Medical residents are starting to avoid states with abortion bans, data shows
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Via: hallux • 8 months ago • 112 commentsBy: Julie Rovner, Rachana Pradhan - NPR + KFF Health News
S E E D E D C O N T E N T
Isabella Rosario Blum was wrapping up medical school and considering residency programs to become a family practice physician when she got some frank advice: If she wanted to be trained to provide abortions, she shouldn't stay in Arizona.
Blum turned to programs mostly in states where abortion access — and, by extension, abortion training — is likely to remain protected, like California, Colorado and New Mexico. Arizona has enacted a law banning most abortions after 15 weeks.
"I would really like to have all the training possible," she said, "so of course that would have still been a limitation."
In June, she will start her residency at Swedish Cherry Hill hospital in Seattle.
According to new statistics from the Association of American Medical Colleges (AAMC), for the second year in a row, students graduating from U.S. medical schools were less likely to apply this year for residency positions in states with abortion bans and other significant abortion restrictions.
Since the Supreme Court in 2022 overturned the constitutional right to an abortion, state fights over abortion access have created plenty of uncertainty for pregnant patients and their doctors. But that uncertainty has also bled into the world of medical education, forcing some new doctors to factor state abortion laws into their decisions about where to begin their careers.
Fourteen states, primarily in the Midwest and South, have banned nearly all abortions. The new analysis by the AAMC — exclusively reviewed by KFF Health News before its public release — found that the number of applicants to residency programs in states with near-total abortion bans declined by 4.2%, compared with a 0.6% drop in states where abortion remains legal.
Notably, the AAMC's findings illuminate the broader problems that abortion bans can create for a state's medical community, particularly in an era of provider shortages: The organization tracked a larger decrease in interest in residencies in states with abortion restrictions not only among those in specialties most likely to treat pregnant patients, like OB-GYNs and emergency room doctors, but also among aspiring doctors in other specialties.
"It should be concerning for states with severe restrictions on reproductive rights that so many new physicians — across specialties — are choosing to apply to other states for training instead," wrote Atul Grover, executive director of the AAMC's Research and Action Institute.
The AAMC analysis found that the number of applicants to OB-GYN residency programs in abortion-ban states dropped by 6.7%, compared with a 0.4% increase in states where abortion remains legal. For internal medicine, the drop observed in abortion-ban states was over five times as much as in states where abortion is legal.
'Geographic misalignment'
In its analysis, the AAMC said that an ongoing decline in interest in abortion-ban states among new doctors ultimately "may negatively affect access to care in those states."
Dr. Jack Resneck Jr., immediate past president of the American Medical Association, said the data demonstrates yet another consequence of the post- Roe v. Wade era.
The AAMC analysis notes that even in states with abortion bans, residency programs are filling their positions — mostly because there are more graduating medical students in the U.S. and abroad than there are residency slots.
Still, Resneck said, "we're extraordinarily worried." For example, physicians without adequate abortion training may not be able to manage miscarriages, ectopic pregnancies or potential complications, such as infection or hemorrhaging, that could stem from pregnancy loss.
Those who work with students and residents say their observations support the AAMC's findings. "People don't want to go to a place where evidence-based practice and human rights in general are curtailed," said Beverly Gray, an associate professor of obstetrics and gynecology at Duke University School of Medicine.
Abortion in North Carolina is banned in nearly all cases after 12 weeks. Women who experience unexpected complications or discover their baby has potentially fatal birth defects later in pregnancy may not be able to receive care there.
Gray said she worries that even though Duke is a highly sought training destination for medical residents, the abortion ban "impacts whether we have the best and brightest coming to North Carolina."
Rohini Kousalya Siva will start her obstetrics and gynecology residency at MedStar Washington Hospital Center in Washington, D.C., this year. She said she did not consider programs in states that have banned or severely restricted abortion, applying instead to programs in Maryland, New Hampshire, New York and Washington, D.C.
