If the fetal heartbeat bill passes, what happens to the University of Iowa OB-GYN residency?

They had just interviewed the next wave of promising new candidates when leaders of the University of Iowa obstetrics and gynecology residency program — the only of its kind in the state — learned that they may soon no longer have a program.

Specifically, program leaders learned about the proposed abortion ban lawmakers have been debating since earlier this year. If made into law, abortions after a fetal heartbeat can be detected would be barred. According to the University of Iowa, the obstetrics and gynecology department within the Carver College of Medicine would not be able to provide the full scope of family-planning training required to be accredited by the Accreditation Council for Graduate Medical Education.

Dr. Marygrace Elson, director of the OB-GYN residency program, says she is concerned for the ripple effect the ban would have on recruiting for her program and other UI studies that require an accredited OB-GYN residency program, and more importantly, the ripple effect it would have on the health of Iowans for years to come.

'A fair amount of money'

At this stage, Elson said, the program has not started putting together a game plan should the restrictions be made into law — even if the ban does pass, she still hopes the courts will shoot down the legislation the same way a similar North Dakota ban was shot down in 2014.

More than likely though, Elson says the program would probably have to arrange some sort of regular out-of-state training for students if it can no longer provide training in Iowa. Elson said her program has not identified a place that might be willing to provide such training or estimated the cost of doing so.

"There would have to be sort of a contractual arrangement between the university hospital and this other entity, wherever it is, which no doubt would involve things like malpractice coverage, housing and additional expense,” Elson said, adding that if such an arrangement was made, it would cost "a fair amount of money."

The program wouldn't lose its accreditation overnight if an alternative option takes time to develop.

The Accreditation Council for Graduate Medical Education, which reviews programs annually, gives those that do not meet accreditation standards some time to fix their noncompliance. After the first year without providing the training, the program would get a warning. Then it would be put on probation before losing its accreditation if arrangements cannot be made.

But the impact would still be felt immediately. There is still an obligation to provide the education to current students who opt into the optional training.

Elson says the loss of accreditation would also affect sub-specialties fellowships that require an accredited OB-GYN program. There are at least five of these programs, including maternal fetal medicine, gynecologic oncology, reproductive endocrinology and infertility, female pelvic medicine and reconstructive surgery, and neonatology programs.

The program doesn’t have to lose accreditation immediately for there to be an effect on recruiting, Elson said. This past fall, more than 400 medical students applied for the five open resident positions, but this can change in the coming years, Elson said.

“Let’s say it doesn’t go all the way — even if you get a warning, everybody knows that,” she said. “Everybody knows that, and your quality of candidates coming in is going to drift down. And if your quality starts to drift down, you have trouble keeping and attracting faculty.”

'Hard to think about practicing here in the future'

The University of Iowa program has 20 residents, with about one-third staying in Iowa after the program is over.

Retaining a few of these residents each year is pivotal in a state that lags behind the number of national OB-GYNs, Elson said. There are fewer than two OB-GYNs per 10,000 women in Iowa, and about four per 10,000 women between the ages of 15 and 45, according to 2014 data from the American College of Obstetricians and Gynecologists. Nationally there are fewer than three OB-GYNs per 10,000 women and about five per 10,000 women between the ages of 15 and 45.

Up until this proposed legislation, UI medical student Emily Boevers said she hadn’t thought of practicing anywhere but her home state. The longtime Iowan found out she was accepted into an OB-GYN residency program in Kansas last week.

“This legislation makes it really hard to think about practicing here in the future," she said. "Because even though nobody likes the idea of abortion — that’s never the thing that we hope for for our patients — it’s an important part of the spectrum of care for our patients that needs to be able to be offered.”

Boevers is among the dozens of medical students who signed a letter opposing the ban. They are joined in their opposition by the Iowa Board of Regents and the Iowa Medical Society.

“The medical society typically will defer and not weigh in on abortion procedures, recognizing that it’s an issue our membership is divided on,” said Dennis Tibben director of government affairs for the Iowa Medical Society. “But when we get to something to this degree where it is ultimately impacting the ability of medical schools to be able to train the next generation of physicians, we need to weigh in.”

'Logical beginning point for civil governance'

The ban was tacked on as an amendment to Senate File 359, a bill prohibiting the sale of fetal body parts, when the original bill detailing the ban was in jeopardy of not clearing the funnel deadline.

There were some changes, most notably the new version dropped the threat of criminal charges for physicians who perform abortions after a heartbeat can be detected.

Proponents of the ban say it’s a matter of protecting unborn children. Just before the former version of the bill passed out to the House, Sen. Amy Sinclair, R-Allerton, said protecting unborn children is part of the oath lawmakers took.

“This bill is the most logical beginning point for all of civil governance. ... The logically understood right to life acts as a prerequisite to every other law we enact,” she said. “So, as legislators, our very first duty should be to protect each and every individual's basic right to life, frankly, above all else.”

Iowa already has one of the tightest restrictions on abortions in the nation. Current law bans most abortions after 20 weeks. If passed into law, the fetal heartbeat ban would reduce that time period to around six weeks — before many women know they are pregnant.

'Having well-trained OB-GYNs in the state of Iowa means ...'

Corbin Weaver, a UI medical student who recently matched with an out-of-state OB-GYN residency program, said she’s acutely aware of how the idea of allowing abortion can be a nonstarter for Iowans.

She says it’s also difficult to get others to understand how something like an OB-GYN program can have an effect on the whole state, but it’s what makes her passionate about going into the field.

“I feel that when women’s health is taken care of, the health of the community goes up as well,” she said. "I think that by taking care of women, you make a big difference in not only the lives of individual women, but in the community as well.”

Beovers also said people may not understand that a program like the one at the University of Iowa can impact something like Iowa's tax base.

"Having well-trained OB-GYNs in the state of Iowa means that we can have healthy moms and healthy babies," she said. "It means that we will have healthy kids to go to our schools, and it means we will have healthy college students in our universities, a young healthy workforce to work in our jobs.”

Looking back on her own training, Elson said she would never have fathomed a serious attempt to bring back an abortion ban.

Elson started her medical career in the early 1980s, when the memory was still fresh of what hospitals were like prior to the Supreme Court striking down abortion restrictions in 1973.

“Women died,” Elson said. “I’m not that old that I actually took care of these women, but I learned under faculty members who were around before Roe v. Wade, when there were wards full of women who had to have hysterectomies or died, because they got an abortion that wasn’t safe. It was bad in those days, and people just don’t remember it anymore.”