Eugene OBGYN moved from Idaho to be able to provide care to patients legally

A recent paper published in the Journal of the American Medical Association shows that Idaho has lost approximately 35% of doctors specializing in obstetrics and gynecology, leaving many counties without any maternal or reproductive health care providers at all. That comes after the state passed one of the most restrictive abortion bans in the country after the U.S. Supreme Court overturned Roe v. Wade in 2022. Amber Nelson, executive director of the Idaho Coalition for Safe Healthcare, says 85% of these practicing specialists work in just seven of the state’s urban counties.

Dr. Amelia Huntsberger was a practicing OBGYN in Idaho for many years before the ban. But after the ban, the emotional strain of navigating patient care amid the possibility of prosecution led her to uproot her family and move out of state. Huntsberger now practices in Eugene, but she says her family still deals with the grief that transition brought. We talk with her and Nelson about the larger trends and what they mean in the lives of people seeking reproductive and maternal care.

Note: The following transcript was transcribed digitally and validated for accuracy, readability and formatting by an OPB volunteer.

Dave Miller: From the Gert Boyle Studio at OPB, this is Think Out Loud. I’m Dave Miller. After the U.S. Supreme Court overturned Roe v. Wade three years ago, Idaho passed one of the most restrictive abortion bans in the country. Now, a new study has found that the state lost more than a third of its OBGYNs who practiced obstetrics. What’s more, the vast majority of the specialists who remain are in just seven of the state’s urban counties, meaning many people in rural areas have no maternal or reproductive healthcare providers at all.

Amelia Huntsberger is one of the doctors who left. She was an OBGYN in Idaho’s panhandle for many years. She and her family moved to Eugene after the ban. Amber Nelson is the executive director of the advocacy group Idaho Coalition for Safe Healthcare. They both join me now. Thanks so much for making yourselves available.

Amber Nelson: Thank you, pleasure to be here.

Miller: Amber Nelson, first – can you explain what the current law says in Idaho?

Nelson: Sure, the current law in Idaho allows for termination of pregnancy in just a small handful of circumstances. The first is in the case of rape or incest, if the patient can provide a completed police report to their physician within 12 weeks of conception. The second is in cases of ectopic pregnancy. The third is in cases of molar pregnancy. And the final one is to save what our law refers to as “save the life of the mother.” And that has been a big piece of confusion for clinicians across the state.

Miller: In what way?

Nelson: I’m gonna say I think Amelia would be able to answer this much more clearly and from a clinical perspective than I would. But from my layman’s perspective, how are we determining what it means to save the life of the mother? Are we waiting until she’s almost expired? Are we understanding that if I do a preventative measure now, I can help her avoid something that could be terminal or very problematic later? There’s just no clear line about where that is or, from a clinical perspective, what indicators would legally allow a clinician to proceed with the termination earlier than the point at which the patient is literally sitting on death’s doorstep.

Miller: Amelia Huntsberger, can you give us a scenario that would help us understand the terrible dilemma that Amber was just talking about?

Amelia Huntsberger: One of the challenges is that pregnancy care is complicated and there’s often a lot of nuance present. And I think what’s important to understand is that there’s not a clear line between when a pregnant patient’s health alone is at risk and when their life is at risk. It’s not like a black and white marker between those two. There’s sort of a spectrum there. In medicine, we are trained to protect health. So we act to protect a patient’s health. We are not trained to wait until a patient is dying in order to act.

So the Idaho laws really put us in a difficult position of not knowing when it’s legally safe for us to act. No longer are we thinking about our medical training, consulting our textbooks, and thinking back to what we’ve learned in medical school and how we were trained in residency. Suddenly, there’s this new element of wondering about, legally, what does the law say I can or can’t do? And this is when a patient is experiencing a health threatening crisis or a life threatening crisis. And that is just really dangerous, frankly. We just need to think about how serious it is. In some ways, it’s hard to believe that we’re having a conversation about whether or not doctors should be able to act to protect the health of a pregnant patient.

