Abortion Ban States See Steep Drop in OB/GYN Residency Applicants

By Fenit Nirappil, Frances Stead Sellers / The Washington Post

14:56 JST, April 22, 2023

States that have enacted abortion bans saw a 10.5 percent drop in applicants for obstetrics and gynecology residencies in 2023 from the previous year, according to new data from the Association of American Medical Colleges.

That decline carries a potential long-term impact on the availability of doctors to care for pregnant people and deliver babies across a large swath of the South and Midwest because medical residents often choose to stay and work where they trained.

“Everybody is saying they knew this would happen, but this is concerning,” said Atul Grover, who leads the association’s Research and Action Institute to examine the most pressing issues affecting American health care. He has a message to policymakers: “You may be discouraging some of the best candidates from coming to your state to train.”

The abortion bans implemented across more than a dozen states after the Supreme Court overturned Roe v. Wade last June prompted many medical students to question whether states with new restrictions would offer them the training necessary to care for patients.

When it came time to submit applications to OB/GYN training programs last fall, Lucy Brown decided against storied medical residencies in Texas and Florida. Nor, to her disappointment, would the Indiana medical student be training close to her family in Kentucky, a region that is losing obstetricians even as its maternal mortality crisis worsens.

In her clinical rotations through Indiana University School of Medicine, the 26-year-old has cared for patients who needed to terminate pregnancies because of cancer and other health reasons. Indiana passed a near-total abortion ban last August that a judge has blocked while the law is being challenged in court.

“When you are in a blue state, you can give her all her options. But in a red state, you are just like, sorry, there’s nothing more that we can do,” said Brown, who decided to do her residency in Maryland, where abortion remains legal. “Everything is up in the air whereas in a blue state, I just follow the guidelines. I can just counsel the way I’m supposed to counsel.”

Grover cautioned that it is too early to tell exactly what’s driving the decline in interest in OB/GYN residencies in states with abortion restrictions. The association also found a 5 percent drop in OB/GYN applicants nationally. Despite the decline, nearly all of the 1,503 residency positions were filled this year because the number of applicants exceeded the number of training slots available, the association said.

Abortion bans influenced Mindy Sharon’s decisions about where to pursue a residency in emergency medicine because ER doctors may need to terminate pregnancies or work with OB/GYN doctors to terminate them. Sharon, who is graduating from the Marshall University Joan C. Edwards School of Medicine in Huntington, W.Va., next week, felt she could not receive a well-rounded medical education in states where abortion is outlawed.

While abortion bans generally create exemptions to protect the life of the mother, hospitals and doctors say ambiguities in laws have resulted in medically necessary abortions being delayed or denied and caused confusion in emergency rooms.

“It really ties peoples’ hands,” said Sharon, 31. “I didn’t want to be in a situation of letting that decision dictate what type of care I could give.”

She decided against applying to residencies in Texas, despite it being home to multiple coveted emergency medicine programs, because of the state’s ban on abortion after six weeks. And she no longer saw West Virginia, where she also received her bachelor’s degree and master’s in public health, as suitable for the final leg of her education after lawmakers passed a near-total ban on abortion.

“The way health care has been treated here with this ban and the politics of it all just don’t align with my values,” said Sharon, who will head to Stanford Medicine in California this summer. “I would love to come back and take care of West Virginians, but for right now, this is not a place that’s going to advance my training.”

The Accreditation Council for Graduate Medical Education requires OB/GYN residency programs to offer education and training in comprehensive family planning – including clinical experience in induced abortion – to maintain accreditation, prompting programs in states with bans to send residents to other jurisdictions for training.

“Clinical experience in performing induced abortions is essential to the evidence-based practice of obstetrics and gynecology, and the decision was made to preserve the integrity of the requirement for preparing physicians to practice anywhere in the United States,” the council said in a statement by spokesman Justin Dreyfuss.

Tennessee’s abortion ban has complicated the University of Tennessee Graduate School of Medicine’s ability to train doctors in abortion care and attract applicants to its obstetrics and gynecology residency, said Nikki Zite, vice chair of education and advocacy at school’s OB/GYN department.

Sending residents out of state for abortion training can be complicated, she said. Two residents who were unable to obtain licenses to train in another state were only able to observe abortions instead of receiving hands-on training. Other residents with young children may not want to leave town for more than a weekend.

As legislators weigh further abortion restrictions in the neighboring states of North Carolina, Virginia and South Carolina, Zite said officials at the University of Tennessee hospital are exploring options to offer abortion training as far away as Chicago, New York and Pittsburgh.

Zite, who used to run the university hospital’s OB/GYN residency program, worries more doctors will turn away from OB/GYN as a specialty because of the complications caused by abortion bans.

“We are already seeing OB/GYN deserts, places where hospitals close or they had to close labor and delivery units due to lack of providers,” Zite said. “That means patients are traveling for their care and unfortunately that means more disjointed care and potentially metrics they are trying to improve like maternal mortality and other complications are going to go up.”

Ingrid Skop, an obstetrician and director of medical affairs at Charlotte Lozier Institute, which opposes abortion, said it is “premature to draw the conclusion that states with abortion restrictions will have fewer physicians choosing to attend residencies there.”

Skop said she had spoken to many medical students who do not want to be trained to perform abortions during their residencies. Medical residents have long been allowed to opt out of participating in induced abortions for moral or religious objections, according to the Accreditation Council for Graduate Medical Education.

“The procedures and medications used to perform elective abortions are the same used to manage pregnancy loss,” Skop said, “so residents will obtain adequate experience without actively ending human life.”

The waning medical student interest in furthering their OB/GYN training in states with abortion bans comes at a time when established members of the medical profession are also exploring ways to respond to the new restrictions. Medical professional organizations are debating whether to hold their annual meetings in states with bans, and some senior doctors are opting not to work in those states.

Pamela Parker, an OB/GYN who worked for years in Texas along the Rio Grande, said she left the state following the enactment of its six-week abortion ban because she could no longer work in such a restrictive climate.

“As I seek jobs, I keep the Guttmacher map on my desktop,” Parker said, referring to the reproductive rights research organization that tracks state restrictions on abortion. “I get a lot of requests for temporary or permanent jobs from states with bans, and I let them know why I would not ever practice in their state.”

Carrissa Gomez, a first-year medical student at the American University of the Caribbean School of Medicine, said abortion laws would definitely influence where she eventually seeks a residency because she wants to learn how to perform elective abortions as she sees reports of women struggling to find doctors willing to provide them.

“It is a number one factor for me,” said Gomez, 31, who can’t envision herself training in Florida, where many of her peers complete rotations, or her home state of Texas. “I don’t see myself ever wanting to practice in a state that has abortion bans even if I don’t go into OB/GYN practice.”

Medical students also worry about their safety working in states roiled in intense debates over abortion.

Brown, the Indiana University School of Medicine student, said she is hesitant to practice in states with lax gun laws and aggressive antiabortion movements. She was shaken by the experiences of her mentor Caitlin Bernard, an obstetrician-gynecologist and professor at her school who was investigated by the Indiana attorney general and faced backlash after sharing a story of providing an abortion for a 10-year-old rape victim who could not receive an abortion in her home state.

“I witnessed how she dealt with literal threats to her life, just horrifying things. It’s not something I would wish on anybody, and it’s not something I myself could handle here,” Brown said. “I don’t think that’s a good learning environment.”