Dobbs decision could worsen physician shortages in some states
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Key takeaways:
- Dobbs decision altered where physicians choose to practice medicine.
- Most survey respondents preferred to apply to work or train in states with preserved abortion access.
The Dobbs v. Jackson Women’s Health Initiative decision in June 2022 had, and continues to have, broad implications for reproductive health rights nationwide.
When the Supreme Court decision came out, it became increasingly apparent that it will impact not only patients with cancer, but also the physicians caring for those patients, Morgan S. Levy, BS, MD/MPH-student at the University of Miami Miller School of Medicine, told Healio.
“That is what prompted our study about physicians and the choices they make in terms of where they train in particular and where they end up working,” Levy said. “The Dobbs decision has shaped the supply of physicians in certain locations and where physicians want to practice, which has broad implications on the practice of medicine and health care in America as a whole.”
Preferred locations
Levy and colleagues distributed a survey via social media to a non-probabilistic sample of 2,063 physicians and trainees (76.3% women) that included U.S. medical students and international medical graduates applying to U.S. residency programs, residents, fellows and physicians across all specialties, between Aug. 12 and Aug. 23, 2022.
Researchers pooled data on demographics, including age, gender, race, ethnicity, sexuality, relationship status, specialty and practice location by state.
Survey questions included respondents’ intent to apply to train or work in states with abortion restrictions, including a complete or early ban, emergency contraception ban and legal consequences for providing abortions.
Overall, 890 respondents (43.9%) were from states with current or likely abortion bans.
Results of the survey, published in Journal of General Internal Medicine, showed that 82.3% of respondents preferred to apply to work or train in states with preserved abortion access. Further, 76.4% stated they would not apply to states with legal consequences for providing abortion care.
Results of the survey also showed that although the preference to apply to work or train in states with preserved abortion access appeared strongest for states without abortion bans, most respondents that resided in ban/likely ban states preferred not to work in states with complete (61.3%; P < .001) or early (56%; P < .001) abortion bans.
“Most of our study sample did not want to apply to work or train in locations with abortion restrictions,” Levy said. “Reproductive health care physicians — including those in obstetrics and gynecology and family medicine — made up less than one-third of our sample. Yet, we still found that 82% of respondents did not want to apply to work or train in states with abortion restrictions or bans. To me, this shows that loss of reproductive autonomy has major implications for the practice of medicine across all specialties.”
Physician access
Levy and colleagues additionally found that reasons for physicians’ preference to not work in states with complete or early abortion bans included preserving patients’ access to care (77.8%) and preserving access to care for themselves or their partner (56.1%).
“In addition to concerns about caring for patients, survey respondents were also concerned about access to care for themselves and their family members. This is consistent with our previous work that showed 11.5% of physicians who had been pregnant had at least one abortion during their reproductive years,” Levy said. “The point of this work is not to suggest that people should not apply to work or train in locations with bans. The goal is to create awareness of how restrictive abortion bans will shape the physician workforce in upcoming years.”
Levy mentioned an Association of American Medical Colleges report on the percentage of applications to OBGYN residency programs across the country, which showed a lower number of applications in states with abortion bans.
“However, OBGYN residency programs in states with abortion bans still filled,” Levy said. “It’s all very challenging because there are factors beyond applicant preference that ultimately shape where people apply to train for residency. There are complicated personal feelings that come into play when considering where people have family roots, and other factors that shape where people train.”
Levy said it is important to support individuals who perhaps did not want to practice in a state with abortion restrictions but now find themselves in one.
“Whether that means ensuring that people have access to adequate training or making sure that those who need out-of-state care [have] programs in place to ensure they are able to get time off to do that,” she said. “It is important to professionally recognize that it is a responsibility of physicians across all fields to advocate for this and to play an active role in whatever appropriate capacity to ensure their patients receive good care and are a part of the advocacy to improve laws in states that they’re in.”
Moving forward
Levy and colleagues are now examining qualitative data from the survey to better understand the exact motivations for practice location preferences.
“This work is ongoing, and it will be enlightening to be able to provide some perspective on how to move forward and the types of actions that we need to take as a profession to address some of these problems and shortages in coming years,” she said.
With her clinical interest in gynecologic oncology, and as someone who recognizes the potential impacts of Dobbs decision for patients with cancer, Levy said she has thought a lot about the implications for the oncology field.
“As I was learning more about this in the days following the Dobbs decision, one of the places where I learned the most was the Healio podcast with Shikha Jain, MD, and Eleonora Teplinsky, MD, where they discussed the implications of the decision for oncology,” she said. “They made many excellent points. Something for oncologists to consider is that the freedom to decide whether to be pregnant or not has huge implications on the type of oncology care that a patient can receive. When someone is dealing with the challenging decision of what to do in the face of a cancer diagnosis and a pregnancy at the same time, it is vital for individuals to have access to every option they want, whether it is to stay pregnant and to plan their treatment accordingly, or to end the pregnancy to utilize the best treatment option that makes the most sense for them.”
It is important to give all individuals what embodies reproductive justice at its core — the freedom to be pregnant or not to be pregnant, and to be able to raise a child on their own terms, Levy continued.
“I hope to continue to see advocacy across all specialties in medicine,” she said. “Oncology is a key specialty in this conversation to ensure that patients with cancer have the autonomy to make medical decisions that align with their goals.”
References:
- Association of American Medical Colleges. Training location preferences of U.S. medical school graduates post Dobbs v. Jackson Women’s Health Initiative decision. Available at: www.aamc.org/advocacy-policy/aamc-research-and-action-institute/training-location-preferences?utm_source=newsletter&utm_medium=email&utm_campaign=newsletter_axiosvitals&stream=top. Published April 13, 2023. Accessed May 11, 2023.
- Bernstein SA, et al. J Gen Intern Med. 2023;doi:10.1007/s11606-023-08096-5.
- Levy MS, et al. Obstet Gynecol. 2022;doi:10.1097/AOG.0000000000004724.
For more information:
Morgan S. Levy, BS, MD/MPH-student, can be reached at morgan.levy4@gmail.com.
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