Category Archives: Medical School

KALAMAZOO, MI -- In 2006, Susan Brown lost a close friend to suicide. Another friend died the same way in 2011.

The two incidents left her reeling. Both men were highly accomplished, with plenty of resources at their disposal. If even people in that position could succumb to mental illness, what did that say about the status of mental-health care?

It was such a shock to all of us to have a contemporary die that way, said Brown, a longtime Kalamazoo resident and wife of Bob Brown, founder of the Treystar commercial real estate firm. How did this happen?

For the past decade, Brown -- who is now 80 -- has channeled her grief into action, rallying friends to raise money and researching how to improve access to mental-health services.

Her efforts led to the formation of the Kalamazoo Collaborative Care Program, which provides social workers and other mental-health expertise to help primary-care physicians treat patients with behavioral health issues.

Now Brown wants to take her efforts to the next level. The vision: Creating a Kalamazoo psychiatric clinic modeled after the University of Michigan Depression Center, a place that would combine high-quality care with cutting-edge research and education on mental health.

The tentative proposal calls for a clinic that would hire a dozen or more psychiatrists and include outpatient services for children, adolescents, adults and geriatric patients. Doctors would treat a wide variety of behavioral health disorders, including depression and anxiety, autism and autism spectrum issues, attention deficit disorder, bipolar and schizophrenia, psychosis, PTSD and Alzheimers and other memory issues.

Under this proposal, the clinic would be affiliated with the Western Michigan University School of Medicines psychiatric department. Brown is looking to raise about $25 million to finance a facility.

Such a project would achieve multiple objectives, say Brown and others. One would be the ability to recruit and retain psychiatrists based in Kalamazoo, addressing a critical shortage.

Treatment for mental-health disorders typically involve both medication and talk therapy. While a psychologist or other therapist can provide the latter, patients need a psychiatrist or other medical doctor to prescribe medications and oversee treatment regimes, especially for people with other medical issues.

A psychiatric clinic also would be a way to pull together the communitys fragmented mental-health system, improve coordination and create more consistency in regards to quality, said Dr. Rajiv Tandon, who recently retired as chairman of the WMU medical schools psychiatry department.

Absolutely, such a clinic would benefit the Kalamazoo community, especially people with private insurance, said Jeff Patton, CEO of Integrated Services of Kalamazoo, the countys community mental health agency.

His agency provides very comprehensive mental-health services for clients, but the vast majority are Medicaid patients, he said. By comparison, people with private insurance lack the same kind of comprehensive system.

Kalamazoo psychologist Larry Beer said having a comprehensive psychiatric clinic would be great.

My practice has really tried to recruit psychiatrists, even psychiatric nurse practitioners, but its been really, really hard to do that, Beer said. Services provided by such a clinic would go a long way toward filling a void.

The idea of creating a psychiatric clinic to get more psychiatrists to base here is a model used in other domains, and its been very successful, said Troy Zukowski, a clinical social worker in Kalamazoo. We dont want a situation where people are graduating from the WMU medical school and taking jobs in New York or Chicago. We want them to stay in Michigan and hopefully the Kalamazoo area, because theres definitely a shortage of psychiatrists here.

Patton added such a project would be an excellent way to leverage the assets of the WMU medical school, which was established in 2012 and is based in downtown Kalamazoo.

I think we need to promote our med school much more, and support their abilities to recruit and retain both students and (medical) residents, Patton said. Its quite a gem for a community the size of Kalamazoo to have a med school;. Its quite extraordinary to have that infusion of knowledge and science coming into our community. We need to talk that up.

Is WMU medical school on board?

While people in Kalamazoos mental-health community are enthused about the idea, institutions that would be key players -- the WMU medical school, Ascension Borgess Medical Center and Bronson Healthcare -- are much more cautious.

Borgess and Bronson did not respond to requests for comment for this story. As for the WMU medical school, Tandon -- who drafted the vision that Brown would like to bring to fruition -- recently retired and no long speaks for the college.

The WMU medical school has not yet hired Tandons permanent successor, and the new psychiatry chair undoubtedly will have their own vision of the departments direction, said Dr. Michael Redinger, the interim psychiatry chair of the WMU School of Medicine.

