Health

University of Iowa fears impact of 'heartbeat' bill

OB-GYN residency could lose accreditation

Trent Place, a resident physician at University of Iowa Hospitals and Clinics' obstetrics and gynecology residency program, plans to remain in Iowa to practice following his residency. (Rebecca F. Miller/The Gazette)
Trent Place, a resident physician at University of Iowa Hospitals and Clinics' obstetrics and gynecology residency program, plans to remain in Iowa to practice following his residency. (Rebecca F. Miller/The Gazette)

Dr. Trent Place said he applied for a residency at the University of Iowa Hospitals and Clinics because of the standing of its obstetrics and gynecology program.

Not only that, but Place, a third-year OB-GYN resident, also hopes later to get into the department’s reproductive endocrinology fellowship. That’s a subspecialty that identifies and treats infertility in men and women.

“Our subspecialties are some of the best in the nation, we can’t get any better specialty programs than you can here in Iowa,” he said.

But Place and other OB-GYN residents may be unable to complete their advanced medical trainings in Iowa due to a piece of abortion legislation making its way through the Statehouse.

UI officials, expressing their opposition to the legislation, say it not only would affect the university’s stance as one of the most comprehensive OB-GYN programs nationwide, but also could impact the access to health care for women in the state.

This year, state legislators proposed legislation — dubbed “the heartbeat bill” — that would prohibit physicians from performing an abortion in Iowa if a fetal heartbeat is detected, which can be as early as at six weeks of pregnancy.

It since has passed through the Senate and made its way to the House, where it was amended and attached to Senate File 359, which bans the buying, selling or transferring fetal body parts.

It awaits a full House vote.

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If signed into law, this could mean the UI would lose accreditation for its obstetrics and gynecology residency program — the only one of its kind in the state.

And that could have major implications for the state of women’s health care in Iowa, university officials say.

The university’s program receives annual accreditation from the Accrediting Council for Graduate Medical Education, the not-for-profit organization that approves the majority of the nation’s medical residency, subspecialty and fellowship programs.

The Council requires that OB-GYN residency programs “must provide training or access to training in the provision of abortions” in its family planning curriculum, according to accreditation rules.

This includes training in managing complications of abortion services as well as all forms of contraception.

“Given our role as Iowa’s only comprehensive academic medical center and our commitment to train the next general of medical professionals, the proposed legislation would require us to invest significantly in making arrangements for this training to occur outside of the state, including hundreds of thousands of dollars annually in medical malpractice coverage,” stated a March 15 letter from the Iowa Board of Regents opposing the legislation.

“As such, this would mean that other important investments — such as those to provide outreach to underserved rural areas — would be jeopardized,” the letter added.

The UI’s Department of OB-GYN accepts five medical students per year for its four-year residency program, totaling to 20 residents at all times. The loss of accreditation means the university no longer could accept residents.

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And it’s a competitive program, said Dr. Marygrace Elson, clinical professor and program director of the department’s residency program. There were more than 400 candidates who applied for a spot this academic year.

The university also offers subspecialty training in maternal fetal medicine, gynecologic oncology, reproductive endocrinology and infertility and urogynecology — which also would be affected.

“It has taken decades to build and to receive approval for these highly specialized training fellowships — but it will take just a few months to lose these fellowships if the obstetrics and gynecology residency program is placed on probation” by the Accreditation Council for Graduate Medical Education, the Regents letter states.

As a student at the Chicago College of Osteopathic Medicine at Midwestern University, Place said the high stature of programs factored into his consideration when applying for residency.

“When a program doesn’t have accreditation or if there’s a significant difficulty in obtaining certain procedures to get through residency program, then that’s something you’re going to think about when you’re choosing your residency program — especially the more competitive candidates that have a lot of options,” Place said.

‘Good practice’

The implications go beyond the OB-GYN department. Elson said the neonatology fellowship in the pediatrics department — the subspecialty of doctors who care for ill or premature newborns in the neonatal intensive care unit — requires an accredited OB-GYN residency.

The Accrediting Council for Graduate Medical Education rules added that “residents who have a religious or moral objection may opt-out, and must not be required to participate in training in or performing induced abortions.”

Elson said opting out of abortion services training does not affect an individual physician’s success in the residency, just as there’s no impact on faculty members who chose not to offer those procedures.

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Place said he did take part in the abortion training. The procedure is similar to the procedure used to treat women with complications from a variety of gynecological and obstetric issues such as retained placenta after a vaginal birth and bleeding after a miscarriage.

“So performing abortion procedures also makes residents better prepared to better deal with these issues when they arise in their practice,” he said.

OB-GYN shortage

If the UI loses accreditation, the impact would create “a domino effect,” Elson said.

“You’re perhaps not getting as good of candidates for residency as you might have enjoyed before,” she said.

“You may start losing grant funding because you’re program is losing stature. You may start not attracting the same level of faculty members because your program’s not seen as great as it once was.”

Already the United States is facing a shortage of OB-GYN physicians, which is projected to reach 8,800 short by 2020, according to the American Congress of Obstetricians and Gynecologists.

Iowa is experiencing an overall physician shortage that is projected to heighten in the coming years, and health care experts say the best way to address the issue is by recruiting and retaining physicians who grew up in Iowa or were trained in the state.

However, Iowa ranks 50th out of 51 states for the number of practicing obstetricians and gynecologists fellows per 10,000 women in the state, according to a 2017 American Congress of Obstetricians and Gynecologists report.

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That report shows in 2010, there were 227 practicing fellows. When compared to the about 1.5 million female state population, it resulted in about 1.5 OB-GYNs per 10,000 women.

“Nationally, your best chance of keeping providers in your state is to have them do their residency there,” Elson said. “Most people set down roots during residency and stay.”

Place, who grew up in Oskaloosa, intends to practice in the state after completing his medical training.

l Comments: (319) 368-8536; michaela.ramm@thegazette.com

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