That’s really what has been an ongoing debate in Idaho. Do doctors follow the federal law, EMTALA [Emergency Medical Treatment and Labor Act], which requires us to act to protect the health of pregnant patients seeking care in an emergency room or in an emergency setting on labor and delivery? Or do we act based on state laws, which in Idaho are very different from federal laws, and say we can only act to protect the life, to try to preserve the life of a pregnant patient?

Miller: I think it’s good to foreground the health of the patient here. Obviously, it’s the most important question here, life or death. But what’s at stake for medical providers? What else would be or was, before you left, in your mind as a doctor in terms of your own livelihood or your family’s?

Huntsberger: Well, this is sort of twofold in my family. I’m married to an emergency room physician. So for us, for better or worse, the Idaho abortion laws immediately impacted both of us in the emergency room and on labor and delivery, due to our specialties in medicine. For us, the potential legal impact on our lives was really immediately quite real to us. In Idaho, there are both civil and criminal penalties for providing abortion care. So we had to think about, is the care that I’m recommending to my patient, that otherwise I would be providing without delay, potentially putting me at legal risk? Will I lose my medical license? Will I end up in jail for up to five years? Will both of us end up in jail? Who will raise our three children? These are questions that we had to ask ourselves.

The thing that we know to be true is it’s only a matter of time, given our specialties, before some sort of clinical situation enters the hospital – whether that’s the emergency department or the labor and delivery unit – where state law, federal law, the needs of the patients, where these things all collide. And we’re put in a really difficult position of needing to decide whether we’re taking on our own legal risk or we’re taking care of patients in the way that we trained years to know how to do. That’s a really difficult position to practice medicine in. It’s certainly not good for patients, nor is it good for their doctors.

Miller: Dr. Huntsberger, I want to hear more about your own decisions and the conversations you had as a family. But Amber, to get a deeper understanding of what this new study found, there had been studies in the past about what happened to provider numbers in the first year after the Dobbs decision, after the ban went into effect in Idaho. What stands out to you in this new fuller data?

Nelson: Let’s say broadly, while this is very devastating, it is not at all surprising. Clinicians like Dr. Huntsberger are often married or partnered with other health care providers. So what happens when one of them goes, the state as a whole is losing clinicians from a broad variety of specialties and clinical areas. It’s not just OBGYNs, it’s broader than that.

What we know for sure is that health care access should not in any way be controversial. It’s essential. And our laws are pushing out doctors and the consequences are evident across the state. You mentioned that most of our OBGYNs currently are clustered in our seven most populous counties. That leaves 23 OBGYNs to serve 569,000 Idahoans in the remaining counties. And if you just do a little back-of-the-napkin math on that, it’s unsustainable for 23 OBGYNs to serve almost 570,000 people.

Miller: The study found that a little under half of the obstetricians who had been practicing before the ban either stopped practicing obstetrics, left the state, closed their practices within the state or retired. Now, there’s a lot of different categories, a lot of different outcomes there. But I’m curious about that first category: stopping practicing obstetrics. Because as I read that, my take was that these were doctors who stayed in Idaho, but they would no longer deal with pregnancies. Meaning maybe they would treat fibroids or ovarian cysts, but refuse to see pregnant patients. Am I understanding that correctly?

Nelson: That is right. And when we put it into percentages, that’s about 16% of those who left the practice in the year 2024. But they did move to gynecology only because of the risks that are associated with delivering babies that Doctor Huntsberger has spoken to.

Miller: Dr. Huntsberger, was that something that you considered essentially removing the OB from your professional life and only focusing on a gynecological practice?

