Navigating Obstetrics and Gynecology Residency Amidst Abortion Law Changes

Residency training requirements in reproductive health care, while mandated by the Accreditation Council for Graduate Medical Education (ACGME) are currently threatened in states with abortion bans and restrictions. There is growing concern in the field of obstetrics and gynecology (OB-GYN) that trainees may not be able to get the training they need to provide comprehensive care to the populations they will serve upon completion of training. With more states imposing legal restrictions on reproductive health, many are concerned about continued downstream effects of new legislation including future shortages of medical professionals in these areas.

Following the landmark Dobbs decision by the Supreme Court in June 2022, which overturned federal abortion protections established in Roe v. Wade, 14 states implemented complete abortion bans, with an additional six states restricting the procedure before 15 weeks of pregnancy. Early data from the Association of American Medical Colleges (AAMC), released in April, indicates a notable decline in residency applications in states with abortion bans during the 2022-2023 cycle compared to states with legal abortion or gestational limits. While there was a 5.2 percent decrease in OB/GYN residency applicants nationally, states with abortion bans experienced a much steeper decline of 10.5 percent.

Associate Dean for Students and Associate Professor of obstetrics, gynecology, and reproductive sciences Karen George, M.D., recently explored this topic in a new paper, titled “Trends in Obstetrics and Gynecology Residency Applications in the Year After Abortion Access Changes.” This study, which appeared in the February 2024 issue of JAMA Network Open, analyzed data from 2463 unique applicants who applied to 292 OB-GYN residency programs for the 2023 cycle, along with data from 2019, 2020, 2021 and 2022.  

George, alongside colleagues in OB-GYN educational leadership from across the country and researchers from AAMC, examined the impact of abortion bans on applicant behavior, noting that residency programs in states with bans and gestational limits received fewer unique applicants than those in states without bans. This study found a decrease in the percentage of unique M.D. applicants applying to programs in states with abortion bans, particularly those from states without bans. The analysis revealed a small decline in the proportion of applicants to programs located in states with abortion bans and restrictions during the 2022-2023 match cycle compared to previous cycles. Despite this decrease, residency placement rates remained consistent, indicating that the impact of abortion restrictions on overall residency positions has so far been limited. However, there are concerns about future potential workforce shortages in states with abortion restrictions if fewer physicians choose to practice in these areas.

While assumptions about the future of reproductive care have been previously made about the impact of the Dobbs decision, George’s study is unique—it is the first to investigate changes in numbers of applicants to OB-GYN residency programs after the landmark decision in 2022 that overturned the fundamental right to pregnancy termination. Her study also examined the implementation of a program signaling initiative alongside the changes in abortion legislation. Signal programming is a relatively new aspect of the residency application process—it allows applicants to indicate interest in a limited number of residency programs. Across all specialties, including OB-GYN, applicants who signal have a stronger chance of landing an interview slot with their preferred program.

It’s difficult for researchers to draw definitive conclusions in the initiative's inaugural year, but it should be noted that initial findings suggest that the number of signals sent to programs in states with abortion restrictions was comparable to those in states without such restrictions. This could imply that applicants were reassured by the ACGME requirement for training programs to provide in-person complex family planning services, influencing their application choices. George acknowledged the study’s limitations, noting that further investigation is needed to fully understand the effects of the program signaling initiative on applicant preferences and intentions.

Despite the challenges posed by abortion bans and restrictions, the field of OB-GYN remains competitive, with most residency positions attracting highly qualified applicants. Nonetheless, ongoing monitoring of applicant behaviors and patterns is crucial to assess any potential long-term consequences on the OB-GYN workforce and patient care.

Challenges to the provision of comprehensive health care are evolving quickly in the post Dobbs environment. In addition to concerns on the effect of legislation on reproductive health, these new laws risk unintended consequences in graduate medical education and the future work force and require continued surveillance.