Medical students say strict abortion laws are driving them away from pursuing careers as doctors in states where the procedure is banned.
The finding comes from a survey of third- and fourth-year medical students, conducted from August through October of last year — just after the June 2022 Supreme Court Dobbs decision that overturned Roe V. Wade, which for nearly 50 years granted the right to an abortion across the U.S.
The reluctance to be a medical resident — young doctors who train in hospitals or clinics after graduating medical school — in states with abortion bans could further strain health care shortages in many parts of the country.
The survey results reflect the feelings of future obstetricians and gynecologists as well as doctors who plan to go into other specialties, such as surgery or internal medicine, said Ariana Traub, a third-year medical student at Emory University School of Medicine, who conducted the survey.
"The most significant data that we found was that the changes as a result of Dobbs would impact" where in the U.S. medical students would apply to residency, Traub said.
Most respondents, 57.9%, were unlikely or very unlikely to apply to a single residency program in a state with abortion restrictions.
The findings, scheduled for presentation this weekend at an annual meeting of the American Congress of Obstetricians and Gynecologists, have the "potential to shift the geographical makeup of health care," Traub and her fellow researchers wrote.
The survey included responses from 494 medical students in 32 states. Most were women. More than three-quarters, 76.9%, said that access to abortion care would influence where they would pursue their residency.
The U.S. is already facing a major shortage of between 37,800 and 124,000 doctors in the coming years, according to the American Association of Medical Colleges. Most concerning for women's health, separate AAMC data found a significant drop in the number of med students pursuing OB/GYN residencies in states with strong abortion policies.
The decrease for OB-GYN residency applications, 5.2%, was seen in all states, regardless of abortion laws. That percentage dropped by almost double — to a 10.5% decrease — in applications in states with near-total abortion bans.
If the surveys bear out, there could be a serious shortage of OB-GYNs in states with the tightest abortion restrictions. These states already tend to have higher maternal and infant mortality rates.
"I worry that this will impact who will want to apply to our state to train," said Dr. Beverly Gray, residency director for the Duke University School of Medicine. North Carolina became the latest state this week to tighten abortion restrictions, making them illegal in most cases at 12 weeks gestation or later.
Beyond worries about having enough residents in hospitals, Gray said that her medical school program may be forced to send their medical students to other states for adequate OB-GYN training that includes abortion care.
"Abortion care is part of comprehensive obstetric and gynecology care. If you are unable to receive that basic training, the skill, the technique, and the counseling and managing of complex patients, I believe you're inadequately trained," Gray, also an associate professor of obstetrics and gynecology, said.
Ian Peake is leaving his home state of Oklahoma for a similar reason. He graduates medical school Friday from the University of Oklahoma College of Medicine in Tulsa. On Monday, he'll fly to New York City, where he'll begin his OB/GYN residency at SUNY Downstate Health Sciences University.
Dobbs was the deciding factor in choosing to practice medicine somewhere other than Oklahoma, which last year enacted the strictest abortion ban in the country.
"For me, it was very clear after the Dobbs decision and the subsequent ban in Oklahoma that this is not the place I would like to train," Peake said, preferring instead a residency in a state where he can legally "practice the full range of health care when it comes to OB/GYN."
Nell Mermin-Bunnell, a third-year medical student at Emory School of Medicine who was also involved with the new survey, explained that procedures to carry out abortions are often done in emergency situations to save lives.
The vast majority of procedures done in the second or third term "are medical emergencies, where either the fetus is no longer viable, and it is dangerous for the pregnant patient to continue carrying the pregnancy, or the pregnant patient is medically unstable, and it is dangerous to their long-term health or to their life," Mermin-Bunnell said. "This happens terrifyingly often."
"It is hard to walk into work every day and be told that you can't provide the care that might save a patient's life," Gray, of Duke University School of Medicine, said. "There's tremendous moral injury with being put in that situation, to be asked to care for people and not allowed to do the right thing."
Where to start a family
Many of the surveyed students are in the midst of their child-bearing years, and may be thinking of planning for their own pregnancy.
In fact, 72.7% of respondents said that abortion access changes would likely or very likely influence where they would start a family.
Traub and Mermin-Bunnell have several more years of medical school before they must decide where to apply for residency, and for which specialty. The Dobbs decision has caused them both to consider careers in OB/GYN.
Traub is unsure whether to stay in Georgia, which bans abortion after six weeks gestation, or go home to California, which has fewer restrictions on abortion care.
"Part of me is like, if I leave this state and if other health care professionals leave the state, we're leaving the population that so desperately needs help," Traub said.
A move back to California would afford her more experience in abortion care for her patients.
"I want to have reproductive health care for myself or my eventual family that I may have," she said.