"Abortion is as common as a hernia repair," said Carolyn Westhoff, professor of public health and obstetrics and gynecology at Columbia University. "What are we going to do -- have one hernia surgeon in each state that does repairs? It's absurd. Abortion is an everyday piece of women's health. [Doctors] should have a clue about something so common."

In January 1996, the Accreditation Council for Graduate Medical Education, the private body that establishes educational standards for thousands of residency programs in all specialties, called on OB-GYN programs to require abortion training. The decision capped an enormous controversy -- letters, debates, articles in the professional literature, all flowed freely -- with pro-choice activists, women's health groups and some educators on one side, and antiabortion organizations and Catholic and other religiously affiliated hospitals on the other. The council stopped short of imposing a blanket mandate. "No program or resident with a religious or moral objection will be required to provide training in, or to perform, induced abortions," the council said.

By granting individual physicians and training centers the right to opt out, the accreditation council recognized that choice lay at the heart of the abortion issue -- and subtly reinforced the marginality of abortion. Nowhere else in medical training may doctors decline to serve a patient because they don't personally approve of the necessary treatment.

"I did not get much pleasure doing a below-the-knee amputation when I was an intern," Toub said. "Its not a procedure you feel good about afterward. But I'm very glad I had the opportunity to receive the training. It adds to your pool of knowledge."

Law students, even those heading for careers in patents or divorces, must study criminal procedure whether or not they "object" to crime. Imagine if a group of hospitals refused to teach residents how to do C-sections because some influential donors considered them largely unnecessary.

Even with this important loophole, the accreditation council's abortion-training standard had a dramatic effect. Reliable statistics are hard to come by, but according to various estimates, 35 percent to 40 percent of OB-GYN residency programs now include abortion training -- roughly triple the percentage in 1992. The University of California at San Francisco, which continued to rotate OB-GYN residents through its outpatient abortion service even at the national low point of training, launched a program three years ago to promote abortion education around the country. The Kenneth J. Ryan Residency Training Program helps teaching hospitals set up abortion clinics where residents do five- to 10-week stints. Fifteen clinics have opened under the program, and 20 more are in the works, said Uta Landy, the program's director.

But until this summer, the expansion of medical training to include abortion happened one hospital at a time, without much public notice. The new training mandate at New York City hospitals, issued by Mayor Michael Bloomberg, was a breakthrough. It was the first time a city government required abortion training in publicly funded hospitals. And its installation has already sparked talk among proponents of abortion training for medical students in California of promoting legislation to require abortion training at public teaching hospitals throughout that state.

New York is also one of the largest training grounds for doctors -- one in seven U.S. doctors does a residency in a city-owned hospital there. This year, more than 150 OB-GYN residents will work in eight New York public hospitals. If any training program can help to replenish the ranks of abortion providers, it is New York's.

Finally, the city is a media nerve center, so the announcement got a lot of press. Unfortunately, the crush of publicity created the impression that New York's abortion-training mandate was novel-- instead of a new twist in a longtime trend. There were other distortions in the coverage, the most dangerous being the idea that doctors would now be forced to perform abortions no matter what their moral or religious objections. That is not the case. Nonetheless, a headline in the conservative Washington Times blared: "N.Y. hospitals to deny choice on abortion training."

Choice, of course, is what's at stake -- a doctor's choice to learn how to perform abortions, and a woman's choice to have one. Certainly, it makes no sense to force doctors to end pregnancies, just as it makes no sense to force women to carry pregnancies to term. But is it asking too much to expect all OB-GYNs to understand the basics of such a common procedure? Is it asking too much to require them to know how to handle post-abortion complications?

More than 1 million women in the U.S. will seek abortions this year. Many will turn first to an OB-GYN. It is not too much to hope that these doctors will offer options and wise counsel, instead of conjuring some rosy image of a great pregnant lady and then dishing out guilt. Patients, no matter what ails them, want professionalism, not patronization.

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