect (or be required) to travel for abortion training, which may
require additional costs for trainees or their programs. Sites absorbing additional trainees may also face
challenges with expanding training, as they may require additional supervising faculty and space for new
trainees.
This Insight discusses the federal role in paying for medical training and some options that may be
considered to assist programs with accommodating increased demand for training. Physician Assistants
and nurse midwives, among others, may also seek abortion training and some of the considerations
discussed in this insight may also apply to these trainees; however, these professions are outside of the
scope of this Insight.
Congressional Research Service
https://crsreports.congress.gov
IN12002
CRS INSIGHT
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Federal Role in the Content of GME Training Is Limited
The federal government provides approximately $16 billion in funding for GME (estimated in 2015);
however, the federal role is primarily as a funder. It does not set specific content of training programs;
rather, to be eligible to receive federal payment, a program must be accredited. Accreditation, through
ACGME, involves, among other things, a determination that the program has the appropriate volume of
procedures to provide training, has a set curricula in place that includes adequate training in the
competencies required for the specific medical specialty, and has appropriate faculty to supervise resident
training.
Federal payment for GME is not a reimbursement for the full cost of training. Rather, Medicare—the
largest source of GME funding—pays for training by a statutory formula based on a hospital’s historical
residency training program costs, trended forward. Hospitals determine the type of trainees (i.e., which
medical specialties they train, for example family medicine or pediatrics) and Medicare payments do not
adjust for any cost differences associated with specialty training (e.g., costs to send residents out-of-state
for certain training due to state-level restrictions). Experts have raised concerns about this system,
including how much Medicare pays for training and the lack of data available about the true costs of
training medical residents. Given that payment is not set to cover the full costs of training, adjusting
payment for increased costs that programs may incur due to the Dobbs decision (or any other type of
policy change) would be a significant deviation from the Medicare GME funding status quo. Moreover,
implementing a payment change would require amending the underlying existing statutory formulas that
govern Medicare GME payments.
Other federal programs pay for GME. As with Medicare GME, these programs require that training
programs be accredited, but do not set content. These federal programs are also not structured in a way to
pay for increased training costs. Specifically, the Health Resources and Services Administration (HRSA)
uses statutory formulas to determine payment in its GME programs. HRSA programs may also not be
applicable to abortion training, because the training HRSA funds is for outpatient primary care focused
facilities and Children’s hospitals, which generally do not provide abortion services and, if they do, would
not have the volume to support training. Medicaid provides GME payments, but states determine whether
GME payments are made and how these payments are provided. Training programs through the
Departments of Veterans Affairs (VA) and Defense (DOD) may have GME funding flexibility. However,
unlike other types of GME training, the VA and DOD pay for training at their facilities. Both the VA and
DOD have restrictions in place regarding the provision of abortion that may make increasing such
training challenging because these facilities generally perform few procedures and a sufficient volume of
procedures is necessary for training.
Federal Support for Training Content Could Be a Model
No specific grant programs support abortion training or the expansion of such training. However, federal
grant programs do support the expansion of medical training in a number of areas. For example, HRSA’s
Bureau of Health Workforce funds grants to encourage training in primary care and geriatrics. Such
support may be provided for developing academic units, for continuing education in specific topic areas
(e.g., providing care to underserved populations), and for faculty development. Though some existing
primary care programs may support obstetrics and gynecology training, these programs are not focused
on abortion training. Existing grant programs in other topics could serve as models to create new
programs to expand the capacity of existing programs to absorb additional trainees, which may require
additional resources and faculty.

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Author Information

Elayne J. Heisler

Specialist in Health Services

Disclaimer
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IN12002 · VERSION 1 · NEW