Two OB/GYNs – one local, one from Idaho – describe medical exodus, packed practice schedules, and other ripple effects.
By Johannes Werner
Original Air Date: Mar. 27, 2024
Host: When it comes to abortion, Florida is in a state of suspension. The Florida Legislature has passed some of the most restrictive laws in the nation. But there has been a legal challenge to a 15-week abortion ban passed two years ago, and the Florida Supreme Court has yet to rule on this. If the court rules in favor of the state, not only a 15-week, but a six-week abortion ban passed by the legislature last year would go into effect. And then there’s pushback. A constitutional amendment that would grant a right to reproductive healthcare got enough signatures to make it on the ballot in the elections this fall. This Monday, the Florida Supreme Court is expected to rule on the language of the ballot question.
One of the groups that has backed that petition drive is the League of Women Voters. Amid all the political push and shove, their Manatee chapter organized a panel featuring two abortion providing doctors – one in Southwest Florida, and one in Idaho – to talk about how the restrictions are affecting medical practice. Our news team reports.
Johannes Werner: Even though things seem restrictive here in Florida, this state actually still is a refuge for women patients from more restrictive neighboring states. In contrast, Idaho is one of the states where the effects are already in full display.
The most visible effect is a shrinking reproductive healthcare infrastructure. Doctors, nurses and midwives are dropping out of the field, particularly doctors specializing in high-risk pregnancies. Dr. Misa Perron-Burdick was one of two panelists of the Zoom event offered by the League of Women Voters Manatee on Monday. She described the situation in Idaho.
Misa Perron-Burdick: We have lost about 20% of our workforce that provides pregnancy care. That’s a combination of family medicine physicians who provide obstetric care, midwives, or OBGYNs like me and Dr. Sampson. We have had four hospital labor and delivery shut down.
I think one of the most critical losses that we’ve experienced is within the field of obstetrics and gynecology. There are specialists called maternal fetal medicine physicians or perinatologists or high risk obstetricians, they do training like me and Dr. Sampson, and do an additional 3 years specifically to take care of women with complications.
And when I moved here a year and a half ago, we had 9 maternal fetal medicine physicians, and within 9 months we lost 5 of them. We have 4 and then some, I think we might’ve just hired one. One of our hospitals hired one. So we have 5 of these physicians for the entire state of Idaho. And so it’s really hard, if you have a high risk pregnancy, to access this care.
JW: Dr. Perron-Burdick may actually be one of the disappearing doctors. She is considering leaving Idaho.
A less visible effect is this: Shrinking OB/GYN staffing does not just affect care for women. It trickles through the entire medical system, affecting everyone. Dr. Perron-Burdick:
MPB: Because we OBGYNs are so full, more of our primary and our family medicine doctors are trying to see more patients, but it means that they can’t see other patients who might have high blood pressure, heart conditions, etc. And so this crisis doesn’t just affect women, people who have uteruses — it affects healthcare everybody.
I have this op-ed in my head that I’d like to write. My father in law was admitted to the ICU for cardiac disease problems because it took him so long to see his cardiologist, and his cardiologist was so busy because he was seeing primary care patients because the primary care doctors are seeing pregnant patients. It’s just this snowball that affects every person in Idaho.
JW: The new restrictive laws put physicians into a difficult, often impossible spot. Dr. Perron-Burdick explained that Idaho laws force her to delay life-saving decisions for mothers. Patients often hold that against her.
MPB: And I have had at least one patient, I’ve had a couple of patients actually, walk away feeling like … the patients experience delays of care, so oftentimes we have to wait until there’s no cardiac motion to actually treat these life threatening conditions.
And so patients walk away feeling like they got substandard care, which, to be honest, they did. But they also feel that it’s my fault, and that my decision to follow these laws is motivated by politics, or that I could have decided not to follow the law. So, I think the other misconception I run into is that when these laws result in poor patient care, that it’s actually the physician’s fault.
JW: New state laws often put doctors in a position to pick which law to violate. A federal law called EMTALA tells medical institutions that accept Medicaid to treat emergency patients unconditionally. But state laws now often block that when it comes to reproductive health.
MPB: Any hospital or institution that has Medicare funding is required to provide emergency medical care to protect the life of a patient. And in Idaho, initially our complete abortion ban actually said that we couldn’t follow EMTALA that was taken to court. We were able to reinstate EMTALA laws. And so patients are protected under EMTALA laws. If they’re receiving care in an emergency room or on a labor and delivery floor.
And so then, unfortunately, the protection from EMTALA was taken away from us again, and that’s actually coming up in a Supreme Court case of Idaho vs. the Supreme Court. So, basically, it doesn’t matter your ability to pay, who you are, where you come from, what you do if you walk into an emergency room, or a labor and delivery. There is a federal law that says you must receive healthcare.
JW: Dr. Marian Sampson was the other panelist. An OB/GYN provider for Planned Parenthood Southwest and Central Florida, she had her first of three children at age 18 and worked as a teacher before going to medical school. She is based in Naples and Fort Myers.
Dr. Sampson painted a picture of overwork, due to Florida being a destination for women patients from Georgia, Alabama and Louisiana.
Marian Sampson: Because the other states surrounding us have restrictive abortion laws. Where do they come? They come to Florida. So my schedule is completely full, just like she said, with the patients who need the abortion care, but we’re the only ones who can do that.
Dr. Marian Sampson
So we end up packing our schedule as much as possible to try to see all of these patients. And I service two areas, I service the Ft. Myers area and the Naples area. And then we, if need be, will travel off because we’re the affiliate for Southwest and Central Florida. It bleeds over into other things because I have a lot of patients who need to have cervical things taken care of, like precancerous conditions, or they need what’s called a leap procedure.
So they go to see the nurse practitioners, get the pap, if the pap is abnormal, perform a colposcopy and a biopsy. And then if they need a procedure, then we try to get them on the schedule to do that, especially with them being uninsured or underinsured because we’re going to be cheaper than doing it and anywhere else. And this is something that’s time-sensitive. We’re trying to beat it becoming a cervical cancer, but we got to find time on the schedule to do it.
JW: Dr. Sampson was actually prompted into becoming an abortion care provider by the repeal of Roe vs. Wade and new restrictive state laws.
MS: There was something about it that said, “Somebody’s trying to boss somebody around,” and they don’t need to do that. It was like a bell rang; it was like, “Somebody really needs you to help here.” And that’s just where you need to be. I can’t explain it any further than that. So I realized that I had used this resource and never really considered my contribution to that resource and how that could be fostered and help later on because it wasn’t in jeopardy. It wasn’t threatened, and now it is.
JW: Supreme Court ruling notwithstanding, supporters of the Florida constitutional amendment are plowing ahead with a central event in the Orlando area on April 13th.
This has been Johannes Werner, reporting for WSLR News.
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