Were looking for somebody who can take a lot of the work that started with Rajiv and Susans conversations, look at the resources from U-M, the lessons we can take from them and build that out, Redinger said.

What form that takes, I cant really tell you right now, because the new chair is going to be the one who has the prerogative in terms of modifying and building that vision. he said.

All that said, the shortage of psychiatrists is a very real issue, Redinger said, and is a nationwide problem attributed to a number of factors.

One is a so-called retirement drain: A common scenario these days is that when a psychiatrist retires, theres no one to take over their caseload. And its a problem thats getting worse.

In Michigan, more than half of practicing psychiatrists are over the age of 55, one of the highest proportions among all physicians. Meanwhile, it can be hard to convince young doctors to specialize in psychiatry, especially when many have enormous medical school debt and psychiatry pays less than many other medical specialties.

The shortage of psychiatrists is definitely a bottleneck, no doubt about that, Redinger said. And the more the sub-specialty, the more acute the bottleneck, especially for people needing to see specialist in children and adolescents, or geriatric, or substance-use disorder. That doesnt mean we have an abundance of adult psychiatrists, but the waiting lists are just that much longer for the sub-specialties.

Addressing that shortage requires a multi-prong strategy, Redinger said. Already, the Kalamazoo Collaborative Care Program is arranging for consultants between psychiatrists and primary-care physicians, which is a way to extend the expertise of local psychiatrists.

One thing thats clear is that the mental health needs in the community are significant, they are not going away, and its going to take a multifaceted multifaceted approach to tackling all of that, Redinger said.

Institutional barriers

Tandon, the former psychiatry chair of the WMU medical school, agrees more than one approach is necessary. But hes also convinced that a standalone psychiatric clinic would be an immense boost for the public, the local mental-health system and the medical school.

For the public, such a clinic would provide much-needed high-quality specialized mental-health care. For the local mental-health system, the clinic would be a huge resource, particularly in providing access to research and professional training and support.

For WMU, it would be a way to hone the reputation of the medical school and help put Kalamazoos name on the map.

In terms of creating a nationally recognized program, psychiatry is an easy win because theres not many high-quality, go-to psychiatry places in the country, Tandon said.

Secondly, from a cost perspective, investing in psychiatry makes sense, he said. You dont make money in psychiatry, but you make money off it by significantly improving the quality of outcomes for people across the board -- surgical patients, cardiac patients, orthopedic patients.

Such a clinic also would provide WMU medical students with a better education, help with faculty recruitment, and expand the opportunities for research, as well as help recruit and retain psychiatrists to base in Kalamazoo, Tandon said.

Bu there are institutional challenges sin creating such a clinic, related to the particular setup of the WMU medical school.

Unlike most medical schools, WMU does not have its own hospital. Rather, its affiliated with Bronson and Borgess. Each hospital has three seats on the medical schools 11-member board, which means the hospitals together control the med school.

Thats a challenge in creating any new clinical programs because Bronson and Borgess are in competition, with legendary turf wars that extend back decades.

To complicate matters, of the two hospitals, Borgess is the one that operates an inpatient psychiatric unit. But Borgess is no longer locally operated; its now part of the Ascension healthcare system based in St. Louis. That means Borgess is now a very small fish is a very large pond.

And its unclear whether Ascension would back plans for a standalone Kalamazoo psychiatric clinic that would might require their investment -- or at least their approval -- especially if that clinic is perceived as creating competition to Borgess operations.

Its very frustrating, Brown said. We know the local people (at Borgess), who are fabulous and they get it, but they dont have control in making major decisions.

Its also unclear whether Bronson would want to expand its investment in psychiatry, and if or how that aligns with the hospitals future plans.

But Brown doesnt want to let the vision die.

I think Kalamazoo could do this, she said. WMU has a really good medical school. We need this. If people would just step up and get the word out, we could get this going.

This story is part of the Mental Wellness Project, a solutions-oriented journalism initiative covering mental health issues in southwest Michigan, created by the Southwest Michigan Journalism Collaborative. SWMJC is a group of 12 regional organizations dedicated to strengthening local journalism. For more info visit swmichjournalism.com.

Read more on MLive:

Mental health counseling can be highly effective. But finding the right therapist is key.

