Most mornings Dr Stacy Seyb is awake by 6am. He begins his day with meetings before a packed schedule seeing 18-20 patients going through high-risk pregnancies in Boise, Idaho. He has had a long career of treating people with all sorts of obstetrical complications so he’s used to stress. But it’s never been like this.
Now that federal protections for abortion have been gone for more than a year and Idaho is approaching the anniversary of its near-total abortion ban, the state has seen an exodus of OB-GYNs and other medical providers, leaving Seyb as one of the last remaining maternal-fetal medicine physicians in his state.
He estimates his patient load has already increased 20-30% since last year, and there’s a constant fear gnawing at him and his colleagues.
After growing up along Kansas’s border with Colorado, Seyb knew he wanted to treat patients in rural areas. He moved to Idaho 23 years ago to do just that. The now 61-year-old is growing increasingly frustrated with his state and worried that when he retires, his patients aren’t going to have doctors left to care for them. It can feel like there’s “a noose around our necks”, Seyb says.
Last year, Idaho’s strict abortion bans immediately made it difficult for providers like Seyb to help people experiencing pregnancy complications or lethal fetal anomalies end their pregnancies – what was previously considered the standard of care. In the 11 months since the bans have been in place, Idaho has seen OB-GYNs, nurses, midwives and other staff speak out about these challenges. They’ve made difficult decisions to leave for states where they felt they could practice without the threat of criminal penalties. Multiple hospitals in Idaho have closed maternity units in part due to staffing issues, with one explicitly citing the political climate. Democratic state legislators have wondered aloud whether they can continue raising children in the state. And, in arguably the most dramatic change, five of the state’s nine full-time maternal-fetal medicine specialists have left or will leave their jobs by the end of this year, according to doctors at St Luke’s medical center, where Seyb works.
Seyb is sad to see his colleagues leave, but it’s not just their friendship that he misses. As specialists in high-risk pregnancies at the largest hospital in the state, a major part of the job is advising other physicians on caring for their patients when pregnancies turn complicated – something that happens every day.
Medicine has gotten more collaborative in recent years, Seyb says, which is usually a good thing. Physicians learn from each other and those who work in smaller communities can access the expertise of doctors in Boise. But the exodus is already increasing patient loads, adding stress to other women’s health providers and threatening this delicate balance.
“It feels like a step backward in improving the health of women and children in the state,” Seyb says. Soon, he warns, “we’ll see a collapse in women’s healthcare” in the state.
Idaho’s abortion ban, which took effect after the supreme court overturned Roe v Wade last year, only offers exceptions if the pregnant patient’s life is in danger and in the case of rape or incest – if the patient reports the incident to the police. Additionally, that exception is only allowed in the first trimester.
Another law that went into effect last August allows patients’ family members to sue a provider for at least $20,000 if they believe an abortion violates the law. A newer third law makes it a crime to help a minor travel out of state to end their pregnancy without parental permission.
Between all of these laws, doctors can face not only civil suits with fines, but also the suspension of their medical licenses, felony charges and prison time.
Even before the new laws, Idaho had a limited number of healthcare providers. But Dr John Werdel, the medical director for women’s services at St Luke’s medical center, says the state’s access to nature and outdoor activities made it a desirable place to live. When the hospital previously offered physicians jobs, up to 90 or 95% of them would accept, Werdel says.
Now abortion bans are making it much more difficult to recruit physicians and keep them there.
“As access becomes complicated, then the workload of everybody goes up to the point where it’s not sustainable. And that’s where you end up losing more people,” Werdel says.
Seyb’s practice at St Luke’s is made up of six maternal-fetal medicine physicians, most of whom are nearing the end of their careers. Five years ago, the group recruited two younger female doctors to join the practice, and both of those women have left this year for states where abortion is still legal.
“We all want to do what’s best for our patients,” says Dr Kylie Cooper, one of the maternal-fetal medicine specialists who left. “Not being able to do your job and not being able to help people, and just the weight of that, I see it in my colleagues and it just breaks my heart.”
