By Allie Reed

The American Board of Obstetrics and Gynecology will hold a virtual certification exam in the fall in part due to concerns for prospective OB-GYNs’ safety following the Supreme Court’s decision to overturn Roe v. Wade.

About a thousand future OB-GYNs would have had to travel to Texas in the fall to take their board certification exam, which advocates worried could increase their risk of being prosecuted under the state’s strict anti-abortion law.

The board, which is based in Texas, requires future OB-GYNs to pass written and oral exams. It moved these exams online due to the Covid-19 pandemic, but had planned to host them in person again starting in October.

The legal landscape for OB-GYNs has changed vastly since the exam was last held in person, with Texas adopting one of the most stringent anti-abortion laws in the US prior to the fall of Roe v. Wade.

In order to prioritize the “safety and well-being of candidates, examiners, and our staff,” the board switched to remote delivery in light of the uncertainties ahead in the next few months with the Covid-19 pandemic and the SCOTUS opinion on Dobbs v. Jackson Women’s Health Organization, according to an email sent to test-takers.

More than 500 OB-GYNs previously wrote a letter to the board asking for it to be moved online.

“The state of Texas has severely restricted access to abortion and has allowed private citizens to take legal action against anyone suspected of assisting or performing terminations. Mandating travel to the state poses an unacceptable risk to our personal safety,” the letter said.

The pivot to an online exam “is really overdue,” said Melissa Wong, a maternal fetal medicine specialist at Cedars-Sinai who signed the petition. “I tragically don’t see our laws changing any time soon,” she said.

The American Board of Obstetrics and Gynecology did not respond to a request for comment.

SB8 Boundaries Unclear

Texas’ SB8 law bans abortions after around six weeks of pregnancy, and emboldens private citizens to report those who perform abortions, aid and abet them, or plan on aiding and abetting them.

The law obviously applies to OB-GYNs in Texas, but it could also potentially be used to prosecute out-of-state doctors who perform abortions on Texas residents in states where abortions are legal, said Cary Franklin, professor at UCLA School of Law and faculty director of the Center on Reproductive Health, Law, and Policy.

“Given how many people are leaving Texas to get an abortion in other places, the reach of SB8 potentially becomes very large,” Franklin said.

The Accreditation Council for Graduate Medical Education requires trainees to “have experience with abortion and its complications,” the letter said. “Due to the ‘aid and abet’ clause included in SB8, we may be targeted for legal or political retribution.”

It’s unclear whether providers stepping foot in Texas take on any increased liability above what they face elsewhere in the country, said Josh Blackman, a professor at South Texas College of Law.

“I don’t know that the fetal heartbeat law would apply to an abortion performed out-of-state that had no connection to Texas,” Blackman said.

But a large-scale event like the exam could make OB-GYNs “an attractive target for anti-abortion advocates who want to stop doctors from performing abortions,” Franklin said.

The online format may not be enough to protect OB-GYNs from legal liability for their practice.

“I honestly don’t know how the practice of obstetrics and gynecology is feasible any more in Texas,” said Sara Rosenbaum, a professor of health law and policy at George Washington University’s Milken Institute School of Public Health.

Doctors as Patients

Some of the OB-GYNs taking the exam could be pregnant themselves, as was the case for Michal Elovitz, a professor of OB-GYN and maternal fetal medicine. She started bleeding during her board exams years ago. “I wouldn’t get optimal care in Texas because providers are restrained by the law,” Elovitz said. “That really scares me for pregnant individuals.”

The Biden administration has assured providers that the Emergency Medical Treatment and Labor Act, which requires them to stabilize patients experiencing medical emergencies, prevails over state law. But today the Texas attorney general sued to block the administration rule.

“Doctors will be chilled from providing the best health care,” Franklin said.

Advocates also asked that the exam be held online due to the “risks of travel and congregating in large settings during the ongoing Covid-19 pandemic.