Saying these words could help someone who is contemplating suicide

Finding affordable mental-health care getting easier with reforms, new programs

Behavioral health urgent care planned for downtown Kalamazoo

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How Kalamazoo can address the shortage of psychiatrists -- and make a name for itself in the process - MLive.com

If you think about it, a priest and a doctor have similar roles. One cares for physical health and the other for spiritual health, but both are called to a vocation of compassion and healing.

Today, most medical schools use highly realistic medical simulations as a way to train and prepare future doctors. But up until now, priests didnt get anything comparable in seminary. The closest thing was role playing in their classes.

But these medical simulations inspired a breakthrough in seminarian formation: What if highly realistic simulations could be used to prepare future priests, too?

This is the idea behind a major new initiative at University of St. Mary of the Lake (USML)/Mundelein Seminary.Its called the Cor Iuxta Meum (After My Own Heart) Project: an innovative effort focused on integrating new pedagogical methods into formation programs for seminarians, priests, and lay leaders within the Church.

A key component of the Cor Iuxta Meum Project is developing the simulation-learning methodology. This allows seminarians to practice pastoral encounters in a safe and supportive environment before entering the priesthood. They also receive thoughtful, targeted feedback from faculty observers to refine their approach.

USML/Mundelein Seminary has received a $5,000,000 grant from Lilly Endowment Inc. through its Pathways for Tomorrow Initiative.

These funds will be used to develop a complete simulation laboratory on the USML campus, along with a group of professional simulation actors who will be trained to portray the lives of standardized parishioners, each with a fully developed background story specially crafted to meet the goals of the seminarys learning objectives.

The grant will also fund administrative support for the Seminary Formation Council, which provides training and support to those who serve in diocesan seminary formation, including faculty, advisors and vocation directors.

You can learn more about the Cor Iuxta Meum Project through this YouTube video:

Father John Kartje, rector of USML/Mundelein Seminary, shared with Aleteia how incredibly realistic the simulations are.

Ive been a priest for over 20 years, and when Ive watched these simulations, you couldnt convince me it wasnt the same as a real scenario, he said.

The Cor Iuxta Meum Project is a major investment in Mundelein Seminary. Will the majority of the project focus on the simulation learning approach to training?

While the simulation learning is a significant component of the project, it is only one of several focal points. Others include the development of new pedagogical teaching methods designed to maximally leverage the benefits of the greater emphasis on students personal encounters with parishioners.

In addition, we are launching a major collaboration with six of the largest Catholic seminaries in America to develop a series of best practices to help prepare parish pastors and their staffs to partner with the seminaries in the mission of training future priests.

What will simulation learning look like? How will it be implemented? How is it different from what Mundelein is doing now?

While much of the methodology will be similar, major changes consist of the different types of cases that we will be simulating: rather than strictly medical scenarios, we will be creating cases that touch on the broad array of pastoral encounters that parish priests engage with every day (e.g., marital issues, anxiety and depression, spiritual direction, struggles with Church teaching, etc.). In addition, we will be simulating the types of leadership situations that are also common to pastors (e.g., human resource decisions, effectively leading groups, effective collaboration with parish staffs, change management, etc.).

The learning will look like what is portrayed in the video [above], except that we will construct our own simulation lab on the Mundelein campus, with the capacity to reproduce a variety of spaces, from small counseling rooms to large meeting spaces.

While we currently employ small role play scenarios within some classes, simulation is much more than role play. It entails an incredibly accurate portrayal of actual scenarios, using professionals to portray the parishioner roles, and providing extensive background research into every case.

In addition, the simulation runs are carefully watched and assessed by several faculty members to provide much more thorough feedback designed to address both the students interior experiences as well as his exterior pastoral handling of the situation.

What will the simulation laboratory look like?

Were building a full simulation lab, a very flexible space, which were able to convert in different ways to simulate everything from a confessional or small one-on-one counseling room to a large meeting room where a priest would hold a parish council meeting.

What is the most important thing for others to know about the Cor Iuxta Meum Project?

That it is much more than role playing! It is an attempt to realize the vision laid out by St. Pope John Paul II in his seminal document Pastores Dabo Vobis, in which he called for a seminary formation program that is built around the integration of all aspects of the humanity of the seminariana large part of which can only be developed via personal encounter between the future priest and the people he will be serving.

