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A Medical Brain Drain Out Of Texas

Make Me Smart June 22, 2023 Transcript

Kimberly Adams

I am good to go when y'all are.

Kai Ryssdal

Okay!

Kimberly Adams

Hello, I'm Kimberly Adams. Welcome back to make me smart where we make today make sense. It is June 22.

Kai Ryssdal

I'm Kai Ryssdal. Thanks for joining us today. We're gonna do some news. I'm gonna do the smile thing. And then we will move briskly on about our day. So we'll do some news items. Why don't you go first?

Kimberly Adams

Yes, indeed. So there's been a lot of great reporting coming out around the one year anniversary of the Dobbs decision at the Supreme Court, which you know, as everyone probably knows, overturned Roe vs. Wade, and the 19th has been just spot on, on so much of its coverage over the last week. Last year, sorry, the last year about the fallout of this decision. And they have a piece about abortion bans and gender affirming care bans in different parts of the country and how it's doing. These, these bans are doing exactly what people in the medical profession predicted would happen, which is that it's making doctors leave the states and communities and bringing fewer medical medical students willing to do residencies, fewer medical students applying to jobs there or applying to college there. And they've got some really interesting statistics I'm going to read some of them starting in 2022, months after the state, this is Texas by the way, the state six-week abortion ban took effect, "the number of medical students applying to Texas-based OBGYN residencies fell by 10.4%. The trend has continued in 2023: Texas saw a 5.4% decrease in applicants to its medical residency programs with a 6.4% decrease for OBGYN specifically. Both of those are significantly larger decreases than the national average." There's some really heartbreaking stories in this piece about, you know, people who've had very severe complications because of the lack of access to care. But currently, this is from the piece also, Texas only has in terms of the ratio of adolescent medicine providers to patients is much lower in Texas than the rest of the country. This is related to the gender affirming care stuff. "Currently, Texas has only 0.5 providers per every 100,000 potential pediatric patients in the entire state. For contrast, Massachusetts has 3.2 such providers per 100 100,000 patients." So, "despite having less than a third of the number of people as Texas, Massachusetts is home to more adolescent medicine clinicians." Yeah, it's it's, it's, it's, this piece is great, you should read it. And Shefali Luthra, the health reporter over at the 19th wrote it. And you know, this was all predicted, literally, right when the decision came down, and it's having real life consequences for people.

Kai Ryssdal   

Yeah, I would also say this all was predicted, but it's an object lesson in the law of unintended consequences, right? Because the Supreme Court, if you remember, in that Dobbs decision said "We now return the question of abortion to the states." And what is happening is unequal treatment. It is denial of services on an equal basis. There's a lot of things that I don't think anybody thought was going to happen other than the big denial of service thing that are really bad, that are really bad.

Kimberly Adams   

I mean, I feel like a lot of the pro-abortion advocates certainly predicted this and warned in even in some of the briefs for the case, were warning about this stuff potentially happening. And so, like it was definitely predicted, but just not as loudly and I mean, we talked about this before. I think so many of us just didn't seriously think that Roe would be overturned that we probably didn't give it enough attention beforehand.

Kai Ryssdal   

All right. So mine is sorry, I was gonna close the door because they're mowing the lawn next door. Anyway, mine is a piece by the New York Times today, a big interactive piece and a data journalism piece from the New York Times by Ana Swanson and a bunch of other staffers, on Indian oil imports. And I mentioned that number one, because Prime Minister Modi is in town today. But number two, we've talked a bunch of times on this podcast, specifically back when the invasion first happened last year about American and Western efforts to limit Russian oil flow and sales into the wider world. And what we've seen since and what the New York Times reports on in great depth and detail today is that what's happened is Indian Oil, Chinese sorry, Indian oil purchases and to some degree Chinese as well. But this article is mostly about India, India is buying a ton of Russian oil, right. And you say to yourself, well, that's bad, we don't want the Russians to be able to sell their oil. But what is happening is twofold. Number one, the Russians aren't getting the price they used to for their oil, so they are getting less revenue, which is a good thing, and which is what the Western allies wanted when they put sanctions on. But number two — and this is a little counterintuitive, but let's remember that oil is a global market — what the West wanted to do was punish the Russians to some degree, but also to keep Russian oil flowing. Because we need Russian oil globally, right, we use basically every drop of oil that we produce every day, we use that up in this economy. So if we had taken Russian oil completely out of circulation, it would have meant higher prices for the rest of the world, economic shock. And you can see where that's going. So what has happened is that as a result of Western sanctions, the Indians are buying more oil from the Russians, which, okay, fine, but the Russians are getting less money for it. And that Russian oil is displacing Middle Eastern oil that the Indians would have otherwise bought, and thus used up that global share. So it's really interesting piece, it's a little bit of a connect the dots thing. But the Western sanctions, I think you can argue, are kind of working, they're kind of doing what they were supposed to do or what people wanted them to do. And that's I thought that was interesting.