Huntsberger: No, it wasn’t. My husband and I came to the conclusion together that it wasn’t safe for us to practice medicine in Idaho anymore. And we had made the decision to leave and submitted our resignations to our hospital. A week later, we found out that the hospital planned to close labor and delivery. So not only had I decided to leave, therefore destabilizing the remaining doctors providing obstetric and gynecologic care, but the hospital had decided to close labor and delivery. As a result, all three of my partners left the area because they wanted to provide full scope care, both taking care of pregnant patients and taking care of folks for the myriad reasons that we see them, including fibroids, contraception, tubal ligation, incontinence, prolapse. So all four of us left Idaho. None of us considered continuing to work in the state of Idaho. And all of us have gone to states that don’t have abortion restrictions.

So now, my [former] community, not only do they not have access in town to delivery care, they also don’t have access to gynecologic care. So, those things, if you lived in town, were only minutes away, are no longer available to them. Know that in a rural area like the panhandle of Idaho, when we were working there, patients often traveled an hour or two, sometimes from Eastern Washington, from up to the Canadian border, from Western Montana to see us. People were already traveling long distances to receive both pregnancy care and GYN care prior to the closure. So the impact was felt not just in our town, but into the surrounding areas and extending into the surrounding two states.

Miller: I should say, you’d been practicing in Sandpoint, in Northern Idaho. So what have you heard about the decisions that your former patients or other people in the community are now having to make?

Huntsberger: It’s really hard. Let’s just talk about pregnancy care for a minute. Folks have routine prenatal visits that are often relatively quick, if they’re having an uncomplicated pregnancy. But those visits are happening monthly at the beginning of pregnancy, weekly at the very end. So it’s one thing if you need to drive 10 minutes to go have your 15 to 20 minute visit and drive home. It’s another thing if you need to drive an hour away for a 15 minute visit. Now you have to take time off of work. Let’s say you’re not working and you have other children at home, you need to figure out childcare. You’re paying for gas money. This trip back and forth, for some of our patients, would be three hours for them to figure out, again, time off of work, childcare, gas money or making sure they have reliable transportation. This is a really big burden to be putting on someone every single week at the end of pregnancy.

We just can’t underestimate the burden of what that means for pregnant patients. I know folks who are pregnant in Sandpoint and they worry that they won’t recognize labor fast enough. They worry that they won’t have time to get to the nearest hospital, that they might have a baby on the side of the road. These are really real concerns of a patient of mine. Right before I left, near the time of the closure, she had had a baby on the side of the road before because her labor [was] so fast. And she was terrified that that would happen to her again. So these are the circumstances that patients face with regard to pregnancy care, wondering, what should I pack in my car just in case my labor goes faster than I think it does and we need to pull over on the side of the road?

Miller: Broadly, what else have you learned from this recent study about where doctors who’ve left Idaho are going?

Nelson: This is such a great question and really underscores the impact of these laws. So what we know is none of the OBGYN physicians who left Idaho moved to states with abortion restricted policies similar to ours. They all went to places where they could actually practice the care they’ve been trained to deliver. Let me just pause and say what’s really interesting about this study is it’s not based on statistical modeling. Literally every single OBGYN who was working in the state, at the time of the Dobbs decision, their location currently and their practice currently have been validated. So this is literally a one for one report about where each doctor went and what they are doing currently.

So, in terms of the out-of-state moves, we know that five of our doctors went to Washington; three each to Minnesota, Nevada, Oregon and Utah; two to Colorado; and one each to Illinois, Maine, Montana and New York.

Miller: The overall number of obstetricians is significantly down because of everything we’ve been talking about, because many more have moved away or stopped practicing than have moved to Idaho. But the study did say that there are some people who have moved in, not nearly enough to make up the difference, but either new doctors or new to Idaho doctors. Do you know much about the doctors who are newly practicing in Idaho?

Nelson: I don’t have a great insight on the doctors who are coming to Idaho, but I can tell you that the organizations that are able to draw them are able to do so because they’re able to provide benefits and enticements that financially make it worthwhile in many ways to come here as opposed to coming to another state. So it’s our larger health care systems that are able to be competitive and recruit OBGYNs into the state. So it’s unlikely that some of our rural areas are getting these new physicians. They’re really coming to those seven most populated counties.