Simulation learning is a powerful tool for that endeavor, but it has to be embedded within a much broader approach to overall seminary formation, from the classroom instruction to the onsite parish ministries.

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How medical school and a cast of actors are changing how future priests are trained - Aleteia

Jen Reinmuth-Birch, 51, took the plunge after her new husband convinced her to go back to school to kick start her career, and after witnessing the incredibly work of medical staff

Image: Courtesy of Jen Reinmuth-Birch SWNS)

A woman has switched retirement for medical school in order to train to practice as a doctor at the age of 50 - proving that it's never too late to chase your dreams.

51-year-old Jen Reinmuth-Birch was encouraged to return to school by her new husband, to reinvent her career.

She was inspired after witnessing the incredible work of medical professionals who work with children with special needs, which chimed with her own experience of parenting a boy with autism.

It took the mum-of-two four years to build work experience and get her science qualifications before she was accepted into her dream medical school, Pacific North West University of Health Sciences in January 2021.

She is now in her second year, and is inspiring others to do exactly what they want.

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Hailing from Yakima, Washington, student Jen said: "I just suddenly found my passion for medicine in my late 40s but I never thought it was possible.

"I was a single mum and working two jobs to keep us afloat.

"Then I met my now-husband who gave me the push to go and do it.

"Now after four years of hard work I'm on the path to become a doctor and I'm loving every second.

"It's hard work but I've never been happier."

Jen has twin boys - Jack and Michael - who are aged 20, and she has always been a stay-at-home mum.

But when her marriage broke down in 2008, she was forced to go it alone.

She said: "I became a busy city mum juggling two jobs.

"My boys came first."

But Jen did find the time to go back and do a masters in special needs education and found a love for medicine when shadowing doctors.

"I found it so interesting, but I didn't think I would ever have the option to do that," she said.

But in 2012 she met Norm Birch, 66, a distribution manager, after being introduced through a friend.

When he heard about her dream to be a doctor, he told her he wanted to help her make it a reality.

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"I told him it wasn't possible because I had the boys," Jen said.

"But he told me he would help out with them and any excuse I came up with he had an answer.

"So I re-enrolled at school."

Jen went back to school in September 2012 and took four years getting her science qualifications and work shadowing before applying for her medical degree.

"When I found out I got accepted into my dream medical school my legs collapsed," Jen said.

"I was so shocked. It's life-changing."

Jen started at the Pacific North West University of Health Sciences in August 2021 and gets up at 4am each day to study before her classes start at 8am.

She finishes at 5pm and uses the evening to have quality time with her family.

"I thought it would feel strange starting school at 50 when all the other students are young enough to be my children," Jen said.

"But everyone just sees me as Jen. I'm no different. I'm one of the kids."

Jen has dealt with some nasty comments such as - 'good luck grandma' and 'you'll be dead before you graduate' from people online- but she has mostly had positive feedback from others online.

"People tell me I've inspired them to go back to school which is amazing," Jen said.

"I get tears in my eyes reading some of the messages I get."

Jen is on a four-year programme consisting of two years of studying and two years of placements in hospitals before she will then start her residency.

"I'm loving it," she said.

"I am so thankful to Norm for pushing me to do this. He's my biggest cheerleader."

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Woman swaps retirement for medical school proving it's never too late to chase your dreams - The Mirror

Gaining a place in medical school has always been a lottery, made even more difficult for aspiring doctors this year. For those who failed to achieve their A level conditional offer grades, this will come as a hard blow and may seem grossly unfair.

Some students are entitled to feel victims of the A level grade inflation in 2020 and 2021 when exams were cancelled due to the Covid pandemic and acceptance to medical school was determined by over-generous teacher-assessed predicted grades. As the government returns the cap on the number of medical school places to approaching pre-pandemic levels, fewer places have been offered to students for 2022 entry and examination boards have been directed to reduce the number of top grades. For England, Wales and Northern Ireland, A and A* grades have been reduced from 45 to 36 per cent. This years students are no less bright than those in the previous two years but will achieve poorer grades and fewer opportunities as a result of these manipulations. Meanwhile, medical schools are still demanding top grades.

