By Caroline Pilgrim, 2nd-year Physician Assistant Student, Virginia
Last week, California’s Governor Brown signed into law assembly bill 154 that allows midlevel providers—nurse practitioners, certified nurse midwives, and physician assistants to perform suction aspiration abortions. This opens broad new territory for Planned Parenthood and other outpatient abortion clinics who often struggle finding medical doctors to come to their facilities and perform surgical abortions. And I can almost guarantee that this sort of bill will not be limited to California but will most likely spread to most states and quickly.
In less than three months I will be a certified Physician Assistant (if I pass my boards) which means that if I chose, I could immediately move to California and start aborting babies under the supervision of a licensed medical doctor. Let me be clear about my purpose in this article: it is not to bash my profession or my training. My purpose is to alert the reader to the reality that is hitting California when this law is implemented.
I learned about a predecessor of this bill a couple of years ago and remember thinking, “Oh no. I want the Physician Assistant’s scope of practice [what we are legally allowed to do] to expand but please not to abortion!”
You see, our training is short—only 2 years—but we as PAs are fast learners medically. Our purpose is “physician extenders.” We are in school less time so we can get out there and treat patients. We become experts on the job. We do 12 months of clinical rotations. We don’t do residencies. We don’t do have to do fellowships. I don’t want to be inhibited from doing procedures that I am trained in doing because of our legal system is lagging behind the reality of doctor shortages. I have even gone to D.C. and lobbied for PAs to be legally allowed to do more. Yet I must object to my colleagues and my profession being burdened with the stigma of abortion-performers. I must object for the mothers and the preborns’ sake.
This law is dangerous of course for the small preborns that will die under vacuum aspiration, but also to the women undergoing the abortion itself.
Image: an aspiration abortion at 9 weeks gestation. From ClinicQuotes.com http://clinicquotes.com/how-a-suction-abortion-is-performed/
According to the stipulations of the law, advanced practice clinicians (CNMs, NPs, PAs) will be permitted to perform aspiration abortions beginning January 1, 2014 if they comply with stipulations of the Health Workforce Pilot Project No. 171. That sounds official but right now it means that NPs, PAs, CNMs will be educated “in specific skills and knowledge required for first trimester pregnancy termination or complications.” (http://www.oshpd.ca.gov/hwdd/pdfs/HWPP/Abstract_HMPP171.pdf) It’s so vague! We have no earthly clue what these providers will be trained in before they start shoving dangerous surgical abortion tools into vulnerable women.
In PA school, we are not trained intensively in surgery or emergency obstetrics! CNMs and OB/GYN NPs are trained in birthing babies and pregnancy complications, not abortions. In California, PAs only need a doctor to sign off on their competence in a skill before they can perform an abortion solo. Their supervising physician will still hold the liability but, as we have seen repeatedly, abortion doctors aren’t usually concerned about patient safety because even medical doctors who receive three times the amount of school as midlevels can kill women in abortions. In addition, a midlevel’s purpose is to make healthcare more affordable because our salaries are often 1/3 of the doctors’. This means that with “cheaper” abortions, the abortion business will have more profits and more opportunity to expand.
Lastly, there is no predicting what this will do to damage the reputation of my profession whose own oath says that we as PAs will, “hold as my primary responsibility the health, safety, welfare and dignity of all human beings.” I suppose abortion-practicing California PAs can amend their oath with three words: “except preborn babies.”
About the Author
Caroline Pilgrim is a PA student in Roanoke, VA interested in pursuing OB/GYN and family medicine. She enjoys spending weekends with her two nephews and avoiding homework at all costs. Follow her on twitter @carolinepilgrim or her personal blog at www.handswithholes.wordpress.com