Tuesday, December 30, 2008

The Greying of Abortion Providers: Doing the Math

Anyone who follows reproductive politics is likely aware that the doctors who provide abortion services have been rapidly aging. Now, a new survey of abortion clinics helps us quantify the situation. It reports that nearly two-thirds of providers (63 percent) are aged 50 or older.

The survey has some limitations. It looks only at clinics and not at doctors who provide occasional abortion services as part of a broader ob/gyn practice. The survey was circulated in 2002 and I have no clue why results are only now being published.

Still, the statistic on the aging of abortion providers seems solid enough that I decided to do the math and try to project what it means for the future availability of abortion services.

Let’s say we have 100 doctors. Assuming an average retirement age of 65, over the next 15 years 63 will retire, leaving 37 still in practice. This assumption is subject to error because while some providers may stay on past age 65 for lack of a successor, others may retire earlier due to burnout or fears for their personal safety.

Now let’s assume that the rate of entry into practice has been linear over the past 25 years – in other words, that the 37 younger doctors began practicing over the past 25 years and trickled into the field at a steady pace. This is probably optimistic. Training in abortion techniques has become less common in medical schools, and it’s more likely that the number of entrants per year has declined steadily over time.

Over the course of the next 15 years, the retirees will be replaced by (37 divided by 25 for the number of entrants per year) x (15 years) = 22 new doctors. Instead of the original 100 doctors, we’ll have only 59.

In other words, we can expect the number of abortion providers to decrease by about 40 percent over the next 15 years.

However you do the math: The current shortage of abortion providers is on course to become an all-out crisis.

Let's make one further assumption: A safe abortion, performed by a qualified, trained doctor, is preferable to an unsafe one. So I won't respond to comments that demonize abortion in general; that's not what this post is about. While I recognize that some opponents of legal abortion may see the provider shortage as an another route toward reducing the number of abortions, that idea belongs in fantasyland. There are much more effective strategies for reducing abortions that don't put women's health at risk.


Christina Dunigan said...

Let's make one further assumption: A safe abortion, performed by a qualified, trained doctor, is preferable to an unsafe one

I notice that the survey was of members of the National Abortion Federation. I have to quibble a bit about how they define "safe", which if you go by their referral process means "a NAF member.

Supposedly they require their members to adhere to strict standards of care. Consider that among their members was Abu Hayat, who made headlines when he ripped the arm off a 32-week fetus in an abortion attempt, only to have the maimed child born live at a nearby hospital and her outraged mother go public. Turns out he'd been sexually abusing his patients, and had fatally botched an abortion on a teenage girl, then tried to deny he'd ever seen her.

Another NAF member managed to fatally injure two teenage abortion patients almost simultaneously.

Hanam Rotem, another NAF member, had an untrained receptionist providing general anesthesia.

Even the cream of the crop is pretty cagey. It doesn't seem like abortion attracts the best and the brightest. Which is no surprise. One aspiring abortion doctor, very active in Medical Students for Choice, was excited to practice abortion technique on a papaya at a workshop. But she changed her mind about wanting to go into abortion practice after spending time in an actual abortion facility. Why? In her words, "A papaya doesn't bleed and scream."

Sungold said...

Hi GrannyGrump. I checked out your blog and I have to say, I respect your intelligence and your thorough research. We will have to agree to disagree on a whole slew of points, but if you ever publish a book I'd be interested to know about it.

Your analysis of the decline of maternal mortality over the course of the 20th century is quite good. After 1960, sanitation improvements were no longer the key, however. It's much more plausible that women benefited from doctors' increasing willingness to provide abortions for mental health reasons.

I realize that you probably deplore the broad application of a mental health indication, while I think it was a reasonable response to the carnage of illegal abortion. However, on the level of historical analysis, I think that this change in practice is a factor that you need to account for, and there's good reason to believe that doctors' attitudes were shifting rapidly during that decade. I am a historian of childbirth, so I'm well versed in the literature.

I think we totally agree on one point: Women deserve competent health care providers. I will not defend quacks and incompetents. I agree that it's hard to attract the best young physicians to become full-time abortion providers. If I were a young doctor, I'm sure I'd find it more rewarding to be an ob/gyn. Where we part ways is that I see a need for the provision of safe abortion, while you'd like to eliminate virtually all abortions.

Finally, I'd like to point out that on a statistical level, legal first-trimester abortion performed by a trained physician remains substantially safer than childbirth. You cite a number of appalling cases where women and girls died unnecessarily. And childbirth is, of course, still far safer than in the past. However, medicine still hasn't found a way to cope with the number one killer in Western societies, eclampsia. I'm not saying women should choose abortion because it's safer than childbirth (obviously not! I have two kids of my own). I'm just trying to put the risks in to perspective.

Again, thanks for your comment. And I wish you all good things in the year ahead.