As an osteopathic family physician, I have spent my career guided by the core value that our calling in medicine is to serve the underserved, doing whatever is needed in the community. We treat blood pressure and depression, deliver babies, and many of us perform abortions, often working with the same patient for all these issues.
I am trained to educate and prescribe but, most importantly, to listen and to align a patient’s care plan with their values. The Supreme Court’s decision on Roe v. Wade severely compromises this central tenet of the practice of medicine: By returning the authority to regulate abortion to the people and their elected representatives, the court removes the ability to align patient care to the individual patient’s values, opens a way for medical decisions to be legislated, and politicizes the patient-physician relationship.
Over the past few days, I have watched physicians organize through national academies, state societies, and social media to help each other address the disruption not just to abortion care but care in general.
There are practicalities to consider. Physicians in states with bans or trigger bans need real-time information on rapidly evolving laws and challenges to them. Physicians in states without bans and a desire to help need multiple state licensure, malpractice insurance, and real-time information on regulations around telehealth, which is rapidly changing. In states with bans, there will be a resurgence in life-threatening complications that most of us have not seen in our careers due to the acts of desperation people forced to carry a pregnancy will inevitably perform.
Half of the abortions in the U.S. are done using medication, and already that number is spiking. The Center for Medicare and Medicaid Services has made permanent an allowance for abortion care over telemedicine that began during the COVID pandemic. Most state bans try to address the possibility of providing abortion care through telemedicine, though the surveillance required to enforce such laws is on a par with the severest of autocracies. So, physicians are organizing to help in states where abortion is legal and bracing for a flood of people seeking the care they cannot obtain in their home state.
In order to perform telemedicine, a physician, nurse practitioner, or physician’s assistant must be licensed to practice in the state where the patient is located. It is possible to obtain licensure in multiple states, and the Interstate Medical Licensure Compact makes this process more streamlined. Participating states include Illinois and Colorado, both are surrounded by states with restrictive laws and are preparing for a dramatic increase in people seeking care.