"We're physicians," said Kousalya Siva, who attended medical school in Virginia and was previously president of the American Medical Student Association. "We're supposed to be giving the best evidence-based care to our patients, and we can't do that if we haven't been given abortion training."
Another consideration: Most graduating medical students are in their 20s, "the age when people are starting to think about putting down roots and starting families," said Gray, who added that she is noticing many more students ask about politics during their residency interviews.
And because most young doctors make their careers in the state where they do their residencies, "people don't feel safe potentially having their own pregnancies living in those states" with severe restrictions, said Debra Stulberg, chair of the Department of Family Medicine at the University of Chicago.
Stulberg and others worry that this self-selection away from states with abortion restrictions will exacerbate the shortages of physicians in rural and underserved areas.
"The geographic misalignment between where the needs are and where people are choosing to go is really problematic," she said. "We don't need people further concentrating in urban areas where there's already good access."
From Tennessee to California
After attending medical school in Tennessee, which has adopted one of the most sweeping abortion bans in the U.S., Hannah Light-Olson will start her OB-GYN residency at the University of California San Francisco this summer.
It was not an easy decision, she said. "I feel some guilt and sadness leaving a situation where I feel like I could be of some help," she said. "I feel deeply indebted to the program that trained me and to the patients of Tennessee."
Light-Olson said some of her fellow students applied to programs in abortion-ban states "because they think we need pro-choice providers in restrictive states now more than ever." In fact, she said, she also applied to programs in abortion-ban states when she was confident the program had a way to provide abortion training.
"I felt like there was no perfect 100% guarantee. We've seen how fast things can change," she said. "I don't feel particularly confident that California and New York aren't going to be under threat too."
As a condition of a scholarship she received for medical school, Blum said, she will have to return to Arizona to practice, and it is unclear what abortion access will look like then. But she is worried about long-term impacts.
"Residents, if they can't get the training in the state, then they're probably less likely to settle down and work in the state as well," she said.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling and journalism.
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The malicious 'gods' of unintended consequences are having a field-hospital day.
What happens when you can't find an ob/gyn in Texas or Alabama?
Call the midwife and see how far that gets you.
The health care options in the anti-choice states are going to be increasingly severely limited and restricted, and non-existent in some instances.
no worries, anti-choice states don't believe in science. let them have medical quackery and pay for it with chickens...
sure hope they don't hurt themselves if they do and then require modern medical science to heal...
thoughts and prayers for anything requiring fetal cell lines for treatment in anti-choice states...
Most midwives are highly trained especially if they are RNs. But they may be hard to find, too
No, some do not believe in individual rights or autonomy for women. Or they believe a clump of cells is more worthy.
I didn't bring up science. But I wonder if there's a correlation between the states with more abortion restrictions also have less scientific acumen and prefer dogma like creationism over science.
“…dogma like creationism…”
….plain and simple(tons)….
Among other things.
Yet you mention science in reply to me, even though I didn't mention it or bring it up.
Speak for yourself. I'm addressing your post 2.1.9, which itself was a reply to my post 2.1.8 but has nothing to do with it.
That is true.
not as old as thumper dogma...
[✘]
Incumbents will lose reelection and the laws will change.
Yes, in various states . . .
But if enough people nationwide are tired of "Big Government" interfering in their lives-- then it will not only have an effect on various state elections, but will also effect the national election (i.e. the Presidential election):
If this airs regularly in the appropriate areas:
But if enough people nationwide are tired of "Big Government" interfering in their lives-- then it will not only have an effect on various state elections, but will also effect the national election (i.e. the Presidential election):
If this airs regularly in the appropriate areas:
Je takes full credit---and voters that don't already remember this will be reminded:
What I did by killing Roe v. Wade, which everyone said was impossible . . .
Women suffer.