During the acceptance bulges of 2020 and 2021, some medical schools invited students to defer their starting date by one year because they could not cope with the unexpectedly high number of students. Some even offered financial incentives either to delay or to move to other medical schools.

The cap on medical school places is now back to 7,500 in England. The government has evenrefused to extend the cap to accommodate students deferred from 2021 thusreducing the number of training places available for 2021/2022 applicants. These students have received no compensation for the reduced A level teaching provided as a result of school closures during the pandemic and variably efficient online learning.

Meanwhile most medical schools continue to offer 7.5 per cent of their places to international students because they pay higher fees than UK students.

The medical student cap exists only because of the cost of teaching more students, despite the fact that the NHS is desperately short of doctors. The government was quoted this week as saying that the cap is regularly reviewed to ensure it meets the needs of our NHS. This comment amounts to hypocrisy of the highest order because the government knows that for the past decade the UK has been forced to recruit an ever-increasing number of doctors from abroad to meet the needs of the NHS. In 2021, a staggering 63 per cent of doctors registering with the General Medical Council for the first time qualified abroad. There were 7,377 UK graduates, 2,591 from EEA schools and 10,009 International Medical Graduates from countries outside Europe. Between 2016 and 2021, the GMC has recruited 53,296 doctors from abroad.

The good and the great who run our medical schools, the medical Royal Colleges and the governing Medical School Council are perfectly aware of this data. They pay lip service to the need for more UK medical schools but never, as supporting evidence, mention that since 2018, we have imported more doctors than we have trained. They are self-constrained by political correctness as they promote each other around the circuit of influential jobs. They form an elite club, some of whom have not worked at the bedside for years. The few who see themselves in line for a gong definitely wont challenge government policy. The golden rule for promotion is to make small waves to remind others of your presence but never rock the boat.

Successive governments with their short-termist views have long realised that it is cheaper to import medical graduatesfrom abroad than to train our own. The only exception in the recent past are the five new medical schools commissioned in 2018 by Jeremy Hunt, then Secretary of State for Health. These new schools will graduate a total of 1,500 doctors annually, the first in 2023/4. They will form a drop in the ocean of the needs of the NHS.

Meanwhile the GMC continues at pace to recruit doctors from low-income counties to plug gaps in the NHS. They come mostly from countries with patient/doctor ratios well below World Health Organisation recommendations. These doctors are desperately needed in their home countries to provide essential services. This raises serious moral and ethical issues.

The UK is a signatory and therefore in breach of the WHO code of practice on international recruitment of health workers which states that member states should discourage active recruitment from developing countries facing critical shortages of health workers.

Not creating more UK medical schools amounts to a tragedy for students, the NHS and for patients. We have a wealth of home-grown talent desperate for the opportunity to train as doctors. One way or another, medical education and staffing of the NHS are a disaster and no one seems to care enough to plan the changes necessary. We need more UK trained doctors and more UK medical schools.

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Its time to lift the medical student cap - The Spectator

When fat accumulates in the liver, the immune system may assault the organ. A new study from Weill Cornell Medicine researchers identifies the molecule that trips these defenses, a discovery that helps to explain the dynamics underlying liver damage that can accompany type 2 diabetes and obesity.

In a study published Aug. 19 in Science Immunology, researchers mimicked these human metabolic diseases by genetically altering mice or feeding them a high-fat, high-sugar diet. They then examined changes within the arm of the rodents immune system that mounts defenses tailored to specific threats. When misdirected back on the body, this immune response, which involves B and T cells, damages the organs and tissues it is meant to protect.

For the longest time, people have been wondering how T and B cells learn to attack liver cells, which are under increased metabolic stress due to a high fat high sugar diet, said lead investigator Dr. Laura Santambrogio, who is a professor of radiation oncology and of physiology and biophysics, and associate director for precision immunology at the Englander Institute for Precision Medicine at Weill Cornell Medicine. We have identified one protein probably the first of many that is produced by stressed liver cells and then recognized by both B and T cells as a target.

Back row from left to right: Madhur Shetty; Marcus DaSilva Goncalves; Laura Santambrogio; Lorenzo Galluzzi; Aitziber Buqu. Front row from left to right: Jaspreet Osan; Shakti Ramsamooj; Cristina Clement; Takahiro Yamazaki

The activation of the immune system further aggravates the damage already occurring within this organ in people who have these metabolic conditions, she said.

