Learn how Michigan medical students are navigating their education in a post-Roe world.
Can you imagine being a med student—particularly one who set out to specialize in reproductive health care—right now?
“It felt like the whole rug had been taken from underneath us,” said Madeline Merwin, a fourth-year medical student at Michigan State University’s College of Human Medicine, when asked what it felt like to study reproductive health care after the US Supreme Court overturned Roe v. Wade.
Madeline—who’s studying to be an OB-GYN through MSU’s Leadership in Rural Medicine program (LRM)—is from California, and said reproductive care was something she’d taken for granted before moving to Michigan.
“I’d never lived in a state before where people like myself were getting their access to health care revoked,” she said.
Merwin isn’t alone—she’s one of many medical students who are worried about the long-term effects that the Dobbs decision will have on their future careers in the field of obstetrics and gynecology.
Dr. Rachel Rezmer—who also graduated from MSU’s LRM program—is an OB-GYN and an assistant professor at Central Michigan University’s College of Medicine in Mt. Pleasant. She said the overturning of Roe v. Wade adds a level of complexity in the classroom. There’s more of an emphasis, she said, on teaching students to be aware of the legal or political circumstances of the state they’ll practice in after graduation. However, Rezmer noted that she hasn’t seen any students get deterred from pursuing a career as an OB-GYN, post-Dobbs.
“I think this upcoming generation sees a problem and actively wants to change it. They want to be the people on the frontlines advocating for women and their health care needs over being scared of what is to come.”
So what does educating the next generation of OB-GYNs in Michigan look like?
“The majority of my daily life is not only clinically seeing patients myself, but also teaching and training residents during the four years after medical school to complete their residency in OB-GYN specifically,” Rezmer said.
Being an OB-GYN can be a pretty intense specialty, according to Rezmer. She says that many students look like “deer caught in the headlights” when they enter her department during their third year of clinical rotations.
“Things happen and they happen very quickly. A lot of times students are just overwhelmed with the sheer amount of things we do in a day—not to mention the kind of intensity of the procedures and surgeries that we are able to do,” she said. For example, it’s not uncommon for students to assist obstetricians with delivering babies on their first day in their clinic.
By the end of their rotation, students have the confidence to assess an actual clinical patient who is seeking care at the labor and delivery unit and plan the next steps of that patient’s care. This not only shows clinical staff that the students understood the material that they were taught, but is also an opportunity for students to contribute to someone’s actual health care. Rezmer says that this real-world experience allows students to go through the stages of providing medical decision-making for a patient.
“It’s great to see that kind of evolution over the four to six weeks that we get to be with them,” said Rezmer. “I do think we have a good amount of students that—by the end of the program—the students can see themselves in our shoes and doing this kind of work.”
That was the case for Madeline Merwin. Her experience during the clinical portions of her medical training further fueled her fire to become an OB-GYN.
“I knew I wanted to be involved with reproductive health as an OB-GYN, and as a rural health advocate,” said Merwin.
Eager to learn more ways to better serve her future patients, Merwin accepted an additional internship at University Hospital in Ann Arbor—the University of Michigan’s hospital for adult patients. While there, she assisted doctors who provided reproductive health care for both in-state patients and those traveling from states with reproductive care bans.
That’s because here in Michigan, voters passed Proposal 3 in 2022, which made reproductive health care a right for all residents. In the same election, voters elected the first Democratic trifecta in 40 years, putting Democrats in charge of the state Legislature. That allowed lawmakers and Gov. Gretchen Whitmer to pass the Reproductive Health Act in 2023, which removed a number of the anti-abortion laws and ensured that in-state providers could offer their patients—whether Michiganders or not—the reproductive health care they needed.
In the year after Roe was overturned, the number of patients traveling from out-of-state to get an abortion in Michigan increased 66%, according to data released by the Michigan Department of Health & Human Services.
After completing her internship with the University of Michigan, Merwin split her time working in the pediatric care unit at MyMichigan Medical in Alma and the outpatient pediatric office at the Midland Regional Campus in Midland. Today, her days consist of checking on the health of newborn babies and their families.
With so many folks in need of help, medical students—like Merwin—are looking for ways to impact the communities they serve outside of the hospital walls.
In her “downtime,” Merwin and other LRM students in Midland are taking what they learned in class and finding a way to further support the community that they serve. They published research on how the lack of obstetric care affects rural communities, and even partnered with the West Midland Family Center to provide monthly educational classes to community members.
“Selfishly, I just really wanted to talk about menstrual products and menopause and all things OB-GYN,” said Merwin. She was able to get her wish—Merwin and her classmates organized a class that was dedicated to teaching parents and guardians what they should know about menstruation. The med students collected donations of different menstrual hygiene products to give to event participants, too.
“It was awesome to have a non-judgemental space for parents and guardians to ask questions about certain things,” said Merwin. “They were incredibly grateful for it.”
While Michigan struggles to fill the gaps in reproductive health care for its rural residents, students like Merwin make medical professionals like Dr. Rezmer optimistic about the future.
“I love to see the next generation being excited about taking care of women because our country needs health care providers that are focused on women’s health,” Rezmer said. “Our ultimate goal as OB-GYNs is not to get a number of deliveries or make things go faster. Our goal is to have the healthiest mom and the healthiest baby outcome we possibly can.”
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