I'm pretty sure that's the intent, many times. Criminalizing miscarriages, banning abortion even in the case of raped children, proposing laws requiring the reimplantation of ectopic pregnancies - it seems to me that many of the people who are sponsoring and passing these laws just really dislike women.
Is that even possible?
It is not. The placenta contains lots of tiny vessels that connect the mother's blood supply to the fetus's, and those can't possibly be reconnected before the fetus dies, even if an approprate site in the uterine lining were to exist. It may not ever be possible. It's sci-fi level medical care. Implantation is a one-and-done deal.
I didn't think it was, so thank you for your informative comment.
Do you ever get the feeling that legislators never bother to consult the experts before they try and draft laws?
I would have to concur.
No.
Very much so. Even when told it's not a possibility, they still want to mandate it.
That's a stupid beyond description
It really is.
I actually read a suggestion that, if that particular piece of stupidity passed (it didn't, thanks to legislators with more than 2 brains cells), doctors just "pretend" to reimplant the embryo or fetus by accessing the uterus, either surgically or vaginally, and placing the products of conception there. The law would have been satisfied. However, that puts the woman at greater risk of post-op infection.
Some people actually believe that, even though they know it can't be done, women should be forced to undergo this sort of medical "theater" to satisfy "pro-lifers".
That kind of bullshit has convinced me that women really don't matter to some people, at all. They would mandate that we do their virtue-signalling for them with our own bodies, even to the point of our own deaths, if they could get away with it.
those particular legislators think their religious leaders and their warped interpretations of the bible are all the expertise they need...
mandatory ultrasounds like florida has is just another speed bump thrown in the way to satisfy thumper morons.
There are more residency applications than residencies available.
Restricting choice on abortion will take other choices on your healthcare away also
I don't get it either, it's like smoking or drinking, If you don't like it don't do it. If you don't want an abortion you shouldn't get one.
Wait until they enact laws on vasectomies....
... or wait until they experience some amateur vasectomies.
oh dear god
I've composed some lyrics for anti-choice thumpers to the tune of "my favorite things"...
vice grips and ice picks and serrated knives,
geezus can't help you the rest of your lives.
the worst part is eating at the point of a gun,
did you want mustard and a hot dog bun?
chorus...
clever!
you and sandy, and a few others, inspire me...
And...wait 'till they decide what books kids are allowed to read...and arbitrarily remove any they don't like...
The company that makes Twist Ties wants to ban circumcisions.
It already has.
Alabama found out the hard way that this is going to hit infertility treatments hard, so couple who desperately want to have children can't do IVF there.
And there are now multiple cases of women being denied cancer treatment due to pregnancy.
And it won't be long before finding an Ob/Gyn will be difficult in states with abortion bans, so women who want to have children will be more at risk during pregnancy. Sometimes, abortion is part of necessary obstetrical care when things go wrong, and no doctor wants to risk going to jail for doing his or her job properly.
And that is just mind blowing. They don't want to kill "Innocent children" but it's just fine to let an innocent woman die horribly
out the hard way that this is going to hit infertility treatments hard, so couple who desperately want to have children can't do IVF there.
of course they can, and do.
In fact, these laws that impose criminal liability upon doctors just might have an effect on whether students choose to study medicine, or prefer a less dangerous profession.
Doctors have always been subject fox criminal liability, including for performing abortions while roe was the law.
its really amazing to how desperate and ignorant some of the fear mongering is over dobbs.
Criminal liability applies if a doctor goes outside medical ethics and standards of practice, with possible harm to the patient as a result. Now we have legislators trying to tell doctors how to practice medicine through absurd laws imposing even more liabilities. That will only negatively affect the medical profession and cause greater risk to women's health.
literally nothing had changed. Medicine has been intensely regulated by government for decades., including criminalization for abortions.
Wrong. Legislators have made it so doctors are unsure if performing a procedure might put their careers or medical licensure in jeopardy, when it was never an issue before. Now they are forced to deny patients a procedure out of fear more than medical judgement. Or legislators ate simply overriding their judgement. The recent abortion case in Texas us a prime example of this. So yes, things have changed, and not for the better.
