OB/GYN Residency Applications Decreased 10.5% in Abortion Ban States

In mid-April, the Association of American Medical Colleges (AAMC) released a detailed analysis of location preferences by residency applicants in a post-Roe world, noting a 10.5% obstetrics and gynecology (OB/GYN) applicant decline in states with complete abortion bans. While nearly all residency applicant rates were lower in the 2022–2023 application cycle, a drop of this magnitude is exceptionally troublesome for individuals seeking reproductive care in states with abortion restrictions.

Between the 2021–2022 application cycle and the 2022–2023 application cycle, the number of United States MD senior residency applicants declined by nearly 2% nationally. States abortion was legal or had a gestational limit saw a 1.9% decline each. Comparatively, states with abortion bans saw overall residency application rates drop by 3%.

Focusing more on OB/GYN residency applications, the overall OB/GYN applicant pool declined by 5.2% between the 2021–2022 application cycle and the 2022–2023 application cycle, a stark difference from the 4.6% increase of OB/GYN applicants between the 2020–2021 application cycle and the 2021–2022 application cycle.

Data revealed that abortion legislation significantly impacted OB/GYN applicant preferences. In states with legalized abortion, the decline in residency applicants was more reflective of the overall decrease, at 5.3%. OB/GYN applicants in states with abortion bans had declined by almost double the magnitude, with a 10.5% reduction in applicants. Meanwhile, states with a gestational restriction fell somewhere in between, with a 6.4% decline, likely attributed to variations in gestational limits.

The impact of these rates goes far beyond the duration of residency. According to an article by the American Medical Association (AMA), 54.6% of people who completed residency between 2009 and 2018 chose to continue practicing in the same state.

Based on that statistic and the data issued by the AAMC, states with abortion bans are likely to have fewer practicing OB/GYN physicians in the coming year. As a result, individuals in those states may have reduced access to comprehensive reproductive healthcare.

Aside from the healthcare disadvantages of state legislation banning abortion, the impending OB/GYN shortage will likely cause even more adverse patient outcomes. Most individuals of reproductive age with female reproductive organs visit an OB/GYN regularly.

In addition to monitoring pregnancy and delivery, OB/GYNs are responsible for providing other comprehensive reproductive care, including sexually transmitted infection (STI) screening and treatment, reproductive cancer screenings, contraceptive access, fertility counseling, and safe abortions. Without these critical services, patients may experience higher rates of STI transmission, unintended pregnancy, late-stage reproductive cancer, and unsafe abortions.

“Because these results are of limited use in understanding exactly what may be motivating US MD seniors to disproportionately avoid states with more restrictions on the practice of medicine, it will be critical for future research to explore this relationship further (e.g., looking at change among in- and out-of-state applicants) and for residency and fellowship programs (and state medical boards) to collect information from current and future program graduates about what state they choose to practice in and the reasons for their choice,” states the AAMC analysis. 

While more insight is needed to understand better the link between abortion legislation, residency location preferences, and patient outcomes, the data points to lower quality or availability of reproductive care in abortion-banned and abortion-restricted states.