State abortion laws influencing many medical students’ residency choices

Key takeaways:

• Researchers surveyed nearly 500 third- and fourth-year medical students across 32 states.
• Survey results indicate abortion care is changing where U.S. medical students are choosing to apply to residency.

BALTIMORE — A new study found that the Dobbs decision and subsequent restrictive abortion laws are impacting residency application decisions for medical students across all specialties.

Many medical students are choosing to avoid or select programs in U.S. states with restrictive abortion laws based on their personal views, Ariana M. Traub, MPH, and Kellen Mermin-Bunnell, BS, third-year medical students at Emory University School of Medicine, told Healio.

“Dobbs has already had drastic short-term repercussions, and it has the potential to dramatically change the long-term health care landscape in the U.S. ... With an increase in physician shortages, particularly in rural areas, this has potential implications for expanding these shortages in states with more restrictive abortion laws, worsening health outcomes,” Traub and Mermin-Bunnell said in an interview.

The researchers aimed to evaluate how abortion care is changing where U.S. medical students choose to apply to residency.

“With Dobbs, and the eventual implementation of HB 481 in Georgia (6-week ban), impacting us early in our medical education, we wanted to know how this was impacting those further along in the process. Would Dobbs and the later individual state policies impact where a medical student would apply to residency? Would this change the distribution of residents across the country? We also began to think about what powerfully politically driven health care policies would mean for us beyond medical school — how would this change the kind of physicians we end up becoming?” Traub and Mermin-Bunnell told Healio.

The researchers assessed survey responses from 494 third- and fourth-year medical students across 32 U.S. states applying to residency programs from August 2022 through October 2022. According to the results:

• Most respondents applying into OB/GYN and those applying into all other specialties indicated that they are unlikely or very unlikely to apply to a single residency program in a state with abortion restrictions (57.9%).
• Medical students in a state without abortion restrictions indicated that they are less likely to relocate to a state with abortion restrictions, and those in a state with restrictions indicated they are more likely to apply broadly to states with and without restrictions.
• Cis-gender women were more influenced by the Dobbs decision and its impact on where and when to start a family.
• Cis-gender men and/or those that self-identified as Catholic were least influenced by Dobbs when making residency decisions.

“For personal as well as professional reasons, reproductive health care access is now a key factor in residency match decisions as a result of Dobbs,” Traub and Mermin-Bunnell told Healio. “We found it interesting that medical students applying to every specialty, not just OB/GYN, are influenced by Dobbs and subsequent abortion restrictions when choosing where to apply to residency. We had expected those applying into OB/GYN would be more influenced because they are the ones mostly providing abortion care.”

The researchers said they hope to follow-up this work in the future with longitudinal data on patient outcomes and physician distribution across the U.S.

“While our study is a small sample of medical students, if generalizable, it has substantial implications for a shift in where physicians train, and eventually practice,” Traub and Mermin-Bunnell told Healio.