OB/GYNs ‘vote with their feet’ as workforce declines in states that restricted abortion

Key takeaways:

• The OB/GYN practitioner supply increased overall across 26 states after the Dobbs decision.
• However, this supply decreased by 4.2% in the states that enacted abortion laws following Dobbs.

Modest but significant decreases in OB/GYN practitioners occurred in states with full abortion bans following the 2022 U.S. Supreme Court decision in Dobbs v. Jackson Women’s Health Association, a study showed.

However, results of the case-control study revealed the workforce of such practitioners ultimately grew overall across all states.

“This is the first empirical evidence that we know of that there has been a workforce response to the post-Dobbs landscape,” Jane M. Zhu, MD, MPP, an associate professor of medicine at Oregon Health and Science University, told Healio. “Health care providers are like any other group — they can vote with their feet — and the fact that they are leaving the states in which clinical autonomy and decision-making is constrained is very worrisome. These shifts have enormous ramifications for care access and quality.”

There have been rising concerns about potential workforce losses following the Dobbs decision, but evidence “has been strictly anecdotal or survey based, documenting obstetrician-gynecologists’ intent to leave states with restrictive abortion laws,” Zhu and colleagues wrote.”

Healio previously reported on survey findings showing that over 80% of medical student and physician respondents did not want to practice in a location with abortion restrictions.

In the current analysis, the researchers used National Plan and Provider Enumeration System (NPPES) data from 2018 to 2024 and a difference-in-differences approach to determine changes in the state practitioner supply in states that enacted restrictive abortion laws after Dobbs compared with states that enacted abortion laws prior to Dobbs — referred to as control states — from:

• December 2018 to December 2021, or before the Dobbs decision; and
• December 2022 to July 2024, or after the Dobbs decision.

Researchers classified a state’s practitioner supply as the number of women’s health specialty practitioners per 100,000 reproductive-aged women.

They found similar practitioner supply trends prior to Dobbs among 14 control states and the 12 most restrictive states.

Study investigators reported that OB/GYN practitioners increased overall across all states following Dobbs but pointed out that statistically significant decreases in certain states “were noted after the ruling.”

Specifically, the most restrictive states had a 4.2% decrease in OB/GYN practitioners (-3; 95% CI, -5.9 to -0.2) compared with control states.

The results, published as a research letter in JAMA Internal Medicine, “were robust to sensitivity analyses,” the researchers wrote.

They acknowledged several study limitations, which included a shorter follow-up period “and reliance on NPPES data, which can be delayed.”

Maternal mortality and morbidity in the U.S. “is higher than it is in many other high-income countries, and many of the states where reproductive rights are most restricted already experience poorer pregnancy outcomes,” Zhu told Healio. “Further movement away from these areas may lead to maternity deserts and worsen these underlying inequities in care provision and health outcomes.”