Study: Small Decrease in Applicants to OB/GYN Residency Programs in Abortion-Ban States
July 1, 2024 5 minutes read
Researchers looked at the impact of the overturn of Roe v. Wade on OB/GYN residency programs in the first year after the U.S. Supreme Court gave states the power to pass abortion bans with its decision in Dobbs v. Jackson Women’s Health Organization. They found there was a small but significant decrease in the number of applications to states with stricter abortion laws from 2022 to 2023.1
Another analysis looked at only medical student seniors from U.S. MD programs in 2024, leaving out osteopathic physicians and international medical graduate applicants. This one found that, compared to previous years, U.S. MD seniors submitted fewer applications per person in the 2023-2024 cycle, and there were larger decreases in states with complete bans on abortion.2
The overall decrease was 4.2% for programs in abortion-ban states, compared with a 0.6% decrease in states where abortions remained legal. The study’s investigators hypothesized that applicants may be selectively reducing their likelihood of applying to programs in states with more restrictions on abortion care.2
About 44% of OB/GYN residents train in states with abortion restrictions that affect their training. Most OB/GYN residency applicants for the 2023 residency match cycle are women — 85.4%, according to the study that analyzed 2023 data in depth.1
The proportion of applications to programs in abortion-ban states is not the only way to measure how Dobbs is affecting new OB/GYNs. Investigators also looked at how applicants signaled their strong interest in a particular program. Each applicant could send up to 18 signals — three gold signals and 15 silver signals — to indicate the programs they preferred.1
The researchers found that programs in abortion-ban states did not receive a significantly smaller percentage of program signals from out-of-state applicants when compared with programs in states without bans. The absence of an abortion-ban difference in applicants’ signals suggested they had other priorities that were more important to them. For example, they sent more signals to programs that had more available postgraduate year 1 positions, according to the study’s findings.1
Investigators also asked applicants their true intent, and there was no difference between states, says Maya M. Hammoud, MD, MBA, a professor and director of the Women’s Health Division in the department of obstetrics and gynecology at the University of Michigan Medical School in Ann Arbor.
“When you control for intent, there was no difference where abortions were restricted or not,” she explains. “When people are applying everywhere, they are not thinking about ‘I want to go there or not.’”
The study’s findings may offer some comfort to OB/GYN programs in abortion-ban states, since they suggest medical students still will apply for training despite the limitations and national attention on the impact of abortion bans on pregnant people. There were more applicants overall than there were residency spots, she adds.
“A lot of people want to be OB/GYNs but don’t get [a match] — it’s competitive,” Hammoud says.
“The majority of residency spots did fill — no matter where they are,” Hammoud says. “This makes us really happy because people still want to train, and there’s a high interest in this specialty.”
It also is possible that some medical students are even more interested in obstetrics and gynecology because they want to advocate for women’s health at a time when it appears to be under attack.
“Some of them get more enthusiastic about wanting to serve women and advocate for them because of what’s happening,” Hammoud says. “Some want to fight for it.”
It will be important for researchers to continue to watch the residency match data in the years ahead as abortion bans and restrictions increase and some programs face difficulty in providing abortion training.
“We need to continue advocacy and leadership,” Hammoud says. “Some doctors are put in difficult situations.”
Physicians in every state with abortion bans should help advocate for legislation or state constitutional changes to turn this around, she notes.
“In some places we see wins, like we saw in Ohio,” she adds, referring to how Ohio voters passed an amendment that protected access to abortion on Nov. 7, 2023. Michigan voters also enshrined abortion rights in the state’s constitution through Proposal 3 in November 2022.
“We were working with some training programs in Ohio to see how we could help their trainees come to Michigan to train [in abortion care], and then the law passed in Ohio, so we don’t have to do that,” Hammoud explains.
Sending residents to states that protect abortion rights for their training in abortion care is one way that OB/GYN programs in abortion-ban states can help their residents meet national requirements for their profession.
“Every single resident has to have access to that training; it’s very well spelled out in those requirements,” Hammoud says.
Although the trend for new OB/GYNs looks more hopeful than some may have feared, there remains a problem in the United States with a growing number of OB/GYN and maternity deserts, places where there are no practicing OB/GYNs or hospitals with maternity departments. Some pregnant women have to travel hundreds of miles to see an OB/GYN.
“OB/GYN deserts have always existed, but they’re getting worse,” Hammond says. “It has to do with small hospitals shutting down because they cannot afford to run the hospital.”
Pregnancy is high risk, and some hospitals cannot afford or find the staffing necessary for medical care of pregnant patients. This can have a cascading effect since doctors often practice medicine where they trained, she adds.
“When we don’t have those programs that train physicians, we lose them,” Hammoud says. “That’s why some women have to fly [to another hospital] to get care, and some maternal care is worse than it is in third world countries.”
People who are poor suffer the most because they cannot afford to go out of their home town or state for pregnancy care, and they are the ones most likely to give birth in an emergency department.
Emergency physicians often have to handle childbirths in maternal desert areas, and their residency programs are responsible for providing them with that training.
“They’re trained at a minimum level,” Hammoud says. “We do have to think about the places where they may be the only physicians who provide that care and how we might be able to train them to a higher level to provide safer care.”
According to Robert Hatcher, MD, MPH, regardless of what the Supreme Court decides about EMTALA and abortions, one can be certain that in many emergency rooms, if a woman is at risk of dying from a pregnancy, physicians are going to do what is necessary quickly to save her life.
REFERENCES
- Hammoud MM, Morgan HK, George K, et al. Trends in obstetrics and gynecology residency applicants in the year after abortion access changes. JAMA Netw Open 2024;7:e2355017.
- Orgera K, Grover A. States with abortion bans see continued decrease in U.S. MD senior residency applicants. Association of American Medical Colleges (AAMC) Research and Action Institute. May 9, 2024. https://www.aamcresearchinstitute.org/our-work/data-snapshot/post-dobbs-2024
Researchers looked at the impact of the overturn of Roe v. Wade on OB/GYN residency programs in the first year after the U.S. Supreme Court gave states the power to pass abortion bans with its decision in Dobbs v. Jackson Women’s Health Organization. They found there was a small but significant decrease in the number of applications to states with stricter abortion laws from 2022 to 2023.
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