Abortion Training: OPT-IN vs OPT-OUT
January 6, 2026
By Tim Millea, M.D. – Chair, CMA Health Care Policy Committee
Until several years ago, OB/GYN residents who sought training in induced abortion were allowed to “opt-in” if they wished that to be part of their training. However, in 2018, the residency curriculum changed significantly when the Accreditation Council for Graduate Medical Education (ACGME) established the requirement that such training be an “opt-out” system. This protocol requires residents who do not want abortion training to notify the supervisory physicians in their program of their decision. These interactions are with individuals who have a direct impact on the residents’ training, evaluations, and future practices. The potential for intimidation, threats, and other potentially career-threatening actions is clear and real.
There is no question that the need for more OB/GYN physicians is great across the country. However, barriers to entering that specialty, such as the current opt-out system, lead to hesitation on the part of medical students considering OB/GYN. When faced with a situation that conflicts with their ethics and moral beliefs, and which invites dismissal of conscience rights and retaliation, their reluctance is understandable.
Fortunately, there is a potential for corrective action that could return the landscape of OB/GYN residency training programs to a more acceptable level. The Coates-Snow Amendment, enacted in 1996, prohibits federal funds to federal, state, and local governments that discriminate against trainees who refuse abortion training or for a program that refuses to provide abortion training. The current opt-out system is an invitation for programs to identify and then single out abortion-opposed residents, which may well violate the Coates-Snow Amendment. The alternative, and preferred, pathway is to return to what has worked well in the past, i.e., the opt-in system. Residents interested in abortion training would have that option available, but the training itself would not be required. While the Coates-Snow Amendment offers protection as a result of funding for the program, the opt-in system provides protection for the residents as they progress through their training.
Further protections are taking shape on Capitol Hill as well. Senator Lankford (R-OK) has introduced S.3238, “Conscience Protections for Medical Residents Act” that would prohibit opt-out abortion training. In addition, Representative Greg Murphy (R-NC) has introduced a similar bill, H.R.6219. Both bills were introduced in late November and have a growing number of co-sponsors. Please visit the links for each bill to familiarize yourself with them and with their sponsors and look for opportunities to support this legislation.
CMA’s Health Care Policy Committee will continue to monitor these and many other efforts to advance, promote, and protect ethical health care and the right to a life of dignity for all who seek our help. Whether unborn, elderly, disabled, poor, or any other reason, CMA members will continue to provide care grounded in the Gospel message: Love of neighbor and respect for the dignity of all life.
Dr. Timothy Millea is the chairman of the Health Care Policy Committee. He is also a CMA board member-at-large, Iowa state director, and president of the St. Thomas Aquinas Guild of the Quad Cities.