Kimberly Adams 

And India's getting a good deal on oil out of it. Like they're able to buy that oil, so much cheaper. And I imagine that's helpful for their economic growth, even if it's fueling, literally, the war in Ukraine. I did not mean to make that a pun. Yes, it was interesting. Today in the press conference, you know, people were asking about this, and you know, but Biden said that it came up. And, you know, this idea that, and this was in some of the reporting elsewhere, this idea that the US can't press India too hard on this issue, or human rights for that matter, because they really need, we really need India's cooperation on China, because the US and India are pretty aligned and being concerned about the threat of Chinese influence and China's role in that region. And so the US can't really say that much. I mean, they could, they won't. But anyway,

Kai Ryssdal  

Yeah, anyway, Drew let's go

Kimberly Adams

Okay, since I just gave all those horrible statistics from Texas, I wanted to bring a fun story or a good story, a positive story out of Texas, which comes by way of Spectrum News 1, or at least that's where I found it. I'm sure it's one of Spectrum News broadly or nationally. But anyway, we'll have a link to it in the show notes. There is a guy in Texas, Moses West, who is founder of a company called Atmospheric Water Generator Contracting LLC, who has basically created these machines that turn air into drinking water, which it's effectively what a dehumidifier does, like you know, you have a dehumidifier and it collects water from the air to make your house you know less humid, but then you usually just like throw it out, water your plants with it, whatever. But he's created these systems that then run that water pulled from the air through a filtration system and you know, distributes water and he's set these up, you know, helping hurricane Maria victims in Puerto Rico. He's planning to install them for folks in Flint, Michigan. Let's see where else? And they're manufactured in Wisconsin. And it says just one of these units provides a city with hundreds of gallons of water at no cost to residents. And he has been working with a group called the Water Rescue Foundation to cover the cost and you know, according to the video, that's with it, he was saying that it doesn't really take that much energy. And these can be set up, you know, all over the world. They basically look like long, like shipping containers and got a little spout on the side. It's pretty cool. So that made me smile.

Kai Ryssdal 

Yeah, no, that's good. Okay, mine is a little, a little dorky, a little geeky, but it follows the news of the day, which if you listened to Marketplace today, you would have heard me talk about Central Banks raising interest rates all over the world today, the Norwegian Central Bank, the Bank of England, the Central Bank of Switzerland, and also the Turkish Central Bank, and I am making this my make me smile for two reasons. Number one, it appears that some kind of economic sanity has returned to Turkey, because for a long time, a very long time, under the prior Central Bank governor, President Recep Tayyip Erdogan, was cutting interest rates in the face of inflation that is, as of today at 39%. And if you know anything about interest rates and inflation, you know that cutting interest rates in the face of inflation at 40% is a recipe for disaster. And in point of fact, that's what happened because inflation goes up, people have less purchasing power. And there's a burgeoning economic crisis in Turkey. So there's that. So the Turkish Central Bank today raised its interest rate from 8.5% to 15%, just about doubling. So number one that's dorky and interesting, just in a straight-up economic sense. But here's why they did it. They have a new central bank governor. Her name Hafize Gaye Erkan. She is a Princeton-trained expert in financial risk management and a former person at First Republic Bank and Goldman Sachs. So now they have an honest to god person who knows what's going on in the Turkish economy, in charge of the central bank. And that's a good thing. And it made me smile, because Turkey for as much of a pain in the patootie as it can be to the United States and other Western allies, is really important. It's geo-strategically critical. It's a member of NATO. Thank you. Hello, Article Five, "an attack on one is an attack on all." So it's really a critical country that that honestly kind of gets short shrift. And it's good to see that there's some economic stability and common sense returning. Thank you for coming to my TED Talk.

Kimberly Adams

I'm just visualizing her sort of going into Erdogan's office, right, with white poster boards with like graphs and things like they used to do with Trump, where they had to, like put things on one pagers or on big charts to like, get him to agree to stuff. And I wonder if she had to do something like that. Like, let me draw it out for you. We're screwed. Yep. Okay. Absolutely, totally. That is it for us for today. I will be back tomorrow with Meghan McCarty Carino, for Economics On Tap. Please join us, we will be live streaming on YouTube starting at 3:30 Pacific 6:30 Eastern.

