As abortion providers in Illinois gear up for potentially thousands more patients from states that could ban or further restrict the controversial procedure if Roe v. Wade is overturned, there's a mushrooming concern: having enough staff to treat these patients.
"What we're working with now is a crisis, and it's happening so quickly that it's hard to keep up," said Dr. Erica Hinz, an OB-GYN who leads the complex family planning fellowship at UI Health, a hospital system on Chicago's Near West Side.
Hinz said she can hear the strain during monthly meetings with abortion providers across the state, as they all try to ramp up services so quickly.
"I honestly think that there's going to be a similar staffing crisis as there was in COVID," Hinz said.
That's because while there may be enough physicians to provide abortions in Illinois, there might not be enough support staff such as medical assistants and nurses to help provide care.
Health care workers across Illinois are still reeling from the relentless COVID-19 pandemic. Many burned out and became part of the Great Resignation, while others are still getting infected with the virus, leaving a void in the schedule at work and in the exam room.
And then there are health care workers who, without child care or reliable transportation, are having a hard time logistically getting back to work after taking time off. Nurses high in demand can command bigger salaries that some clinics and hospitals can't afford, or don't want to pay.
Should the U.S. Supreme Court overturn Roe v. Wade, as a recently leaked draft opinion indicated it may, Illinois providers are expecting an additional 20,000 to 30,000 patients a year as people travel from other states that could ban or heavily restrict the procedure. That would be a nearly two-thirds increase in abortions across Illinois. In 2020, there were just over 46,000 abortions provided, according to the most recent state public health data.
Dr. Allison Cowett, medical director of Family Planning Associates, a reproductive health clinic that performs abortions in the West Loop, calls the health care worker shortage "perhaps the biggest barrier to a full-scale increase that would meet the needs of folks coming from other states."
Illinois has long been a haven for people seeking abortions in the Midwest. It's essentially an island as neighboring states have made it harder for patients to get abortions, and there are far fewer places to get the procedure compared to in Illinois.
More than two dozen states could ban abortion if the highest court decides to allow states to make that call, according to the Guttmacher Institute, an organization that advocates for abortion rights and that tracks reproductive health policy. Bans would blanket most of the Midwest and the South, the Center for Reproductive Rights predicts, creating a bigger pipeline to Illinois.
Even without total bans, many states have multiple restrictions on getting an abortion, from required ultrasounds to a days-long waiting period between consulting with a physician to getting the procedure.
Many abortion providers in Illinois say they have been expecting this possibility for years. But now they're balancing how to ramp up access without taking away from the other health care services some of them provide, like routine cervical cancer screenings, HIV prevention and birth control.
The majority of abortions in Illinois take place in independent clinics like Family Planning Associates, or Planned Parenthood of Illinois, which is perhaps the biggest abortion provider in Illinois with 17 health centers around the state.
Cowett said she treats patients from Indiana and Wisconsin every day, and patients from Texas a few times a week since that state last fall banned abortions after about six weeks of pregnancy.
Patients she sees come by way of O'Hare International Airport — they buy a plane ticket online, fly out the next day, then fly home after their procedure. But that's for patients who have the means to do so, Cowett emphasizes.
Her clinic is hiring employees for both full- and part-time positions. Like with many providers, it will be a balancing act — how many workers Cowett's clinic will need depends on how busy it gets.
Planned Parenthood of Illinois, meanwhile, is taking a page from hospitals that desperately needed nurses during COVID-19. The organization is looking to tap an estimated $40 million fundraising campaign to recruit new employees with bonuses, and to increase staff salaries to help retain workers. There's a particular need for medical assistants.
"Being fully staffed helps prevent burnout," said Dr. Amy Whitaker, chief medical officer for Planned Parenthood of Illinois.
To take on more patients, the organization has opened more clinics in recent years strategically near the Illinois border and is expanding telemedicine services, where patients can meet virtually with a provider. The call center will also need to grow, Whitaker said, as more patients are expected to book appointments.
"I spend a lot of time with jigsaw puzzles of scheduling, and how can we fit appointments here and how can I get a provider here that I've never had to have before," Whitaker said. "A lot of logistical planning has happened, is happening. ... How can we expand care with what we already have while also thinking about what we can add."
Still, the strain of a potential increase in in-person abortion procedures could be tempered by the rise of medication abortions. Planned Parenthood recently started mailing medication to patients who qualify to receive them. Illinois data show these types of abortions make up just over half of all abortions in Illinois.
Patients must be physically located in Illinois for an appointment, providers said, even driving across the border to have a telemedicine visit on their cell phone. Then they can pick up the medication at a Planned Parenthood clinic, or have it sent to an Illinois address, such as a friend's house. These patients don't have to be Illinois residents, Whitaker said.
At Hope Clinic for Women in Granite City near the Missouri border, executive director Dr. Erin King says she's "on edge" over having enough employees. She's already short-staffed, needing more nurses and medical assistants, someone to work the front desk.
If Roe v. Wade falls, King expects a 40% increase in patients. She foresees needing even more employees.
"If you asked me a month ago, or maybe six weeks ago, I would have been like, 'Well, we'll find some people. Don't worry," King said. "Now I have been ... really pushing the envelope on how many people we're reaching out to and spaces we're advertising in."
She's worried about being able to provide abortions in time for patients.
Back at UI Health on the Near West Side, Hinz said the health system plans to offer abortions more days a week than it currently does and has hired another faculty member to perform them. UI Health isn't necessarily looking to hire more nurses and other staff, but to add more responsibilities to what current employees already do.
That might be tough, not just for UI Health, but for other abortion providers whose employees are already spread thin.
UI Health performs about 50 abortions a month. Hinz expects at least a 10-20% increase in patients should abortion protections fall across the nation.
"It's just so hard to predict because unfortunately those that can make it to us are those that have the resources to get here," she said. "There's a lot of folks that just won't be able to travel to get the care that they need."
The volume of patients might not look big, Hinz said, but she said her patients tend to be the sickest and most vulnerable. The majority are low-income. Patients who get abortions at hospitals instead of clinics tend to be high risk. They might bleed more during an abortion or have high blood pressure or heart problems, for example.
Another strategy to treat more patients? Hinz is also trying to get licensed to practice medicine in Indiana, so she can provide telehealth appointments to patients across the border.
Kristen Schorsch covers public health and Cook County for WBEZ. Follow her @kschorsch.