Small decrease in OB/GYN residency applicants in states with recent abortion restrictions

Key takeaways:

• Applicant numbers differed by state abortion ban status in 2022 and 2023 OB/GYN residency match cycles.
• More applicants applied to programs in states with no bans or with gestational limits vs. states with bans.

Obstetrics and gynecology residency programs in states with abortion bans had statistically significantly fewer applicants in 2023 than in years before the Dobbs decision in 2022, researchers reported in JAMA Network Open.

“A concern raised by educational leaders, residency programs and applicants to OB/GYN is whether access to training in comprehensive women’s health care would alter applications to programs in states with abortion restrictions and bans,” Maya M. Hammoud, MD, MBA, J. Robert Wilson Research professor of obstetrics and gynecology in the department of obstetrics and gynecology and professor of learning health sciences at the University of Michigan Medical School, Ann Arbor, and colleagues wrote. “Additionally, future workforce concerns are part of a growing national conversation, as roughly half of residency graduates typically practice in the state where they train.”

Hammoud and colleagues conducted a serial cross-sectional study using anonymized data for all U.S. OB/GYN residency program applicants during September and October from 2019 to 2023 and identified 2,463 (85.4% women) applicants who applied to 292 programs for the 2023 residency match cycle. Researchers evaluated applications and program preference signals sent to OB/GYN residency programs and analyzed each applicant’s self-reported demographics. OB/GYN residency programs were categorized by state-based abortion restrictions following the Dobbs decision.

In addition, researchers analyzed data on program signals during the 2022 to 2023 residency match cycle. Each applicant was able to send up to 18 signals ranking their program interest — three gold signals indicating their most preferred program and 15 silver signals indicating more preferred programs.

The primary outcome was differences in the percentage of unique OB/GYN residency program applicants from 2019 to 2023. Secondary outcomes included program signal distribution by state abortion ban status.

At the time of application submission for the 2023 match cycle in September 2022, 11 states had fully enacted abortion bans and six had gestational limits.

Researchers observed stable applicant numbers from 2019 to 2023. However, the number of applicants differed significantly by state abortion ban status between the 2022 and 2023 OB/GYN residency match cycles (P < .001 for both states with bans and states with gestational limitations). In 2022, 99.1% of applicants applied to one or more programs in states with no bans and 84.7% in states with bans and 92.3% in states with gestational limits. In 2023, 99.4% of applicants applied to one or more programs in states with no bans and 82.4% in states with bans and 91.1% in states with gestational limits.

Data did not differ between states with bans and those with restrictions, according to the researchers. During the 2023 OB/GYN residency match cycle, 95.5% of applicants provided program signals. When controlling for the number of applications received and program size, researchers noted no differences in the number of signals programs received in states with abortion restrictions and bans. In addition, researchers noted that there were also no differences in the percentage of signals sent by out-of-state applicants to programs in states with abortion laws that differed from their home states.

Limitations of this study include challenges in interpreting changes in applicant data while also implementing program signals during abortion access changes in the U.S. and the possible confusion and knowledge of new information and legislation among applicants due to the changing abortion landscape that may impact 2023 cycle choices.

“While OB/GYN residency programs filled the vast majority of available positions in 2023 as in previous years, continued monitoring for potential consequences of state bans in terms of applicant behaviors will be critical,” the researchers wrote.