Though evidence may not sway some lawmakers’ decisions on abortion, the realities of reproductive health care are driving the decisions for medical school students in the field of obstetrics and gynecology.
For the second straight year, fewer students in MD-granting U.S. medical schools are applying for OB-GYN residencies in abortion-restricted states. Just as numerous states have sent a signal since the overturn of Roe v. Wade by enacting abortion bans and restrictions, future doctors are sending one in return: They do not want to work or live where these restrictions exist.
A recent national survey shows that nearly all medical students applying to OB-GYN residencies ranked programs in states with greater abortion access higher than programs in states with restrictions. Approximately three-fourths of this year’s survey respondents cited the Dobbs v. Jackson Supreme Court decision as having influenced their residency application plans.
That follows a 2023 survey in which 82 percent of early- to mid-career doctors and medical students who responded expressed the preference to work or train in states without abortion restrictions. The Association of American Medical Colleges also has reported that the number of applicants to residency programs in states with near-total abortion bans declined by 4.2 percent, compared with a 0.6 percent drop in states where abortion remains legal.
Abortion-restricted states should interpret this as more than education-related data. It’s cause for alarm regarding medical staffing in their states and, in turn, their constituents’ health.
These surveys mirror frank conversations medical school advisers are having with advisees pursuing careers in obstetrics and gynecology. Political considerations have become more prominent in training and career decisions, as students hesitate to apply to residencies in states where they believe they cannot be fully trained or where they do not want to settle permanently.
Many OB-GYN residency applicants see the field as a calling. But there’s a strong thread of advocacy and reality within that sentiment. Even as they train to help as many patients as possible experience pregnancy, labor and delivery safely, they know that they need to learn how to perform abortions. It is a reality of reproductive health care. There will always be high-risk patients for whom pregnancy may be life-threatening, or patients who experience ectopic pregnancy or incomplete miscarriage.
Residents in abortion-restricted or banned states simply won’t be trained to provide comprehensive care for those patients — potentially putting patients in harm’s way and forcing colleagues in other states to manage the fallout.
One applicant from the school of medicine where we work was interested in an OB-GYN residency in a state with significant abortion restrictions but only applied after being reassured that the program arranges for out-of-state abortion training for residents. That’s something larger residency programs at academic medical centers may have the resources to manage, but other programs may not have that capacity, desire or political will.
Potential OB-GYN residents also are keeping an eye on a shortfall in the field.
About 4.7 million patients already are living in “OB-GYN deserts,” areas with limited access to basic gynecological and obstetric care. Now there’s an anticipated OB-GYN workforce shortage. About 3,000 fewer OB-GYNs will be practicing throughout the country by 2030, the Department of Health and Human Services projects. If current aging, burnout and political trends continue, it’s feasible there won’t be enough fully trained OB-GYNs to care for patients or train future generations of OB-GYNs.
This scenario endangers every facet of reproductive health, and medical educators aren’t well positioned to remove that danger alone. This decision sits where the political meets the professional and personal: After all, these doctors-in-training (and/or their significant others) may not have full bodily autonomy, depending on where they settle. It’s a challenging, fragile responsibility to help future doctors weigh these options.
We’re charged both with training future doctors and advising them on their professional paths. How can we encourage them to move to states where they’re prohibited from using the evidence-based skills and reasonable medical judgment they’ve begun to build in medical school?
Of the graduating medical students we advise annually who pursue OB-GYN, the overwhelming majority are advocates for reproductive rights. That is not a “blue state”-only philosophy. They want to guide patients through safe pregnancy, labor and delivery experiences, to fully meet their patients’ needs. That can include abortion. Does it make sense to encourage graduating students to complete their training in states where legislation has taken medical decisionmaking out of the hands of OBGYN practitioners?
Successful residents have access to complete training in their chosen field. Those who have the most opportunities to hone their skills and learn from more experienced colleagues go far. Though we want our graduates to go where they’re needed, abortion restrictions and bans are creating an environment in which they can’t fully offer OBGYN care.
Medical schools’ role in guiding them through these decisions may increasingly mean helping them accept that their chosen profession is being undermined. And it may mean encouraging them to train — and ultimately practice and live — where they can offer, and perhaps receive, the full spectrum of reproductive care.
Louis Miller, MD, is assistant dean for career advisement and assistant professor at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.
Andrew Yacht, MD, MSc, FACP, is senior vice president of academic affairs and chief academic officer for Northwell Health and professor of medicine and associate dean of graduate medical education at the Donald and Barbara Zucker School of Medicine at Hofstra/Northwell.