Abortion restrictions might be influencing where medical students apply for residency programs, which could have stark implications across entire state healthcare systems, with some doctors warning it could essentially unravel entirely.
According to a new analysis by the Association of American Medical Colleges (AAMC) Research and Action Institute, updated data from 2023 found a continued decline in medical students applying to residency programs located in states with restrictive abortion laws. The trend aligned with a similar one that the research institute saw in the first year after the U.S. Supreme Court overturned Roe v. Wade in 2022.
“The biggest takeaway is that for a second year, we are seeing decreases in the number of applications in states where abortion bans are in place,” Kendal Orgera, a senior research analyst at AAMC told Salon in a phone interview. “And that varies by specialty — for OBGYNs in states where abortion is banned has decreased even more and this shows a big implication of the potential workforce of the future.”
As of May 2, 2024, abortions are nearly totally banned in 14 states across the country. Some, but not all, have narrow exceptions, such as preventing the death of the mother, when the pregnancy is the result of incest or rape, or when there is a lethal fetal anomaly. While many of these states don’t make it technically illegal for a pregnant person to get an abortion, they do penalize providers, like OBGYNs or family medicine doctors, for conducting them.
"It's a big message to legislators that doctors don't want to be told how to practice medicine."
Penalties vary by state. For example, in Idaho, providers live in constant fear that they will have to deny a pregnant patient stabilizing, emergency abortion care, or they will face two to five years in prison and lose their medical license. In Texas, providers can be fined at least $100,000 or face between 5 to 99 years of jail time.
As Orgera said, residency applications for a variety of specialties declined in abortion ban staes. But for OBGYNs, the decline was even more drastic.
“It was a 4.2 decrease overall in the states that have banned abortion, but it was a 6.7 percent drop in OBGYNs,” Orgera said. “Texas has actually seen a decrease in senior med students since 2021.”
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According to the report, states with restrictive abortion laws saw a bigger decrease in the numbers of both OBGYN and emergency medicine applicants applying for residency programs than states with less restrictive gestational limits. The continued decline, the AAMC stated, comes after nearly five years of growth.
“The examination of two years of data suggests that restrictions on women's health care may continue to disproportionately decrease the likelihood that new doctors will apply to residencies in states that offer the most restrictive practice environments,’” the researchers wrote. "Because these policy decisions appear to affect where physicians plan to practice, state governments and health care leaders need to consider the potential impact of those decisions on the physician workforce.”
Dr. Kara Cadwallader, who is a family medicine physician in Idaho, told Salon this shows how the impact highly restrictive abortion laws will have on the country’s healthcare system.
"Why would anyone want to train where they can't really learn the right standard of care?"
“I thought it was very interesting that it's not just the specialties we would imagine, like OBGYN and family medicine, pediatrics and emergency medicine, had a big decline, which is scary, and that’s our workforce pipeline,” Cadwallader said. “I think the fact that it's not just specialties that tend to take care of pregnant women is really telling — it's a big message to legislators that doctors don't want to be told how to practice medicine.”
Cadwallader said abortion bans say “very loud and clear” that if a doctor comes to the state, legislators “will tell you how to practice medicine.”
“Why would anyone want to train where they can't really learn the right standard of care?” Cadwallader said. “I think it's a mistake to think that this is just about abortion — this is about the government dictating medical practice. And that goes bad, especially when they refuse to take any input from doctors and write laws that are ambiguous and harmful.”
Dr. David Hackney, a Cleveland-based maternal fetal medicine doctor, told Salon he often communicates with doctors with different specialties when caring for a pregnant patient. For example, if a pregnant patient has cancer he’s working with oncology. He said he is frequently communicating with people in cardiology, neurology and neurosurgery.
“Pregnancy itself is not siloed away within the field of OBGYN, and I think one of the things that many medical specialties have specifically realized after the Dobbs decision is the extent to which everyone is involved,” Hackney told Salon. “The other major issue, of course, is medical students are generally of reproductive age. A lot of residents and fellows are in the age group that's overlapping with when people would often have children. This is a group that’s potentially deciding where they want to go to start their families.”
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Both Hackney and Cadwallader said medical students frequently choose residency programs based on where they want to practice medicine as well.
This decline in residency applicants also comes at a time when doctors who have practiced in abortion ban states for years are uprooting their practices and moving elsewhere. As previously reported by Salon, a report published last month by the Idaho Physician Well-being Action Collaborative found that Idaho lost 22 percent of its practicing OGBYNs in the 15 months following Dobbs. The report also found that 55 percent of the state’s high-risk OBGYNs have left the state, leaving less than five in the entire state to treat patients.
If there isn’t a pipeline to fill these spots, it will cause chaos in the healthcare system, doctors said.
“I think our system is already starting to fall apart in Idaho, because we've lost our ability to care for pregnant women,” Cadwallader said. “It sounds really dramatic, but I think our healthcare system is starting to unravel.”
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