Dr. Carrie Wang started her medical training to be an OB-GYN in Florida. She said she was interested in the specialty because it lets her do both in-office care and surgery.
“We really get to walk with people through getting their first IUD, getting pregnant for the first time, then walking them through the menopause transition,” Wang said. And she can care for those same patients in the operating room.
“It's wonderful to have a patient come in with terrible periods, and then we take her uterus out, and we get to just fix that problem for her in the OR,” she said.
During Wang’s medical schooling, Florida enacted a six-week abortion ban.
She said it made her concerned about whether she could provide evidence-based care for her patients.
“I also was just worried about my surgical training,” Wang said. For example, one procedure OB-GYNs learn is to empty a uterus.
“That is a life saving procedure. And it's not something that we only do for abortions. We also do it in miscarriage care. And I was really concerned that I wasn't going to get that type of training.”
Wang, a second year resident at Dartmouth Hitchcock Medical Center, now finds herself in a state where she can provide more comprehensive abortion care, since New Hampshire allows abortion up to 24 weeks.
However, she doesn’t have as much legal protection for providing that care as she would in neighboring states.
So-called "shield laws" provide legal protection for medical providers who give abortion care to patients from states with abortion restrictions. After the overturning of Roe v. Wade in 2022, at least 22 states and the District of Columbia passed abortion shield laws. In states with shield laws, so long as a provider follows their state laws for abortion care, they cannot be held to the legal consequences of another state’s abortion laws if they care for a patient from that state.
New Hampshire is the only state in New England that hasn’t enacted a shield law.
The latest attempt to pass a shield law failed in the Legislature this session. Wang testified in favor of a shield law, and said she’s aware that one part of her job tends to get a lot of attention: abortion care.
“I spent an entire day on the labor floor today and spent most of my time taking care of complicated pregnant patients and postpartum mothers,” she said. “We do so, so many other things. I feel like this one part of our field gets so much focus because people have such strong emotions around it, and I completely understand that, but being a full scope OB-GYN is so, so much more than just providing abortion care.”
“Even though it is a contentious field, it's a high liability field. It feels like every day I'm scanning the news to look for laws and updates that are actually going to personally affect me, which is definitely a stressful way to practice medicine, but I would not pick another specialty in a million years.”Dr. Carrie Wang
Opponents of the shield law that was proposed this year say that people from out of state could go to surrounding states for abortion care. But medical needs can be unpredictable, and for some patients in northern New England, residents or not, Dartmouth may be their best option.
Dr. Kali Sullivan, who is also a second year OBY-GYN resident at Dartmouth, often treats patients who have been referred to Dartmouth from smaller hospitals or doctors’ offices in rural New Hampshire and Vermont.
“We primarily get very high-risk pregnancies and very high-risk abortions,” Sullivan said. “There are also more low-risk people as well, definitely. But I would say a majority of what we do is fairly high-risk.”
And with the closure of at least nine rural labor and delivery centers in the state in recent years, people are traveling further to receive maternal care at places like Dartmouth.
Being an OB-GYN already comes with risks. OB-GYNs face some of the highest medical malpractice lawsuits, studies show, in part because of the high risk, complex nature of obstetrics and gynecology.
Sullivan, who went to medical school at Tufts University School of Medicine in Massachusetts, came to Dartmouth from a state with a shield law.
She said she likes that her field is a mix of primary care, emergency medicine and reproductive health and that she gets to work with patients over many stages of life.
“It's just like these incredibly sensitive and special moments in people's lives that we have the privilege to be a part of,” Sullivan said, “as well as very difficult decisions that people sometimes have to make.”
As it stands, if OB-GYNs like Sullivan and Wang provide abortion care for a patient from a state with stricter abortion laws than New Hampshire, they could be legally liable.
Since the overturning of Roe v. Wade, Texas is among the top states for the number of lawsuits against abortion providers, including lawsuits against out-of-state providers. In those circumstances, the state has tried to hold out-of-state doctors legally responsible for providing abortion care to a Texas patient in violation of Texas state law.
For OBGYNs like Sullivan and Wang, the lack of protection for the people providing that care is anxiety-provoking.
“Even though it is a contentious field, it's a high liability field,” Wang said. “It feels like every day I'm scanning the news to look for laws and updates that are actually going to personally affect me, which is definitely a stressful way to practice medicine, but I would not pick another specialty in a million years.”
“I think that it's very important for people who are going to be practicing in the state to have some protection for the care that we provide,” Sullivan said. “I feel like I felt more strongly about that coming from a state that had a lot of support for reproductive rights and reproductive health.”
Right now, since both Sullivan and Wang are only halfway through their residencies, they don’t have to decide just yet whether they will stay in the state. But that doesn’t mean they aren’t thinking about it.
“I think that it's very important for people who are going to be practicing in the state to have some protection for the care that we provide. I feel like I felt more strongly about that coming from a state that had a lot of support for reproductive rights and reproductive health.”Dr. Kali Sullivan
“As I think about my future career, I could see myself leaning towards states that both have a higher gestational age for abortion access and also protection for its providers,” Sullivan said.
Wang said she’s interested in doing additional training that could take her out of state, but she could see herself working in New England.
“It's pretty hard for me to think about staying here when I could just go to Massachusetts or Vermont and feel like I'm much more well protected and still get to stay in the New England area,” Wang said.
New Hampshire, like many states across the country, is experiencing a shortage of maternal health providers, which is expected to worsen in coming years.
“That lack of protection would actually make us want to leave,” Wang said. “I know that we don't have enough OB-GYNs in New Hampshire, and I think that would be a real blow.”