In type 2 diabetes or obesity, the liver stores an excessive amount of fat, which can stress cells, leading to a condition known as nonalcoholic steatohepatitis, commonly called fatty liver disease. The stress leads to inflammation, a nonspecific immune response that, while meant to protect, can harm tissue over time. Researchers now also have evidence that B and T cells activity contributes, too.

B cells produce proteins called antibodies that neutralize an invader by latching onto a specific part of it. Likewise, T cells destroy infected cells after recognizing partial sequences of a target protein. Sometimes, as happens in autoimmune diseases, these cells turn on the body by recognizing self proteins.

Dr. Santambrogio and her colleagues, including Dr. Lorenzo Galluzzi, assistant professor of cell biology in radiation oncology at Weill Cornell Medicine and Dr. Marcus Goncalves, assistant professor of medicine at Weill Cornell Medicine and an endocrinologist at NewYork-Presbyterian/Weill Cornell Medical Center, as well as researchers from Dr. Lawrence Sterns group at the University of Massachusetts Medical School, wanted to know what molecule within liver cells became their target.

Examining the activity of another type of immune cell, called dendritic cells, led them to a protein, called PDIA3, that they found activates both B and T cells. When under stress, cells make more PDIA3, which travels to their surfaces, where it becomes easier for the immune system to attack.

While these experiments were done in mice, a similar dynamic appears to be at play in humans. The researchers found elevated levels of antibodies for PDIA3 antibodies in blood samples from people with type 2 diabetes, as well as in autoimmune conditions affecting the liver and its bile ducts.

Unlike in autoimmune conditions, however, improving ones diet and losing weight can reverse this liver condition. The connection with diet and a decrease in fatty liver disease was already well established, Dr. Santambrogio said.

We have added a new piece to the puzzle, she said, by showing how the immune system starts to attack the liver.

Many Weill Cornell Medicine physicians and scientists maintain relationships and collaborate with external organizations to foster scientific innovation and provide expert guidance. The institution makes these disclosurespublic to ensure transparency. For this information, see profiles for Dr. Lorenzo Galluzzi and Dr. Marcus Goncalves.

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Researchers Identify the Target of Immune Attacks on Liver Cells in Metabolic Disorders - Weill Cornell Medicine Newsroom

On a Monday morning, a group of obstetrics and gynecology residents, dressed in blue scrubs and white coats, gathered in an auditorium at Indiana University School of Medicine. After the usual updates and announcements, Dr. Nicole Scott, the residency program director, addressed the elephant in the room. "Any more abortion care questions?" she asked the trainees.

After a few moments of silence, one resident asked: "How's Dr. Bernard doing?"

"Bernard is actually in really good spirits I mean, relatively," Scott answered. "She has 24/7 security, has her own lawyer."

They were talking about Dr. Caitlin Bernard, an Indiana OB-GYN who provides abortions and trains residents at the university hospital. Bernard was recently caught in a political whirlwind after she spoke about an abortion she provided to a 10-year-old rape victim from Ohio. Bernard was the target of false accusations made on national television by pundits and political leaders, including Indiana's attorney general.

The doctors interviewed for this article said that they are not speaking on behalf of their school of medicine but rather about their personal experiences during a tumultuous moment that they worry will affect the way they care for their patients.

The vitriol directed at Bernard hit home for this group of residents. She has mentored most of them for years. Many of the young doctors were certain they wanted to practice in Indiana after their training. But lately, some have been ambivalent about that prospect.

Dr. Beatrice Soderholm, a fourth-year OB-GYN resident, said watching what Bernard went through was "scary." "I think that was part of the point for those who were putting her through that," Soderholm said. They were trying "to scare other people out of doing the work that she does."

In early August, Gov. Eric Holcomb, a Republican, signed a near-total abortion ban into law, making Indiana the first state to adopt new restrictions on abortion access since the Supreme Court struck down Roe v. Wade in June. When the ban takes effect Sept. 15, medical providers who violate the law risk losing their licenses or serving up to six years in prison.

