Wisconsin OB-GYN student: The April 1 election will affect your doctor’s ability to take care of you

There’s already a shortage of OB-GYNs in Wisconsin. The repeal of Roe v. Wade in 2022 made the deficiency worse, forcing many doctors to flee the state in order to practice, and leaving students unable to get required training. Now, as the Wisconsin Supreme Court considers a case that will determine the enforceability of an 1849 abortion statute, increasing numbers of OB-GYN students want to get out of Wisconsin, exacerbating the problem further.

“I’ve known since I was probably about 5 years old that I wanted to become a doctor,” said Laurie Lapp, a medical student at the University of Wisconsin-Madison. It wasn’t until Laurie got to college though, that the Menomonee Falls native decided what her focus would be. “I was really interested in women’s health care,” she said.

Shortage of doctors

Laurie is one of a declining number of students who want to practice women’s health care in Wisconsin.

The state already has a shortage of doctors who specialize in obstetrics and gynecology, particularly in rural areas. It’s a trend that was growing prior to the overturning of Roe v. Wade, which ended the federal constitutional right to abortion and allowed states to regulate or ban the procedure. But it’s gotten exponentially worse since.

“I know that over the past decade or so, we’ve seen a lot of rural hospital closures and specifically rural labor and delivery units,” Laurie said. “That makes access a real challenge for people who are trying to get pregnant and have babies.”

“It’s kind of scary.”

Laurie Lapp wants to stay in Wisconsin for her OB-GYN residency for women to be able to access necessary care. Photo courtesy Laurie Lapp

Reluctant to practice

Scarier still is the realization that after the 2022 Dobbs decision that overturned Roe v. Wade, the rush of conservatives to ban abortion in their states is resulting in even fewer medical services available for women.

Doctors are reluctant to practice in places where making the best decision for a patient could result in losing their medical license, huge fines, or even a prison sentence. And when clinics that provide abortions close their doors, all the other services offered there also go away—things like breast cancer screening, exams, and providing contraception.

State Sen. Kelda Roys (D-Madison) said health care providers and physicians shouldn’t have to fear prosecution for providing necessary medical care.

“We already had a huge shortage of health care providers and we see, in states that have abortion restrictions, health care providers are fleeing the state because they don’t want to be put in a position where they’re not allowed to help a patient in need—and they also don’t want to live in a place where their own rights are not respected,” Roys said. “This is true of OB-GYNS, it’s true of emergency room doctors, it’s true of nurses, and other health care providers.”

In Wisconsin, the Dobbs decision triggered a debate over the state’s 1849 abortion law, which some argue bans abortion except to save the life of the mother. A Dane County judge ruled the language was designed to criminalize feticide (killing a fetus without the mother’s consent), and not necessarily abortion. Now, there’s legal uncertainty as the appeals process continues.

“If we can’t practice medicine the way that we’ve been trained to, we’re not going to stay here,” Laurie said. “And that’s a decision I’ve seen a lot of my classmates grappling with, and a lot of them have chosen to leave.”

A study published in the journal Obstetrics & Gynecology in 2023 found that a significant number of graduating OB-GYN residents who had taken part in an abortion training program were planning not to take fellowships or practice medicine in states with abortion restrictions.

Dr. Eliza Bennett, an OB-GYN in Wisconsin, said she’s seen the drop herself.

“There’s good evidence to show that there’s a decrease in people wanting to go into obstetrics and gynecology—and even those who want to go into obstetrics and gynecology rank states with restrictive laws lower, so you just don’t have the same numbers of people getting trained if you continue to infringe on these rights,” Bennett said.

“We already have maternal health deserts in Wisconsin where people have to drive from county to county in order to access maternity care, so having fewer OB-GYNs is only going to further that problem,” Bennett added. “You have longer to drive and babies don’t wait.”

Wanting to stay

For Laurie, the 27-year-old med student, the wait for where she will continue her training will soon be over. She will find out where she’s matched for her residency program this week.

Despite the uncertain atmosphere, she is one future doctor in a growing minority who want to remain in Wisconsin.

“Everything that has gone on has made me more sure that this is what I want to do,” Laurie explained. “And I think it strengthened my resolve that people should have access to evidence-based medicine.”

“That’s true for every field in medicine—but for some reason, OB is just the one field where it’s politicized the most.”

She admits she did “grapple” over whether she wanted to practice medicine in a state where doctors can be criminalized for providing care, but she ultimately decided that her fears weren’t going to deter her from serving patients in Wisconsin.

“One thing I have come to realize is that places like that—Wisconsin was one of those states for a little bit after Dobbs—those are the states that need people the most,” Laurie said.

Reproductive freedom on the ballot  

The Wisconsin Supreme Court is currently considering a case that could determine the enforceability of the 1849 abortion statute, putting the issue front and center in this year’s April 1 race for an open seat that will determine ideological control of the court. 

“We have two candidates up for Supreme Court,” Laurie said. “One of them thinks that the 1849 abortion ban is a great idea—it’s a law without flaws.”

Candidate and Waukesha County Judge Brad Schimel has supported the conservative interpretation of that statute, as a means to ban abortion with no exceptions for rape or incest and with criminal penalites for doctors and nurses.

Laurie goes on to describe Dane County Judge Susan Crawford, the other Supreme Court candidate.  “And we have a judge who has submitted herself to reproductive freedom and protecting our rights to bodily autonomy.”

“The Supreme Court election coming up in Wisconsin is going to decide the ideological balance of the court,” Laurie said. “And with that, so many decisions that affect not just our reproductive freedom, but our ability to practice evidence-based medicine in general.”

“I think people need to hear that these elections affect your doctor’s ability to take care of you.”

An unexpected activist

Laurie never expected to be an activist in this fight for reproductive freedom, but she is determined to be, even though she assumes it to be a constant battle. “It’s something I’ve given a lot of thought to and I’m okay with having to fight, because I think that’s also part of what drew me to Madison,” Laurie said. “I think that doctors are among the best advocates that a person can have, and I have committed myself to that.”

“I don’t think everyone signs up for this career thinking that they’re going to have to fight tooth and nail to be able to do their job, but, that’s kind of implied that I’m signing up for it.”

Laurie said it’s going to take more OB-GYNS and doctors from all specialties speaking up about “patients’ ability to access care or the inability to access care.”

Dr. Bennett fears the consequences if voters elect Schimel. “I lived through Dobbs, I lived through our year-and-a-half of near-ban of abortion in Wisconsin,” she explained. “It was really difficult.”

“I saw patients with very significant problems have to leave the state to get necessary health care. I saw patients have to jump through so many hoops in order to be able to make the pregnancy decisions that made sense for them—that were safe for them—and I don’t want to go back to that. It was really, really difficult to practice medicine at that time. It was really difficult for every single obstetrician that I practiced with and we struggled constantly to try to take care of patients and I don’t want to go back to that.”

With the Supreme Court election April 1, Bennet said “the onus is on all of us.” She suggests voting for what’s in your best interests, as well as the state’s. “And it’s always in the best interests to have high-quality physicians that are well trained. Making sure you’re not passing laws that criminalize physicians is a way to make sure that you continue to have physicians that want to work in your state.”