Kai Ryssdal

And if you want to find out what our team is reading and drinking this week, sign up for the Make Me Smart newsletter out every Friday morning. You can find it and all the other marketplace newsletters marketplace.Org/newsletters. That's where we go with that.

Kimberly Adams

Make Me Smart is produced by Courtney Bergsieker. Today's episode was engineered by Drew Jostad. Ellen Rolfes writes our newsletter. Our intern is Nilou Shahbandi.

Kai Ryssdal 

Marissa Cabrera is our senior producer. Bridget Bodnar is the director of podcasts. And Francesca Levy is the executive director of Digital and on demand enterprise. Your enterprise. Enterprises.

Kimberly Adams

So many enterprises.

Abortion Clinics In Neighboring States See More Texans Than Locals

Shardae Russell has been helping women in Texas navigate abortion since she was 12 years old. She started as a volunteer at the Fort Worth location of Whole Woman's Health, a national organization that provides abortions, where her mother worked.

"I just remember there being a lot of protesters, just screaming at patients and stuff like that. I definitely think that got me into it, because I knew there were so many things that were against people," Russell, now 24, said. "I definitely wanted to be one of those people that helped."

After college, Russell began formally working at the clinic. But a year later, the U.S. Supreme Court released its Dobbs v. Jackson Women's Health Organization decision on June 24, 2022, overturning the right to abortion. Nearly all abortions became illegal in Texas, closing the six-week window for legal abortions that had remained since the state passed Senate Bill 8 in September 2021.

Now, a year after Dobbs, Russell is still helping Texas women get abortions. She's just traveling outside of Texas to do it.

In June 2022, Whole Woman's Health announced it would move its Texas operations to New Mexico. The organization's new Albuquerque clinic opened in March and offers services every Thursday through Sunday. Russell, now a regional community outreach manager for Whole Woman's Health, frequently flies from Dallas to Albuquerque to help staff the clinic on the weekends.

"This last month or so I have been coming back almost every weekend. I go home Saturday night, and then I come back Wednesday night," she said.

During these trips, Russell says she often finds herself on the same flights as patients on their way to appointments at the clinic, as well as other staffers, including physicians, nurses, medical assistants and counselors.

"It's ironic on some level that they all … have to board a plane in order to take care of people who are literally from their own town," said Amy Hagstrom Miller, founder and CEO of Whole Woman's Health.

Getting there

Flying or driving out of state for an abortion can be expensive and inconvenient, especially for residents of Texas' vast interior. Austinites, for instance, face an eight-hour drive to Wichita, Kansas, the nearest city with a clinic that offers legal abortions. Alternatively, they can drive 11 hours to Albuquerque or 13 to Pueblo, the city in Colorado with an abortion clinic closest to Texas.

But data from clinics in these three cities indicate that many Texans are making the trip. Nearly all of the appointments made at Whole Woman's Health in Albuquerque have been made by Texans, according to Miller. She credits this trend partly to the organization's outreach to Texas cities where it used to have clinics, such as Austin and Fort Worth, but also to the sheer size of Texas' population.

CARE Colorado in Pueblo has also seen a flood of Texans. The clinic opened in December 2022. At the time, owner Leroy Carhart IV anticipated that some Texans would seek care at the clinic but that the lion's share of patients would be Coloradans. However, Texans have accounted for 47% of CARE Colorado's patients so far, compared to the 31% of patients from Colorado.

"We did expect there to be a lot of traveling patients, just because of the Dobbs decision, [but] we didn't really expect it to be close to 50%," Carhart said.

Carhart said Texans most often arrive by car, driving in from cities and towns all over the state, whether making the 13-hour trek from Austin or a five-hour trip from Amarillo.

These long trips come with additional logistical issues. In many cases, abortion funds, such as the Austin-based Lilith Fund and Jane's Due Process, help to offset costs and to find out-of-state appointments. But the hurdles of getting time off work and arranging child care can still be prohibitive, abortion advocates say.

Miller said a woman from Houston made and canceled three separate appointments at Whole Woman's Health in Albuquerque, although the organization's in-house abortion fund had raised money to pay for her travel and procedure.

