Fear of legal action worries family medicine doctors

Family medicine doctors are finding it hard to make decisions about treating difficult pregnancies and worry about legal actions in the wake of the Supreme Court’s Dobbs decision, a new study has found.  

Published Nov. 25 in the Annals of Family Medicine, the study found these concerns were noted even in states where legislation protects reproductive rights, such as Washington, California and Oregon.  

“One of the things that stood out to me is that doctors are worrying about legal risk, no matter where they live,” said Dr. Grace Shih, a UW Medicine family medicine physician and a coauthor of the study. “And people are not getting recommendations and guidelines from their institutions.”

Concerns were especially noted in difficult patient cases such as ectopic pregnancies or late-term miscarriages, the study authors noted.  

Shih also noted that family medicine doctors provide most of the maternity care in parts of the United States facing shortages of physicians who provide prenatal care and deliver babies.  

“If family medicine can’t provide adequate reproductive health training, the impact on reproductive care in the maternity deserts will be huge,” she said. “It will be catastrophic.” 

The researchers surveyed 1,196 doctors, nurses and staff across all 50 states between January and February of 2023. States were ranked in five categories, from very restrictive to very protective, based on a scale developed by the Guttmacher Institute, which tracks reproductive rights legislation and issues. The ranking did not include measures during the November elections, when reproductive rights issues were placed before voters.  

Overall, almost one-half of survey respondents reported an absence of reproductive healthcare guidance from their organizations and institutions. Even in the states categorized as most restrictive, 40% of respondents had not received new guidelines on reproductive care. 

Restrictive abortion policies significantly reduced the desirability of, and confidence in, residency training programs, said clinicians who practiced in academic health centers. This finding reflects a trend among OB/GYN residency programs, where decreases in applicants are highest (10.5%) in states with abortion bans and lowest (5.3%) in states without restrictions in place between 2022 to 2023. Some doctors also reported that they perceive patients as less trusting of their advice.  

The bottom line, she noted, is that the Dobbs decision is already affecting reproductive care and the training of future family medicine doctors.  

We are already hearing about cases “like ectopic pregnancy, and doctors are not sure what they can do,” she said.  

In cases of an ectopic pregnancy, in which the fertilized egg implants outside of the uterus, the pregnancy is quickly terminated to protect the mother against severe health risks, including death, according to the American College of Obstetricians and Gynecologists.  

The 991 respondents (82%) with clinical responsibilities reported significant changes in their counseling practices, clinical decision-making, worry of legal risk, and trust in patients’ self-reported reproductive medical history, compared with peers in protective states. Future studies are needed to document the continued impact of state restrictions and inform policy to support family medicine clinicians in reproductive health practice and education, they concluded.  

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