How this Duke ob-gyn’s job has changed since Dobbs

Following the overturn of Roe v. Wade, Beverly Gray told Healthcare Brew she knows providers who left states with abortion bans as a result of changing laws. It’s a “complicated” and “personal” decision, she said.

For the Duke University School of Medicine professor of obstetrics and gynecology, though, leaving was never an option. A born-and-raised North Carolinian, she decided to hunker down and provide the best care possible.

Ob-gyns’ lives quickly changed on June 24, 2022, when the Supreme Court overruled Roe v. Wade and removed federal constitutional abortion protections.

Depending on the state and practice, doctors have faced completely different policies around reproductive care. In states where abortion remained legal, providers may have seen an influx of patients coming from states where new bans were implemented. In others, where abortion was made illegal, they may have seen clinics close.

“It’s frustrating that we have to alter the care that we provide to meet the demands of a law that’s not evidence-based,” she told us. “We are really trying to do our very best to make sure that patients can get the care that they need.”

Gray took us through a day in her work life, and how it’s changed since June 2022.

Abortion care

An average day for Gray can mean a lot of different things. Sometimes she’s on the labor and delivery floor, sometimes she’s in research meetings or a classroom, other times she’s in the clinic.

Overall, though, her practice was most greatly impacted in May 2023 when North Carolina—ranking second among states providingabortions to out-of-state residents in 2024—instituted a strict abortion ban, making care illegal after 12 weeks with some exceptions for rape, incest, and “life-limiting anomalies.” The law also required a 72-hour wait period with in-person counseling and an ultrasound. This was even stricter than the state’s previous 20-week ban that went into place right after Dobbs.

This “created a lot more red tape,” Gray said, for patients who “show up to clinic and feel certain about their decisions.” Sometimes, the 72-hour wait pushes patients beyond the gestational age limit, too, which means they have to travel out of state for their procedures, she added.

Gray implemented a set of new appointment slots to accommodate more patients and avoid missing the 12-week deadline due to the 72-hour wait period. She also moved her clinic to comply with the new law, which requires abortions to take place in a standalone ambulatory care center, standalone abortion clinic, or hospital.

In addition to North Carolina, she’s been practicing in Virginia since the fall of 2023 to help meet the demand. At the same time, her clinic has expanded its hours, as she is seeing more patients traveling from out of state. North Carolina saw a 45% increase in clinician-provided abortions in 2023 compared to 2020, according to sexual and reproductive rights organization the Guttmacher Institute’s Monthly Abortion Provision Study.

“I don’t think we were predicting how much pressure that [additional patients] puts on a medical system and our ability to provide care,” she said. “It can be overwhelming at times for patients, for providers to figure out this very chaotic scene.”

Outside of bans, new technology like ambient scribes have made her practice more efficient, she said. These tools are still relatively new, but are showing a reduction in clinical documentation time. A study in the journal NEJM Catalyst reported in March 2025 that the tools saved 15,700 hours of work in a 10-week pilot.

On top of that, she said pregnant patients are much sicker and have more complicated pregnancies now compared to when she graduated medical school in 2007. The Blue Cross Blue Shield Association reported in 2019 that, since 2014, millennials aged 18–44 experienced a 35% increase in major depression, 31% increase in hypertension, and a 28% increase in Type 2 diabetes. Millennial women account for nearly 85% of US pregnancies, according to a 2020 Blue Cross report.

“We’re taking care of patients that have pretty significant medical illnesses along with pregnancy,” she said.

Coverage loss, menopause gain

The ob-gyn is also concerned that cuts to Medicaid could exacerbate health complications.

Half of pregnant people in North Carolina are on Medicaid, according to the North Carolina Medicaid Division of Health Benefits. With the proposed changes in the One Big Beautiful Bill Act, research organization the Urban Institute estimates up to 195,000 of the 650,000 patients on the federal insurance program in North Carolina are at risk of losing coverage.

Medicaid also covers things like contraception and obstetrics care that patients need outside of pregnancy, she said.

At the same time, though, Gray said she’s seeing increased attention on and treatment options for menopause as well as less stigma around it. This includes more discussions with providers as well as in the workplace as people age. There’s also more work around pain mitigation for things like IUD insertions in practice, she added.

“There are more treatment opportunities,” she said, and “more knowledge about it.”