Why Are OBGYNs Being Forced to Go to Texas?

Doctors shouldn't have to risk arrest to be board certified

It’s hard to imagine a more dangerous place for abortion providers than Texas. Doctors who perform abortions face up to life in prison, with civil penalties of at least $100,000. That’s to say nothing of the physical risks: violence against providers and clinics has skyrocketed since Roe was overturned, with a 2022 study showing major increases in stalking, death threats, and invasions.

So you can imagine how OBGYNs felt when they got an email last month from the American Board of Obstetrics & Gynecology (ABOG) telling them they’d have to take their certifying exams in Texas this year.

Dr. Joseph Ottolenghi, a practicing OBGYN in New York City, is supposed to get his board certification this year. But as an abortion provider, he’s understandably fearful. He and his wife, also an OBGYN (who preferred not to be named), talk about the exam and the possible risks every single day. 

While he’s in New York, Ottolenghi has shield laws to protect him from any out-of-state prosecutions. “I’m terrified that the second I step foot in Texas I could be arrested,” he says.

ABOG, headquartered in Dallas, is telling candidates that they “should not be at legal risk” because Texas’ criminal and civil penalties only apply to abortions performed in the state. But the group hasn’t addressed the danger for doctors in pro-choice states who ship abortion medication to Texas patients via telehealth—potentially a tremendous criminal risk.

It was also just last week that a group of Republican attorneys general, including Texas AG Ken Paxton, pushed the Biden administration to allow them access to medical records of those who get out-of-state abortions. So if there’s a question of how broadly Texas law enforcement plans to interpret their ban, it seems fair that doctors would want to err on the side of caution. 

Especially considering that the exam itself necessitates that some doctors talk about their work in abortion care: In order to be certified, OBGYNs must prepare a list of cases that they’ve worked on and are ready to discuss with a panel of examiners. 

For OBGYNs of reproductive age, the threat of traveling to Texas goes beyond legal concerns. Those who are pregnant or considering becoming pregnant aren’t keen on being in a state that would rather let them die than provide them an abortion. 

And while ABOG says they have a partnership with a nearby hospital offering “high standards of obstetrical care in medical emergencies,” pregnant OBGYNs know better than anyone what the standard of care is—and that they’ll be unable to get it in Texas. After all, the state is being sued right now by 15 women whose lives and health were endangered by the ban.   

There’s also something uniquely terrifying about the idea of hundreds of OBGYNs, many of whom perform abortions, all descending on one publicly-listed building at the same time in a state filled with anti-abortion sentiment, few gun regulations, and a recent spate of mass shootings. (ABOG’s emailed promise that their staff is trained in “active shooter response” isn’t all that reassuring.)

Given the legal, physical, and emotional threats to doctors—testing-taking is anxiety-inducing enough in a state where you’re not afraid of being arrested or killed—there’s no real justification for ABOG’s decision. 

It’s plainly unethical to ask doctors to put their freedom and lives at risk over an exam that could be given remotely or in another state. 

In fact, the organization has held certifying exams remotely for the last few years. The exams were held online in 2021 due to Covid; and in 2022, ABOG announced the exams would remain remote because of a surge in Covid cases and “concerns regarding the U.S. Supreme Court opinion on Dobbs v. Jackson Women’s Health Organization.” (ABOG’s decision that year was also likely influenced by a preemptive outcry from OBGYNs who had heard rumors that the group was considering a return to in-person exams in Texas.)

Given that the exams have been successfully conducted remotely, and that ABOG is explicit in their support for reproductive rights—even threatening to revoke the board certification of doctors who spread misinformation about the procedure—some OBGYNs believe the organization’s insistence on holding the exams in Texas must be a financial one. 

The organization is scheduled to open a new $34 million dollar office building later this year. And according to city permits reported by The Dallas Morning News, the 126,000-square-foot space will include the group’s offices, a conference center, and—you guessed it—a testing facility. 

If you’re wondering why an organization for OBGYNs would spend that kind of money to permanently set up shop in a state so hostile to women’s rights, you’re not alone. In the organization’s FAQs on the new building, ABOG preempts that particular criticism, writing that “the economic impact of ABOG moving out of Texas will not solve or influence Texas legislation or the current national issues regarding reproductive health.” This language mirrors the group’s 2021 statement defending their decision to remain in Texas after the state passed SB8: 

“If the U.S. Supreme Court overturns Roe v. Wade, legislation will once again impact the patient/physician relationship throughout the country. The geographic location of ABOG’s headquarters will not matter.”

But when you’re requiring the nation’s OBGYNs to travel to a place where they could be prosecuted—or their lives endangered—it does matter. Quite a lot. 

Because while OBGYNs aren’t legally required to take the exams, being ‘board-certified’ is only theoretically voluntary. Most hospitals and practices require that OBGYNs be board-certified in order to work there, as do most hospitals when granting admitting privileges. It’s also a requirement if you want to have any sort of leadership position at some point in your career, like being a medical director. Health plans also tend to give board-certified doctors higher insurance reimbursement. 

All of which is to say: simply forgoing the exams isn’t really an option. For doctors who might be at risk in Texas, it’s a no-win situation: If abortion providers and pregnant OBGYNs decide that traveling to the state is too dangerous, it means that those particular groups will be the ones locked out of the best jobs and leadership roles.

ABOG may offer accommodations to doctors whose anxiety about traveling to Texas would seriously impact their ability to take the exam—but that, too, is an issue of privilege. The doctors most likely to get accommodations are those employed by medical centers with good lawyers and the ability to provide adequate documentation to the organization.

As Ottolenghi gears up for the exam and the possibility of having to go to Texas, he’s decided not to put any abortion cases on the list he’s preparing to submit. “But it only makes me only marginally feel better,” he says. It’s also a morally-fraught decision: If no OBGYNs put abortion cases on their lists, and abortion isn’t discussed and examined in the board certification program, it adds to the abortion-training crisis spreading across the country.

But OBGYNs need to turn their case list in to ABOG in just a few days—by August 1. And at the end of the day, doctors need to ensure that they remain personally safe. What Ottolenghi really wants to know from ABOG? “How do they plan on protecting us?”

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