. How can you possibly believe the legislature only regulates abortion?
Legislatures waste too much time regulating things they need to leave up to people's individual decisions.
Good point.
I didn't say it was only abortion. But legislatures are going overboard with regulations surrounding abortion, more than any other medical procedure.
Don't bother replying to me. The only thing I respect of your comments have to do with Israel.
Legislators had to pass a new law to shield fertility clinics from the effects of their ill-conceived abortion ban, and it's a stop-gap measure.
(1) so you were wrong
(2) the alabama court ruling on IVF had nothing to do with Dobbs. The result would have been the same if it were argued in 2019. You've been misled again.
I don't care.
Exactly. No woman who is experiencing potentially fatal pregnancy complications should be forced to ask either a judge or a legislative body if she's allowed to receive life-saving care. And yet, here we are.
Ireland finally took steps against this misogyny after Savita Halappanavar died because "this is a Catholic country", as her nurse told her. We are regressing into religiously-obligated sacrifice of women's lives and health on the altar of the "pro-life" movement.
Fertility clinics shut down, Sean, and there are still concerns with the new law designed to "fix" the problems with the old one. The new law shields only fertility care providers. It doesn't even protect the manufacturers of fertility-treatment products, except to cap the amount for which they can be sued for "wrongful death" if something goes wrong.
The embryos are still considered to be "persons".
That's not what you claimed. You moved the goalpost. Just admit it.
w law shields only fertility care providers. It doesn't even protect the manufacturers of fertility-treatment products, except to cap the amount for which they can be sued for "wrongful death" if something goes wrong.
None of this has anything to do with Dobbs. But it obviously drives an emotional reaction among people who don't know better to pretend it does, so I get why you and left wing claim it does.
I was wrong, for now. For a while, fertility clinics shut down. And the issue is not settled, for the reasons stated.
The "emotional reaction" was the one that led to bad legislation in the first place. "Fetal personhood" laws are based on emotion rather than reason, and the rest of us are paying for legislators' emotional thinking.
I never said anything about Dobbs, but most people are aware that abortion is sometimes a necessary part of IVF treatment in the form of selective reduction. Abortion bans will logically lead to issues providing fertility services and training providers of those services.
Another mole to be whacked due to legislating based on emotion.
You claimed it was because of bad abortion laws, though the case had nothing to do with an abortion law and would have been decided the same regardless of whether abortion was legal or not in Alabama.
The whole point of this seed is that somehow Dobbs opened up a can of worms and an imaginarty parade of horribles has been run out.
Let's review reality:
There's no shortage of residents to fill residencies in southern states.
IVF laws were not impacted by Dobbs or "abortion bans"
Doctors have always faced criminal liability for practicing medicine outside of the law.
“Doctors have always faced criminal liability for practicing medicine outside of the law.”
And when legislators take it upon themselves to determine what is medically legal or ethical in their myopic definition of morality, it is too often to the detriment of the citizens they are supposedly elected to represent. Vote.
The problem is, there is no reason for more restrictive and sometimes vague laws for abortion. Such laws have nothing to do with women's Healthcare and is just an excuse to restrict abortion. In effect, Legislators (likely with little or no medical expertise) are trying to make medical guidelines. Not the medical community.
“Not the medical community.”
And they are united in their opposition to the draconian laws being passed. They should be allowed to serve all those entrusted to their care.
Those that deny and restrict their oath to do so should be ashamed.
I said it was related to bad laws. And so it was.
These are all related to recognition of fetal personhood. Alabama's law recognized embryos as minor children. In the wake of Dobbs, other states have banned abortion from the moment of fertilization, because they see embryos as people. Some have exceptions for IVF, and some don't. Alabama is the canary in the coal mine.
