A High-Stakes Journey for Doctors
For doctors specializing in obstetrics and gynecology, earning board certification is a vital step to prove their expertise. But the process has grown increasingly complex, with some facing unexpected legal and safety risks. In certain states, laws restricting reproductive and gender-affirming care create a challenging environment for providers seeking certification. This issue touches not only the doctors but also the patients who depend on their skills for critical healthcare services.
The American Board of Obstetrics and Gynecology requires candidates to travel to Dallas, Texas, for in-person exams. Texas enforces some of the nation’s toughest laws, criminalizing abortion and restricting gender-affirming care for young people. Doctors who provide these services in other states worry about potential legal action or harassment when traveling to Texas. This situation has prompted urgent discussions about how certification processes can adapt to protect professionals.
A group of 20 state attorneys general, led by California’s Rob Bonta, New York’s Letitia James, and Massachusetts’ Andrea Joy Campbell, has stepped in. They’ve pressed the American Medical Association to advocate for safer certification pathways. Their testimony underscores the need to shield providers while ensuring patients can access essential care. With state laws reshaping healthcare, the issue demands immediate attention.
The Role of Certification in Medicine
Board certification confirms a doctor’s expertise and commitment to high-quality care, especially in fields like obstetrics and gynecology, where reproductive and gender-affirming care are key. Since the 1970s, certification has included reproductive health skills, and by the 2010s, it began addressing transgender care. However, recent state laws have complicated this process, creating barriers that earlier frameworks didn’t anticipate.
After the Supreme Court’s 2022 Dobbs decision ended federal abortion protections, states like Texas introduced severe restrictions. Abortion there is now a felony, carrying a potential life sentence, and private citizens can sue providers. Gender-affirming care for minors faces similar limits. These laws create a risky environment for doctors traveling to Texas for exams, raising concerns about their safety and legal exposure.
The attorneys general argue that requiring in-person exams in such states endangers providers and threatens access to care nationwide. If doctors avoid certification due to these risks, the pool of qualified professionals could shrink, worsening shortages in areas like maternity and primary care, especially in underserved regions.
Balancing Safety and Standards
To tackle this issue, the coalition proposes practical steps: moving exam sites to states with fewer restrictions, expanding remote testing, or offering exemptions for at-risk providers. These ideas aim to maintain rigorous standards while prioritizing safety. The American Medical Association has recognized the problem, adopting a policy in 2024 to encourage alternative testing, but the coalition seeks more decisive action to protect candidates.
Some policymakers in states with restrictive laws maintain that local control over medical licensing reflects community values. They argue that states should regulate healthcare practices, including certification, to align with local priorities, a principle tied to the historical role of state medical boards since the 1800s. This view emphasizes state authority in shaping medical practice.
Yet, differing state requirements risk creating uneven medical standards. Providers in states like California or New York, where care is protected, still face challenges from out-of-state legal actions targeting their lawful work. A consistent approach is needed to ensure doctors can practice without fear, preserving access to care across the country.
Ripple Effects on Patients and Providers
The impact of this issue reaches far beyond individual doctors. Since the Dobbs ruling, medical training programs in restrictive states have seen application drops of up to 10%. Many providers are moving to states with more permissive laws, deepening healthcare shortages in places like Texas and Idaho. This shift particularly affects patients seeking reproductive or gender-affirming care.
States like California, New York, and Oregon have responded with shield laws, protecting providers from out-of-state legal actions by blocking extradition and safeguarding licenses. Medical groups, such as the American Academy of Pediatrics, have also pushed for evidence-based care and flexible certification processes to ensure services remain available.
The clash between state and national standards highlights a broader challenge: maintaining consistent healthcare access while respecting local laws. Ongoing lawsuits, challenging both restrictive and protective policies, place the medical community in a complex position, striving to uphold standards amid a divided legal landscape.
A Path Toward Change
The coalition’s push for reform signals a growing awareness of the challenges doctors face. By urging the American Medical Association to adopt specific policies, they seek a certification process that prioritizes safety and equity. These changes could guide how medical boards adapt to shifting legal environments, allowing providers to focus on patient care without fear.
Finding a solution requires balancing the needs of providers with diverse state laws. Medical associations, state boards, and policymakers must collaborate to create pathways that prioritize patient access while navigating legal differences. The urgency is clear, as delays could widen gaps in healthcare availability.
For both patients and doctors, the outcome of this debate will shape access to reproductive and gender-affirming care. As the medical community works through these challenges, the goal remains clear: ensuring essential services are available to all, regardless of where they live or practice.