State laws restricting abortions and gender-affirming care have created confusion for many physicians as they try to identify the line between essential medicine and legality in a fast-moving political environment.
Physicians gathered at the Association of American Medical Colleges' Annual Meeting on Nov. 11 in Atlanta to discuss the impact of laws that have "criminalized medicine," on physicians and their patients.
Here are 12 takeaways on the rise of this kind of medical legislation and its impact on physicians:
1. Caitlin Bernard, MD, an Indianapolis-based OB-GYN, spoke about the legal consequences she faced after performing an abortion on a 10-year-old Ohio patient who had been raped. She summarized several cases where patients with life-threatening pregnancy complications were harmed or died because hospitals were unclear about permissible care under state laws.
2. Dr. Bernard noted that the "imprecise" wording of many laws, along with unclear guidance from medical organizations, has left physicians and lawyers confused about what procedures are legally allowed.
3. Dr. Bernard and Elizabeth Sepper, a law professor at the University of Texas School of Law, urged medical institutions to do more to counteract misinformation spreading about these laws.
4. Both speakers emphasized the need for state health organizations to provide clearer guidance to healthcare workers about what is allowed under these laws while advocating against proposals that further criminalize physicians.
5. Dr. Bernard highlighted the role of physicians in states with restrictive laws in helping patients access care in states where such procedures are less regulated.
6. "People are not wanting to work in states where these laws exist. That's a big issue for OB-GYN now," Dr. Bernard said. "For example, we've had three maternity hospitals in northern Indiana close since our abortion ban went into effect, partly because of the difficulty in staffing them with physicians."
7. The number of U.S. medical school graduates applying to OB-GYN residencies in states with abortion bans dropped nearly 7% this year, according to AAMC, potentially worsening existing physician shortages.
8. According to The Atlantic, 96% of physicians caring for pregnant women in states with abortion restrictions reported feelings of moral distress.
9. Texas Attorney General Ken Paxton recently filed a third lawsuit against a physician providing gender-affirming care for transgender minors. The physician allegedly violated SB 14, a state law passed in September 2023 that prohibits "gender transition" medical interventions such as surgeries, puberty blockers and hormone replacement therapy for minors. The physician is also accused of falsifying medical and billing records to conceal the nature of the hormone replacement therapy prescriptions he allegedly wrote.
10. According to the American College of Physicians, more than 500 anti-LGBTQ+ bills were introduced in state legislatures in 2024. At least 112 of those bills have proposed restrictions in at least 40 states on gender-affirming care or transgender healthcare. Many of those restrictions have been legislative, administrative methods are also being used to restrict access to gender-affirming care in some states.
In Florida, for example, the state's Agency for Health Care Administration prohibited Medicaid from covering gender-affirming care for patients of any age.
11. In 2021, the American Medical Association sent a letter to the National Governors Association urging members to oppose legislation that would "inappropriately limit the range of options physicians and families may consider when making decisions for gender-diverse pediatric patients." The AMA also detailed the impacts of banning gender-affirming care for patients in their Code of Ethics in June 2023.
12. At least 30 other professional medical associations, including the American Psychiatric Association, the American Academy of Family Physicians and the World Medical Association have recognized the medical necessity of gender-affirming care.