Medical students, residents, and practicing OB/GYNs are saying they do not want to train and practice in states with extreme abortion bans, including Texas, Arkansas, Louisiana, Tennessee, Oklahoma, and others. The authors of a recent study found that four in five physicians and trainees preferred to avoid working in states with abortion bans.1
“Our main findings were that among a very large sample of physicians and trainees on social media — over 2,000 — more than 80% preferred to avoid training and practicing in a state with an abortion ban,” says Vineet Arora, MD, MAPP, study co-author and a professor of medicine and dean for medical education in the department of medicine at the University of Chicago Pritzker School of Medicine.
The preference was consistent regardless of specialty. Physicians said they wanted to improve access to care for patients but also cited personal family health reasons for their preference for states with safe and legal abortion care, Arora notes.
National articles provide a look at how some nurses and physicians are quitting or moving because they cannot handle the trauma they see when women are denied health- and life-saving abortion care during a pregnancy crisis. For instance, Leah Wilson, a Texas nurse, had to watch her pregnant patient for days as the woman’s infection worsened and drew closer to sepsis because the fetus still registered a heartbeat when the woman’s water broke at 19 weeks of pregnancy. The nurse said, “You know what? I’m not doing this anymore,” and she left her job. Wilson had worked with high-risk pregnancy patients before and provided them with support for fetal loss, but she had never seen patients denied standard medical care until after Roe v. Wade was overturned.2
These changes are happening quickly and dramatically. Abortion-ban states reported a greater than 10% drop in OB/GYN residency program applications in 2023.3
The key catalyst appears to be the U.S. Supreme Court decision in June 2022 to end the constitutional right to privacy in abortion care and reproductive autonomy. For example, medical students in Texas say they are worried about fulfilling the abortion training requirement of OB/GYN residencies because if they stay in Texas, there are no residency programs that can offer abortion care training. One Texas OB/GYN resident said she was told to not offer patients information about abortions out of state, and she fears losing her medical license for sharing this information.3
“People trained for a very long time to have these careers, and they picked places to live for a variety of reasons, and now they found they can’t practice to the state of the science,” says Mindy Bergman, PhD, an interim department head and professor in the department of psychological and brain sciences at Texas A&M University. “The law is interfering with what they consider to be good medical practice.”
The result is some providers will leave states for their own well-being. “That’s what the law has created for them,” Bergman says. “They can go to jail for providing best practice care. How does one operate in that space, given their ethical requirements as a physician or nurse?”
Since Texas’ anti-abortion laws allow people to sue anyone who aids an abortion, there may even be a risk in talking to someone about traveling to another state for abortion training.4
OB/GYN residencies have been one of the more popular specialties for years, but there was an overall drop in MD residency applicants in the 2022-2023 year. The decline in applicants was double for states with abortion bans.2 This likely will result in fewer OB/GYNs, obstetric nurses, and midwives in rural counties across the South.
“I think we are already seeing that there are some physicians leaving states with restrictive bans or legal consequences,” Arora says. “I know trainees who are factoring this into their decisions, as well.”
The threat of a further brain drain could lead to even worse outcomes for people who live in abortion-ban states, which already report some of the worst health outcomes in maternal and infant care.
“This is important given that it’s not just obstetric physicians who report this strong preference to avoid states with abortion bans, but physicians of all specialties,” Arora says.
“We’re going to see an effect, state-by-state, depending on their abortion rules,” Bergman says.
The loss of reproductive health providers will affect low-income patients the most — and it is not just about their ability to receive contraceptive care and abortion care. “It’s about having the right pregnancy care, full stop,” Bergman says. “It’s not just labor shortages, but the work will be more complicated, especially for people in the lower income range.”
While there have been anecdotal reports of OB/GYNs and high-risk maternal care specialists leaving states with abortion bans, the first data to show a change in this workforce comes from the 2022-2023 residency program applications. Fewer U.S. MD seniors in 2022-2023 applied to residency positions than in 2021-2022. This is especially true in states with abortion bans. The overall cycle of residency applicants decreased by 2% from the previous year. It decreased by 3% in states with abortion bans. Investigators found that MD applicants in the United States may be selectively reducing their likelihood of applying to states with more laws restricting healthcare, regardless of the number of available residency programs.3
Emergency medicine and OB/GYN saw the biggest drops in applicants. In 2023, there was a 21.4% drop in emergency medicine and a 5.2% decrease in OB/GYN among unique applicants across all states. Emergency medicine applications began to decline in 2022, but OB/GYN applications were on the rise until 2023, investigators found. Also, in states with complete bans on abortions, OB/GYN applicants decreased by 10.5%.3
The loss of obstetric providers in abortion-ban states could have a cascading downward effect on reproductive health in those places. “The interference with best practices makes it very hard to attract people to the profession,” Bergman explains. “The people who enter into healthcare, whether they’re doctors, nurses, or midwives, are not low fliers — they’re high-achieving people.”
These are the students with the best grades. They learn how to work correctly, and then they are told they are not allowed to do it. “That’s not a model to attract people to a career,” Bergman adds.
“Providers are scared, and of course that impacts care and patient outcomes,” says Alice Abernathy, MD, MSHP, an assistant professor in the department of obstetrics and gynecology at the University of Pennsylvania Perelman School of Medicine.
Abernathy was trained in medication abortion because she was tired of seeing the effects of social determinants of health on how people received care. “I wanted to be someplace where there was more access to optimal care, and that includes abortion,” she explains. “I’ve seen firsthand how each state varies in care. A provider may have a longstanding relationship with a patient and may have a deep connection to people or a population in their hometown.”
When their medical training and connection to their patient population are thrown into conflict with new state abortion laws, it can create internal conflict in providers.
“I’ve been able to avoid such direct conflict thus far, but I’m very worried about what that means for medical professionals at all levels — nurses, midwives, physician assistants, and medical students,” Abernathy says. “It will force many people to make difficult decisions about providing care in places where abortion is restricted.”
REFERENCES
- Bernstein SA, Levy MS, McNeilly S, et al. Practice location preferences in response to state abortion restrictions among physicians and trainees on social media. J Gen Int Med 2023;Feb 23. doi: 10.1007/s11606-023-08096-5. [Online ahead of print].
- Novack S. “You know what? I’m not doing this anymore.” Slate. March 21, 2023.
- Orgera K, Mahmood H, Grover A. Training location preferences of U.S. medical school graduates post Dobbs v. Jackson Women’s Health Organization decision. Association of American Medical Colleges. April 13, 2023.
- Benninghoff G. OB-GYN residents are required to receive clinical abortion training. They can’t do that in Texas. Texas Monthly. May 23, 2023.
Medical students, residents, and practicing OB/GYNs are saying they do not want to train and practice in states with extreme abortion bans, including Texas, Arkansas, Louisiana, Tennessee, Oklahoma, and others. The authors of a recent study found that four in five physicians and trainees preferred to avoid working in states with abortion bans.
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