These days, Scott, the residency program director, uses some meeting time with residents to fill them in on political updates and available mental health services. She also reminds them that legal counsel is on call round-the-clock to help if they're ever unsure about the care they should provide a patient.

"Our residents are devastated," Scott said, holding back tears. "They signed up to provide comprehensive health care to women, and they are being told that they can't do that."

She expects this will "deeply impact" how Indiana hospitals recruit and retain medical professionals.

A 2018 report from the March of Dimes found that 27% of Indiana counties are considered maternity care deserts, with no or limited access to maternal care. The state has one of the nation's highest maternal mortality rates.

Scott said new laws restricting abortion will only worsen those statistics.

Scott shared results from a recent survey of nearly 1,400 residents and fellows across all specialties at the IU School of Medicine, nearly 80% of the trainees said they were less likely to stay and practice in Indiana after the abortion ban.

Dr. Wendy Tian, a third-year resident, said she is worried about her safety. Tian grew up and went to medical school in Chicago and chose to do her residency in Indiana because the program has a strong family-planning focus. She was open to practicing in Indiana when she completed her training.

But that's changed.

"I, for sure, don't know if I would be able to stay in Indiana postgraduation with what's going on," Tian said.

Still, she feels guilty for "giving up" on Indiana's most vulnerable patients.

Even before Roe fell, Tian said, the climate in Indiana could be hostile and frustrating for OB-GYNs. Indiana, like other states with abortion restrictions, allows nearly all health care providers to opt out of providing care to patients having an abortion.

"We encounter other people who we work with on a daily basis who are opposed to what we do," Tian said. Tian said she and her colleagues have had to cancel scheduled procedures because the nurses on call were not comfortable assisting during an abortion.

Scott said the OB-GYN program at the IU School of Medicine has provided residents with comprehensive training, including on abortion care and family planning. Since miscarriages are managed the same way as first-trimester abortions, she said, the training gives residents lots of hands-on experience. "What termination procedures allow you to do is that kind of repetition and that understanding of the female anatomy and how to manage complications that may happen with miscarriages," she said.

The ban on abortions dramatically reduces the hands-on opportunities for OB-GYN residents, and that's a huge concern, she said.

The program is exploring ways to offer training. One option is to send residents to learn in states without abortion restrictions, but Scott said that would be a logistical nightmare. "This is not as simple as just showing up to an office and saying, 'Can I observe?' This includes getting a medical license for out-of-state trainees. This includes funding for travel and lodging," Scott said. "It adds a lot to what we already do to educate future OB-GYNs."

Four in 10 of all OB-GYN residents in the U.S. are in states where abortion is banned or likely to be banned, so there could be a surge of residents looking to go out of state to make up for lost training opportunities. The Accreditation Council for Graduate Medical Education, the body that accredits residency programs, proposed modifications to the graduation requirements for OB-GYN residents to account for the changing landscape.

For some of the Indiana OB-GYN residents including Dr. Veronica Santana, a first-year resident these political hurdles are a challenge they're more than willing to take on. Santana is Latina, grew up in Seattle, and has been involved in community organizing since she was a teenager. One reason she chose obstetrics and gynecology was because of how the field intersects with social justice. "It's political. It always has been, and it continues to be," she said, "And, obviously, especially now."

After Roe was overturned, Santana, alongside other residents and mentors, took to the streets of Indianapolis to participate in rallies in support of abortion rights.

Indiana could be the perfect battleground for Santana's advocacy and social activism. But lately, she said, she is "very unsure" whether staying in Indiana to practice after residency makes sense, since she wants to provide the entire range of OB-GYN services.

Soderholm, who grew up in Minnesota, has felt a strong connection to patients at the county hospital in Indianapolis. She had been certain she wanted to practice in Indiana. But her family in Minnesota where abortion remains largely protected has recently questioned why she would stay in a state with such a hostile climate for OB-GYNs. "There's been a lot of hesitation," she said. But the patients make leaving difficult. "Sorry," she said, starting to cry.

It's for those patients that Soderholm decided she'll likely stay. Other young doctors may make a different decision.

This story is part of a partnership that includesSide Effects Public Media,NPR,and KHN.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

This story can be republished for free (details).

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Indiana's new abortion ban may drive some young OB-GYNs to leave a state where they're needed - Salon