BOISE, Idaho — As Idaho reels from an exodus of obstetricians, lawmakers have raised the alarm about the state’s doctor shortage — and this legislative session, they’ve put forward a raft of bills they said would address the problem.

Their efforts to do so have included proposals to allow doctors to refuse to perform procedures they don’t believe in; to limit the ability of a woman’s relatives to sue a physician who performs an abortion on her; and to cut back on Idaho’s involvement with the University of Washington’s medical school.

“Idaho faces a critical need for more physicians, particularly in rural and underserved areas,” said Rep. Dustin Manwaring, R-Pocatello, in a committee presentation of one of the bills to pull back involvement with the University of Washington’s multi-state medical education program. The bill, he said, “is a serious attempt and a serious effort to strengthen Idaho’s medical workforce.”

But in recent years, medical professionals have been pushing for one notable proposal that has yet to move forward: letting doctors perform abortions to protect a pregnant patient’s health.

Idaho consistently ranks last among U.S. states for the number of physicians it has per capita. After a state ban on abortion took effect in 2022, more than one-fourth of obstetricians left Idaho. A survey by the Idaho Coalition for Safe Reproductive Healthcare showed that over 95% of the physicians considering leaving the state since the abortion ban would stay if the law were amended to add exceptions to preserve the mother’s health.

Under the current law, performing an illegal abortion is a felony that could warrant the suspension of revocation of doctors’ medical licenses, or could land them in jail for up to five years.

Susie Keller, CEO of the Idaho Medical Association, said lawmakers are missing the mark. OB-GYNs’ real concerns relate to the state’s abortion ban, she said. The only exceptions for the procedure are in cases of reported rape or incest, ectopic pregnancies, or when the mother’s life is at risk.

That approach flies in the face of doctors’ medical training, and has driven OB-GYNs away from Idaho, Keller said.

“The elephant in the room — the thing that absolutely has to be solved if we are ever going to put any kind of a dent in this deficit — is that we have got to pull back on Idaho’s frankly insane total abortion ban that has no health exception,” Rep. Ilana Rubel, D-Boise, told the Idaho Statesman. Rubel sponsored a bill to repeal all of the state’s abortion bans, though it did not receive a hearing.

One Republican, Sen. Jim Woodward, R-Sagle, introduced a bill this session that would have allowed for such an exception, but it never received a hearing, the Idaho Capital Sun reported.

Abortion ban isn’t ‘primary’ reason for doctor shortage, lawmaker says

A woman who plans to have her baby comes into the emergency room with her water broken when she is only 15 weeks pregnant. It’s a sad diagnosis: At such an early stage in the pregnancy, the fetus is unlikely to survive outside the womb. But if it’s not removed within hours or days, the woman could be at risk of sepsis, or of losing her uterus.

In another state, this might be a clear-cut case for physicians to perform an abortion to protect the mother’s health, Keller said. But in Idaho, because of the abortion ban, doctors will more likely spend time consulting one another and their hospital’s attorneys about whether the woman’s life is sufficiently at risk to end her pregnancy, Keller said.

“That’s a high bar,” Keller said. “What I hear our doctors say is, ‘How close to death does she have to be? Has she lost 10% of her blood? Has she lost (more)?’”

The law, which threatens doctors with prison time, has created uncertainty and anxiety among doctors about what treatment is legally allowed, and when, Keller said.

Manwaring acknowledged that clarifications to the state’s abortion statute may help Idaho to recruit more OB-GYNs and assuage the concerns of those considering leaving the state. But “it is not accurate to say” that the lack of a health exception in Idaho’s law “is the primary reason for our physician shortage,” he told the Statesman by email.

“Idaho’s ranking as 50th in the nation for physicians per capita is attributed to several factors, of which recent legislative measures may be only a part of the story,” Manwaring said. Those include lower pay, lack of access to medical education and, in rural Idaho, possible professional isolation and a lack of job opportunities for physicians’ spouses, he said.

Manwaring said he was “interested in” a health exception to the state’s abortion ban that could “also keep the intent of Idaho’s abortion laws to protect life,” he said. But it can be difficult to thread that needle, he added, without ambiguity in the law leading to legal challenges over its parameters.

A concern about the lack of medical education available to Idaho students prompted him to sponsor House Bill 176, and later, House Bill 368, which aimed to cut or phase out the University of Idaho’s participation in the University of Washington’s multi-state medical education program. The program known as WWAMI — Washington, Wyoming, Alaska, Montana and Idaho — reserves 40 seats in the University of Washington School of Medicine for Idaho students who train and pursue residencies in their home state.

Rep. Bruce Skaug, R-Nampa, who sponsored a bill to limit legal action against doctors who perform legal abortions, argued the proposal would protect “physicians who practice in a way that safeguards the lives of mothers and their babies against frivolous and unreasonable lawsuits.”

“The legislators I work with in this body, which includes all of you here, value our OB physicians, and we seek to defend them as crucial partners in defending and preserving life in Idaho,” Skaug told a committee.

And during discussion of House Bill 59, which would allow medical providers to refuse to provide care with which they morally disagree, sponsor Sen. Carl Bjerke, R-Coeur d’Alene, argued such a change would help attract doctors to the state by allowing them to give patients more honest advice. Bjerke did not respond to a request for comment for this story. Gov. Brad Little has since signed the bill into law.

Meanwhile, other bills passed this session, including cuts to the state’s Medicaid expansion program, and a $500,000 cut to its rural physician incentive program, “managed to make a bad situation even worse” in terms of medical access, Rubel said.

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