“Florida, Florida, Florida…. it’s all about Florida for these two.” Susan, then my fiancé, and I sat there bleary-eyed as we watched the late Tim Russert describe the importance of the pending election recount in Florida in early November 2000. The nation waited on edge to hear which presidential candidate would win the Electoral College. Over the last two decades, Susan and I would frequently look at each other and laugh as we said “Florida, Florida, Florida” each time there was a new story about a bizarre event or upon hearing a funny anecdote about a Florida resident.
Days before writing this column, I found myself thinking back to those three words as I read postings on SGIM connect. One of our members from New England posted what seems a reasonable question—should our leadership consider withdrawing from Florida as a host site for the annual meeting given its restrictions on reproductive care? That member pointed to SGIM previously holding annual meetings in states whose legislative bodies had recently enacted polices clearly counter to our values and stated that at the time the conference was too near to the actual date to pull out. However, we now have an opportunity to consider relocating our planned 2025 annual meeting in Hollywood, Florida. As is usually the case when an issue of importance is raised through an electronic listserv, replies were generated immediately by a few SGIM members and listserv participants. Respondents ranging from assistant to full professor, initially from states like me with legal protection for abortion, were able to express their disappointment at the idea of holding an annual meeting in a state with restrictive abortion law. Each called upon “SGIM leadership” to make clear how we would respond to the issues taking place in states like Florida. One senior member even commented they will likely “vote with [her] feet” and not attend any academic conferences in such states. Sensing the inevitable onslaught of passionate “reply alls” that can occur on listservs, I sought to communicate my gratitude for the issue being raised while clarifying the importance of being considerate of potential unintended consequences that may occur from reflexive action in response to our current political climate. Then I noted a message of great impact. Just as I was preparing this column, I saw for the first time, the reflections of an SGIM member residing in Texas. This member thoughtfully articulated viewpoints she believed were shared among many colleagues in states like Texas and Florida that are restricting access to reproductive care. As I read her post, describing potential feelings of abandonment of our colleagues within these states, I felt a sense of empathy with her. She reminded us that many of our members in these states are working so hard to advocate for equitable care as she described how many of them would feel if we were to pull out of SGIM activities in states. As I read her words, my heart began to hurt. I grew more concerned about the importance of our society’s actions as she described that those in the “lion’s den” would prefer that we “join them in the fight as opposed to leaving them behind.” As she noted the importance of having societies engage in scholarly activity in these states and the impact our collective withdrawal will have on those internists’ opportunities for conference engagement and scholarly participation; participation that often facilitates academic promotion. I remembered how participation in that very first meeting, held within 25 minutes of my office, provided my earliest opportunities to add scholarly work to my own curriculum vitae.
To be honest, I am unsure how to respond to the numerous states that have enacted policies counter to our organizational mission to support improved human health and well-being. Between increasing legislative efforts to prohibit equitable access to care for the LGBTQ+ community and the devastating effects of the Supreme Court’s decision to overturn Roe v. Wade, there are many states in which our members find it objectionable to hold annual meetings. I am concerned that a cadre of society members feel that our continued presence in these states for regional or national meetings may signal indifference to the effects their policies have on our patient populations and on the rights of the physicians we represent. On the other hand, some members value the opportunity to have colleagues supporting them as they endure the difficulties of their environment and fear being left behind. As someone who has spent my entire career in Massachusetts and Delaware, I cannot fathom spending my time advocating for high quality and equitable care in states where the legislature is actively working to make those outcomes much more difficult. However, it seems to me that it is easy for those of us to demonstrate righteous indignation at those actions while paying little attention to the effects of our decisions on many of our fellow colleagues.
To guide our decisions, it is important to understand where the United States stands regarding reproductive rights and how states’ reproductive policies intersect with the population of SGIM members. As of the writing of this column, more than 20 states have either banned or placed term limitations on abortion and several more states have current legislative efforts to do the same (see table).1 SGIM currently has 3,143 full members residing in the United States—of these, 1,223 (39%) live within states that restricted access to abortion.
Regarding the concerns articulated by our members on the listserv about future meetings in Florida, I admit I am unsure about what is most appropriate. Is the right answer that we return to the earliest years of our society in which 21 of the first 22 annual meetings were either held in Washington, DC, or California? Is a better answer that we continue to meet in a diverse slate of locations to better meet the international diversity of our membership? Perhaps the right answer is to compromise where we temporarily restrict meetings only to the 10-15 states that most of our members find less objectionable?
To better understand the perspectives of a more representative sample of our members, our organization’s CEO and I will be attending many regional meetings during academic year 2022-23 to hold brief opened discussions with members. At each meeting, we aim to hear members’ thoughts about the best ways in which SGIM can be responsive to the limitation of safe reproductive care imposed in so much of the country. During these discussions, we hope that anyone with concerns will be there so that we might hear directly from you. Our goal is to have transparent discussions about what goes into making decisions about our advocacy agenda as well as site selection for our annual meetings. Although I may be unsure of the right answer, I am very clear on what is the wrong thing to do. The wrong thing would be to allow our collective frustrations to underestimate the gravity of decisions such as abandoning conferences in more than half of the United States. I am concerned that reflexively withdrawing from states that enact policies counter to our values places us at risk of negatively impacting nearly 40% of our members who reside in states restricting reproductive rights. To me, that is unjust.