Susan Hill is looking for a doctor to replace David Gunn at the Columbus, Ga., abortion clinic where he had worked until he was killed earlier this month.
She has been telephoning every family practitioner between Columbus and Atlanta, including a few who have retired. So far, only one doctor has said he might be interested -- if he can convince his wife that he won't be killed. But that does not surprise Ms. Hill, who oversees eight clinics, including the one in Columbus.
For her, and other abortion-rights advocates, the shooting of Dr. Gunn March 10 outside a clinic in Pensacola, Fla., has only underscored what they see as a crisis in women's health care: the increasing difficulty of finding doctors who will perform abortions.
Fewer and fewer doctors are willing to put up with the death threats, hate mail, "wanted" posters and protesters picketing their homes. Ms. Hill, executive director of the National Women's Health Network, in Raleigh, N.C., recently ordered seven bulletproof vests for doctors at her clinics. "It's a helluva way to practice medicine," she said.
Fear is not the only reason so many doctors shun abortion practice. There are other deterrents like the sheer tedium of the procedure to the relatively low pay -- about $50 an abortion in some cases. And, of course, some doctors are unwilling to perform abortions because of deeply felt religious or ethical concerns.
Furthermore, now that most abortions are performed in outpatient clinics rather than in hospitals, there is a growing sense among younger gynecologists that abortion is not a service they need to provide.
Many of the doctors who now perform abortions, some at considerable personal risk, are older doctors driven by the memory of the women they saw dying from botched abortions more than two decades ago.
But younger doctors who have come of age since the Supreme Court's Roe vs. Wade ruling affirmed the right to abortion lack the collective memory that might motivate them to do abortions.
"Altruism is the driving force that motivates doctors who perform abortions, and that may not be enough," said Dr. David Grimes, a professor and vice chairman of the Department of Obstetrics, Gynecology and Reproductive Sciences at the University of California in San Francisco.
Medical schools have contributed to the marginalization of abortion, advocates say. A 1991 study found that only 12.4 percent of American medical schools and other training programs routinely teach residents how to perform abortions, down from 22.6 percent in 1986. Nearly one third, or 31.2 percent, offer no training in abortion.
And many hospitals are reluctant to enter the abortion fray.
"The threat of having pickets out front, deterring patients from the hospital, may be enough to convince the boards not to get involved," Dr. Grimes said. "Their attitude is 'Why stick our necks out?' "
Dr. Grimes and others are exploring several new approaches to increase the pool of abortion providers. These include restoring training programs in hospitals, teaching physician assistants and nurse-midwives how to do abortions and recruiting retired doctors to work in clinics.
Abortion-rights advocates say that the best route to change is through training. The National Abortion Federation has begun writing curriculum that will help hospitals teach abortion.
"The residencies are in bad shape," said Barbara Radford, the executive director of the federation, in Washington. "We need to tell the medical community that they've got to learn abortions."