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3 ways to stabilize your clinical workforce in a post-Roe world

By Sophia HurrSarah Hostetter

January 9, 2023

    The ramifications of Dobbs v. Jackson on the healthcare workforce are far-reaching. We previously outlined the short-term impacts that healthcare leaders needed to focus on in the immediate wake of the ruling.

    As most provider organizations have transitioned from firefighting to ongoing change management, we are most concerned about implications for female staff and OB-GYN physicians. We expect the most impacts on attrition, timeline for autonomous practice, ability to fill open roles, and patient access. Especially in light of our current workforce crisis, provider organizations don't have the room to lose ground on these key metrics.

    Below we outline three ways the Dobbs ruling could damage your long-term workforce strategy and steps to take now to protect your strategy from these impacts.

    1. Re-examine your comprehensive benefits package to boost retention

    More than three-quarters of the clinical workforce in the United States is female. Specifically, women make up 86% of nurses and 92% of medical assistants—two of the roles most impacted by the current workforce crisis. And according to our 2022 clinician survey, the #2 attribute that clinicians value in their current role is their benefits package. So we can assume that this vast majority of your workforce is paying attention to—and making decisions on where to work based on—the benefits you offer.

    We expect the Dobbs ruling to have ripple effects on what women expect from their employers. Though most of the benefit-focused coverage post-Dobbs centered around covering travel for employees seeking an abortion, the ruling put a focus on the entire suite of benefits, including childcare coverage, fertility coverage, paid parental leave and mental health benefits. These benefits, which are often seen as "nice-to-haves" will become "must-haves" as the Dobbs ruling intersects with the workforce crisis.

    To improve your benefits packages, ask yourself the following self-assessment questions:

    • What have we added to our benefits package to recruit and retain a female workforce? (e.g., childcare coverage, fertility coverage)?
    • What additional supports have we put in place specifically for pregnant people (e.g., paid parental leave)?
    • Have we communicated these changes to our workforce in widespread and easy-to-understand ways?
    • What percentage of our workforce have taken advantage of these benefits?
    • Are there additional benefits that our workforce has requested that we are not offering? If so, is there a way we could offer them?

    2. Revise training protocols to prepare new physicians for state-by-state compliance challenges

    The Dobbs ruling has made medical training in the United States more complex. All accredited OB-GYN training programs must offer access to abortion training because this training is intertwined with other OB-GYN care, such as miscarriage management and excessive uterine bleeding. However, roughly 45% of the nation's current OB-GYN residents train in states that now have restricted abortion laws. This has left residency programs scrambling for ways to provide this necessary training, such as sending students to complete rotations in states that allow abortions.

    The ripple effects of these changes reach farther than residency programs themselves. To free up time to manage this new complexity, some have had to sunset new initiatives, like developing a rotation for complex family planning. Others are adding in new curriculum that will be more critical post-Dobbs, such as training on self-managed abortion or counseling patients grappling with abortion restrictions.

    What we're left with is a patchwork, inconsistent system of OB-GYN training that will impact even provider organizations who do not offer residency programs. It is incumbent on every provider organization to make sure that incoming OB-GYNs are trained to practice in their state, regardless of where they received their training. This may require additional oversight and training for new physicians.

    To plan for inconsistent OB-GYN training, as yourself the following self-assessment questions:

    • If we have a residency program, how will we ensure OB-GYN residents have access to abortion training?
    • Have we communicated curriculum and protocol changes to our clinical students?
    • As we onboard new physicians, how will we assess their readiness to perform dilation and curettage (D&C) procedures, counsel patients on abortion care, and provide comprehensive family planning options?
    • Do we need to implement additional supportive services (e.g., care managers, trauma-informed counselors) to support our OB-GYNs in caring for patients, especially as they transition from residency to practice?

    3. Factor Ob/GYN supply-demand mismatches into workforce planning

    We've already begun to see a shift in where clinicians choose to practice over the past few months. Medical recruiting firms are facing difficulty recruiting OB-GYNs to positions in states with anti-abortion laws, driven both by clinicians' fears of harsh civil penalties in their medical practice and access to abortion services for themselves.

    This is particularly concerning given that HHS predicts a shortage of OB-GYNs nationwide by 2030. Looking state-by-state, only two of the states where abortion is currently illegal (Missouri and Louisiana) are expected to have enough OB-GYNs in eight years.

    The other 10 states who have outlawed abortion are already facing supply/demand mismatches of anywhere from 10% (Tennessee) to 34% (Oklahoma). And this assessment was completed before the Dobbs ruling. We expect these shortages to exacerbate as OB-GYNs elect to practice elsewhere.

    On the other hand, states that have protected abortion should anticipate an increase in women seeking abortion services. According to our analysis, 49% of women who are denied abortion in their home state will seek one elsewhere. In addition, these states face the added demand of residency training we discussed in the previous section.

    To prepare for an OB-GYN supply/demand mismatch, ask yourself the following self-assessment questions:

    • What incentives have we created/do we need to create for OB-GYNs to stay at our organization post-residency?
    • Do we need to restructure our OB-GYN care teams? Should we hire more midwives to offset our supply/demand mismatch?
    • If we are in a state that allows abortion, are we using our location to appeal to OB-GYN staff?
    • If we are in a state that allows abortion, what is our expected demand of abortion seekers from other states? How will this impact our access to OB-GYN care?
    • If we are in a state that does not allow abortion, have we projected the impact of additional pregnancies and complications on our OB-GYN demand? How will we adjust staffing in response?

    Don't wait to act

    As we look ahead to the more far-reaching impacts of the Dobbs v. Jackson decision on the clinical workforce, organizations need to prioritize strategies for female employees and OB-GYNs. Each of these three windfalls from the Dobbs ruling could have serious and long-lasting impacts on your workforce retention, training, and recruitment efforts.

    Deliberate review of your policies and plans for these vulnerable areas can save you from unexpected—but otherwise inevitable—threats to long-term workforce sustainability.

    Abortion laws are continuing to change: Here's how to help your clinical workforce right now

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    The ramifications of the Dobbs v. Jackson decision are far-reaching, and not only do leaders have to navigate consequences for patients themselves, but they must also balance the needs of the clinical workforce.

    Here are a few ways that leaders of provider organizations should address the most pressing impacts of the ruling on their workforce right now.

    Read more

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