"One time her baby was sick, and she couldn't leave. The other time, the car that she was going to drive broke down," Miller said. "Finally, she just called us and she said, 'I'm just going to have this baby. It's easier.'"

'Missing from the narrative'

Abortion data indicates many Texans may be making the same calculation.

In 2020, more than 55,000 abortions were performed in the state of Texas, according to the Texas Department of State Health Services. Since abortion was outlawed, Texans have flooded the rosters of clinics in surrounding states, forming a diaspora of care that crosses Colorado, New Mexico, Kansas and beyond.

But increased abortion activity in these states still does not account for the previous number of abortion-seekers in Texas. A June study from the Society of Family Planning shows clinics in states near Texas completed thousands more abortions in the months since Dobbs than they normally would have; Colorado had about 4,500 more, New Mexico had 2,990 more and Kansas had 3,320 more.

Miller said she wonders about the thousands of people not accounted for by this data and what impact their inability to receive an abortion will have on them.

"People in Texas are being forced to carry a pregnancy against their will, beyond their ability, a pregnancy they didn't feel ready for emotionally, financially, physically," Miller said. "And their stories are missing from this narrative. What's happening to their families? What's happening to their health?"

Pushed farther afield

Those who are able to travel rely on the preservation and protection of abortion rights in other states.

Carhart said he believes Texans are attracted to Colorado's legal protections for abortion seekers. This spring, the Colorado Legislature passed a "shield law" protecting people who travel to Colorado for abortions from legal action initiated in other states. Additionally, Colorado's longstanding "bubble law" mandates that protesters leave 8 feet of distance between them and anyone entering a health care facility, including an abortion clinic.

Kansas, on the other hand, is still fighting to maintain its own abortion rights while serving the needs of an entire region. Although Kansas voters soundly rejected a state amendment that would have restricted access to abortion last year, the state Legislature attempted to pass multiple laws related to abortion during its 2023 session, including one that Planned Parenthood is challenging in court.

"When one provider in one part of the country is unable to offer services, or is affected, that echoes throughout the region, because there are just far too few providers," said Emily Wales, president and CEO of Planned Parenthood Great Plains, which serves Kansas, Missouri, Arkansas and Oklahoma.

When Texas passed SB 8 in September 2021, Planned Parenthood clinics in Oklahoma saw a flood of patients from Texas "almost overnight," Wales said. Then, when the Dobbs decision resulted in near-total abortion bans in Texas and Oklahoma, abortion seekers from both states sought appointments in Kansas. Now, Wales says around half of all patients at Planned Parenthood clinics in Kansas are Texans.

This heightened demand often surpasses the Wichita clinic's capacity, and Texas patients are referred to the more distant Kansas City and Overland Park locations. Even still, Wales says Planned Parenthood Great Plains is currently only able to accommodate 15-20% of the people who call asking for appointments.

"There is no question that there are more people who need care right now than we are able to serve," Wales said.

The view from home

While many clinics that once offered abortion in Texas have shuttered, some still stand, offering other reproductive and sexual health services. Planned Parenthood, for instance, has expanded clinic hours at its Austin locations to offer more appointments during evenings and weekends.

According to Sarah Wheat, a spokesperson for Planned Parenthood of Greater Texas, birth control services, STI screening and women's wellness exams have always been the organization's bread and butter, even when abortion services were still available. In fact, Planned Parenthood's Austin clinics have seen an uptick in patients since adding more hours last year. From January to June 2023, 5,781 patients and counting have visited a clinic, compared to 5,010 during the same period in 2022.

Still, the organization considers abortion to be an important part of the spectrum of sexual and reproductive health care. And while abortions aren't available in Texas, Planned Parenthood still lets people know that abortion is an option elsewhere.

"Ultimately, we want to empower our patients to make the decisions that are right for them, and that includes accessing an abortion if that's that patient's choice," Wheat said. "We're going to make sure patients know it is an incredibly common, safe choice, and we're going to point them in the direction of the resources that are out there to help them."

Although Whole Woman's Health no longer operates locations in Texas, the former clinics' phones are still active — and they ring with calls from Texans who want abortions. Miller says some don't know they can't get one in Texas anymore. Others do and are hoping for advice about where to turn.

Russell says she finds it difficult to tell women that they can't get an abortion in Texas, but she feels it's important to remain in her home state to serve as a resource.

"Some people look it up on the internet, and they try to do something crazy, like at-home abortions and things that can just turn out bad," she said. "So, I'm definitely happy that I'm that person that they can talk to, and I can send them to the right places and help them with funding [and] support."