People rally for abortion rights outside the Idaho statehouse in downtown Boise, Idaho, on 14 May 2022. Photograph: Sarah A Miller/AP
It’s not just the high-risk OB-GYNs who are leaving. Ten general OB-GYNs in the panhandle region of the state alone have left or resigned since last year, says Werdle. The day before he spoke with the Guardian, another physician at St Luke’s told Werdel he was going to start spending 40% of his time in California because, as the doctor put it, “my livelihood isn’t at risk.” Two other OB-GYNs in a nearby practice are cutting back on the types of patients they see due to the legal risks. Younger nurses have asked to move to different units and away from obstetrics altogether.
Idaho’s law this spring that banned gender-affirming care for minors and rightwing lawmakers’ attempts to limit books in public libraries and schools affect retention too. “How do you rebuild when you’ve got the groundwork here now that’s just so poisonous?” Seyb wonders.
His group has struggled to make up for the losses. So far, they’ve found one older doctor who has ties to Idaho and will join the practice for a few years before retiring, and they are hoping they can convince a new physician to join in 2024 with a much higher signing bonus, but there’s no guarantee that new doctor will stay long-term. “That person is likely to find themselves uncomfortable with the law and might choose to leave anyway,” says Werdel.
With more providers leaving, the remaining high-risk OB-GYNs are more at the center than ever.
“We as a group have been forced to ensure that we understand what the laws are so that we can counsel and guide our colleagues,” says Dr Duncan Harmon, another maternal-fetal medicine doctor in the St Luke’s group. “You also want to provide some protection for you, particularly in the sticky scenarios where maybe this could turn into an exception for the state of Idaho law. Is that going to put the patient at risk? Is that going to put me or my colleagues at risk?”
Often, Harmon says the answer is that patients must now be sent to another state to get care. With fewer maternal-fetal medicine physicians, each of them are on call more frequently and have to make more potentially risky decisions. The St Luke’s OB-GYNs are also getting additional patients transferred to their facility from outlying areas where maternity wards have closed or smaller hospitals don’t feel comfortable treating patients under the restrictive laws. This can increase time and costs for patients already in distressing situations.
Harmon plans to stay in Idaho for now, but he is also the lone younger doctor in the St Luke’s practice. The female physicians who left were his closest colleagues and friends.
“When you move to a new city and a new state, part of seeking a new job is you’re seeking a new community and you want to build some roots so that you have social support,” Harmon said. Without them around, he worries that the political climate could push others to retire and leave him entirely alone.
This fear isn’t unfounded. Two of the physicians in the group already work part time. Seyb has started to think more seriously about cutting back. He served on Idaho’s maternal mortality review committee, which the state legislature refused to renew this year. The committee recently released its final report examining maternal deaths, and Seyb said the state’s choice to end that compounded the feeling of “disrespect” he sees for women and children in the state.
St Luke’s has hired temporary physicians to help relieve some of the increasing workload, but it can be hard for doctors only there for a week at a time to build trust with patients and nurses, Seyb says. If the state’s laws don’t change, he expects more providers could still leave and exacerbate the situation.
“If you ever start feeling like you’re starting to cut corners or can’t be involved the way you need to be, it’s extremely stressful,” Seyb said. “Some of us older folks are like, man, we’ve worked hard over the years, and it’s hard to stand and watch that or be part of it. It’s demoralizing.”
The doctors aren’t done pushing their state to change yet. When Roe fell last year, Werdel says the hospital put out guidance to help its doctors navigate the new legal landscape and worked with the Idaho Medical Association to push for more exceptions to the state’s law. But he feels they ultimately didn’t do enough. Lawmakers passed a bill this spring that modified the near-total ban but did not add exceptions for the life or health of the pregnant patient as he and other doctors were hoping. So now they are re-engaging in a much bigger way.
Physicians and leaders in the state have been in touch with the Center for Reproductive Rights, he said, about collecting patient stories like those in Texas, where a group of women has sued the state over its strict abortion law. The hospital is also re-forming its committee dedicated to the abortion laws, and plans to rewrite laws they would like to see passed next year, talk to many more physicians and get providers who identify as “pro-life” on board with pushing for change. “We’re going to try to work our way through this,” Werdel says.
Back at the maternal-fetal medicine practice, Seyb, Harmon and their colleagues are trying to focus on helping their patients, but every day still brings new challenges and risks. They emphasize that they’re still able to care for patients right now, but as more doctors leave, they worry that could shift before legislators decide to change the laws.
“The question is, how long is this going to take to get this resolved?” Seyb says. “It’s going to be a long, difficult journey.”
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