Miller: Amelia Huntsberger, I’m curious … My understanding is you have three school-age children. What kinds of conversations did you have with them when you and your husband were thinking about or had maybe finally made the decision to leave the only home they’d ever known?

Huntsberger: We had had a lot of conversations at home about the challenges we were facing with the government interfering with the health care that was best for our patients’ health and the safety of their lives. So our kids knew that work things had become more challenging. Once we made the decision to leave, that was a really excruciating conversation to have with them. We uprooted them from the only place that they had known. They were very attached to their school, their community and their friends, and really integrated in the community.

Both my husband and I grew up in small towns and there’s something really beautiful about living in a small town and getting to know your community. So for my kids, that was really difficult. While I have no doubt in my mind that we made the right decision in leaving Idaho, it was tremendously traumatic and difficult for all five of us.

Miller: How does your medical practice in Eugene feel to you now, given that … My assumption is you’re practicing medicine the way you had in the past, but in a way that you would be unable to do if you hadn’t left your longtime home. I’m curious just what your day to day work feels like now?

Huntsberger: It’s great. I just go to work and I do my job. I don’t need to consult with lawyers to make sure that the care I’m discussing, recommending and providing to my patients is legally safe for my patients and for me. I just take care of them. We talk about risks, benefits and alternatives, and patients make choices about their health care. That’s the way it should be. At no point in pregnancy is a politician more qualified to make health care decisions than a patient and their doctor.

Miller: Would you consider moving back to Idaho if the law were to change?

Huntsberger: That is really difficult for me to imagine at this point.

Miller: The law changing or you moving back if it were to change?

Huntsberger: Both.

Miller: Amber Nelson, this does get to a political question. When state bans on abortion were being considered and were passed in many red states around the country, I remember hearing either the hope or the assumption that there would be an electoral backlash. This was after seeing poll after poll, including in Republican-led states, that majorities of residents or voters did not want to see significant abortion restrictions in their states. But it doesn’t seem like that’s happened. I don’t remember seeing a major electoral backlash or overturning of one of these laws. I may have missed that in some state, but certainly it hasn’t happened in Idaho. Were you expecting more pushback from voters?

Nelson: It’s such an interesting question because the work that I do every day puts me in touch with voters, and certainly they’re self-selecting. But by and large, they’re in agreement with what Dr. Huntsberger said that there is no politician that is more equipped or has better expertise or experience to help a patient through a pregnancy or any other kind of OBGYN or medical situation.

What we have seen that is interesting to me is recent polling showing more than 60% of Idahoan voters agree that abortion care should be legal and should be between a doctor, a patient and their family. So we know that the majority of Idahoans do not agree with what is currently in place, in terms of our laws concerning abortion care.That has given rise to a ballot initiative that folks are working on right now to bring to the voters in the fall of 2026.

Miller: What are you expecting from that vote?

Nelson: Well, what I’m expecting may be a little different than what I’m hoping for.

Miller: That’s why I asked.

Nelson: I’m hoping that we’re able to get folks out and that that ballot initiative passes with flying colors. What I expect is that it’s gonna be an extraordinarily difficult fight. As we’ve talked about already, Idaho is incredibly rural, so our voters are spread out in some very far flung places. We don’t have the kind of city centers or the metropolises that might be easier to get voters informed and out to polling places. So what I expect is that this is going to be a really hard fight and that no one is going to be able to count on a vote just because. We’re going to have to work for every single vote that we get in support of the ballot initiative.

Miller: Amber Nelson and Amelia Huntsberger, thanks very much.

Nelson: Thank you.

Huntsberger: Appreciate it. Thank you.

Miller: Amber Nelson is the executive director of the Idaho Coalition for Safe Healthcare. Amelia Huntsberger is an OBGYN who moved from Idaho two years ago because of that state’s restrictive abortion laws. She now practices in Eugene.

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