One of the requirements of doing Russell's job is discretion. On flights back to Dallas from Albuquerque, she tries not to bring attention to patients she notices from the clinic. Once, though, a patient stopped Russell as she walked to her seat on the plane and handed her a gift from the airport gift shop.

"I was so, so happy," Russell said. "The gift is not really what matters. But the fact that she was open enough to come talk to me and say thank you … made me validate why I'm doing this."

Copyright 2023 KUT 90.5. To see more, visit KUT 90.5.

Discover Science In Texas With Science Near Me

The Science Near Me blog is a partnership between Discover magazine and ScienceNearMe.Org.

On April 20, 2023, SpaceX's Starship, the most powerful spaceship ever built, lifted off from the company's Starbase launch facility in Boca Chica, Texas. It was a thrilling demonstration of engineering prowess, and a preview of future missions that could loft humans to the Moon, Mars and beyond.

The feat was dimmed by the rocket's "rapid, unscheduled disassembly" (AKA explosion) shortly after liftoff. But, said SpaceX founder Elon Musk, it was an important step in designing and testing this new class of powerful rocket. Now, the company's engineers have more information about what to do to make their rocket better.Space launches may be the most exciting application of STEM (science, technology, engineering and math) know-how in Texas, but they're far from the only one. Companies designing and manufacturing semiconductors, wind turbines and more in the state rely on engineers and scientists to create world-changing machinery.

"The STEM workforce is obviously important, and we know that needs to grow to meet the demand," says Tricia Berry, the cooperative lead for the Texas Girls Collaborative Project (TxGCP), an organization that connects and empowers groups across the state working to bring more girls into STEM.

Growing that workforce begins with exciting people in Texas about STEM, something that the TxGCP is already doing with partners across the state. They're showing young girls in Texas that science can be a lot of fun when you have the chance to get hands-on with it.

STEM in Texas

Growing the STEM workforce in Texas, and across the country, starts with reaching people who might not be considering a STEM career, Berry says, and helping those who are already on their way to a STEM career to thrive. Women and girls are still underrepresented nationally in STEM careers — grow their numbers, and we grow the STEM workforce.

TxGCP partners with organizations in Texas who are already working to educate and inspire girls using STEM, amplifying their efforts and helping bring their opportunities to a wider audience. They also partner with Science Near Me, a one-stop-shop for finding science opportunities in your area, to bring even more STEM opportunities to people in Texas.

"It's really about providing resources, providing connections, connecting the community with opportunities," Berry says.

Science Opportunities in Texas

TxGCP partners with organizations all over Texas to showcase the best of the STEM in the state. That includes organizations like GirlStart, named Austin's top youth STEM program by the Austin Chronicle in 2021. Summer STEM opportunities for girls through the program include weeklong camps exploring what it takes to go to space or explore the depths of the Mariana Trench, while their Girlstart After School programs offer free STEM enrichment at participating schools.

To the northeast of Austin, the Girl Scouts recently opened a STEM Center of Excellence in Dallas. The 92-acre campus includes opportunities to explore robotics, computer coding, chemistry and more through field trips, workshops, day camps and other programs. The Center also hosts robotics clubs that let girls design, build and drive custom-made robots.

"There's a lot of great STEM work being done through the Girl Scouts across the state," Berry says.

You can also find STEM opportunities across Texas by using the new Science Near Me Exchange on the TxGCP website. The Exchange is

"It's hard for families, it's hard for educators, it's hard for program providers to find information or share information without it getting lost," Berry says. Science Near Me "provides that one place that we can point the organizations to to market their information, which gives us the one place to tell families and educators to go look."

Here's just a taste of what you might find on the Texas Science Near Me Exchange:

Join the Texas Stream Team to study and protect the 191,000 miles of waterways in Texas. Monitor waterway conditions and water quality at over 400 sites to help protect this natural resource in Texas.

Monitor the spread of bat diversity across Texas. Watch and record where the more than 30 species of bat in Texas live, sending your observations to scientists.

What does an eclipse sound like? The 2024 total solar eclipse will be moving right across Texas. Lots of interesting things happen in the natural world during an eclipse, like crickets suddenly beginning to chirp. Scientists want you to help them track what it sounds like! Learn how you can get ready to make observations.

You can always find more ways to engage with STEM on Science Near Me, wherever you live. Try out the Opportunity Finder on the website today, and see what you find!

If your organization offers events, projects or programs that invite the public to engage in STEM, add it to Science Near Me!

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