The concept of fetal personhood has led to the denial of necessary abortions in women whose lives are risked by pregnancy, denial of cancer treatment to women, and interference in fertility treatments. You can deny the relationship if you like, Sean. But it's all because some folks see a fertilized egg as a person, with rights equal to and even superceding those of the woman carrying it.
Has it always been illegal to treat a pregnant woman who has cancer?
“Has it always been illegal to treat a pregnant woman who has cancer?”
Simply impossible to rectify. Truly unbelievable that this was even a remote possibility, much less a reality.
Shame does not begin to describe how heinous this is.
No, you specifically claimed " lators had to pass a new law to shield fertility clinics from the effects of their ill-conceived abortion ban"
The abortion ban in Alabama had nothing to do with the IVF issue, nor would it have been decided differently if Roe v Wade were not overturned.
as it always been illegal to treat a pregnant woman who has cancer?
It's not illegal to treat a pregnant women with cancer in Alabama nor any other state, and never has been to my knowledge.
It may be when the treatment involves abortion.
[deleted][✘]
meh, let them kick the door off the hinges of making health choices for others. I'm sure they won't regret that at all...
Those who oppose abortion should not seek treatment for anything related to sex, or going to the bathroom
So only 1/3 of people have access to healthcare. Sure.
They want to take other's healthcare away so let them live by the standard they want to apply to others.
Whatever. Restricting health care so only 1/3 of people can access it will surely be popular.
What is good for the Goose is good for the Gander
What comes around goes around
You think restricting abortions is popular?
You think restricting abortions is popular?
Yes. Per gallup, only 1/3 of people support unrestricted abortion.
Good. There is no reason to restrict abortion anyway.
Yes, we all get that's what the abortion until birth extremists believe.
Belief has nothing to do with it. There is simply no rational or legal reason to restrict abortion. I have yet to see such a reason presented. Restrictions seem more based on emotion or feelings rather than reason.
Brave of you to admit that you are probably the only person in america to believe that. You'd think the fact that 2/3 of Americans disagree with you would give you some pause and might lead you to do some research (you could just read Roe v Wade, unless you think Blackmun is irrational too). I actually go out of my to understand the arguments I disagree with. But that's just me, I guess.
You are not the only person who believes that!
As much so as restricting health care for the half of the population that might need it.
Not a belief, but a fact. If you disagree, the provide a rational and legal argument to restrict abortion. I don't care if 2/3 of people disagree with me. I'm I terested in a rational and legal argument. Not one based on mere feelings or emotion.
Thank you. Everytime I ask for an argument to restrict abortion, I usually get something like "states rights/interest," which isn't really an argument, but rather a deflection. I've even made rational and practical arguments for abortion.
Indeed. Restricting abortion is restricting women's Healthcare or Healthcare options. All restrictions do is put a woman's health in jeopardy. This was made very much made clear in the Texas abortion case.
I've told you to read Roe V Wade for starters.
Do you struggle to understand a rational argument why states restrict murder , as well?
I'm familiar with Roe. But since it's overturned, it's irrelevant now. Murder infringes on another’s bodily autonomy and causes harm. Abortion does not and is not murder. Neither do states make having an abortion illegal.
Care to try again?
You really can't figure out a single argument why the legality of killing a fully viable human depends on its location by a few centimeters?
Lol.
I've played this game countless times, and doing it any more would fit the definition of insanity. You've just offer incredibly solipsistic responses to arguments that essentially boil down to the juvenile "that's not what I think, therefore it's irrational." If you want people to engage, learn how to form an argument that is more than a conclusion.
You can't seem to provide a rational or legal reason to restrict abortion. If you've "plated the game" before, you really suck at it.
But Even Justice Blackmun articulated an argument to restrict abortion. Get it? To pretend that it doesn't exist is just denying reality. Your absolutist, emotional claim about "no arguments" can't even survive a cursory understanding of the most famous ruling that has dominated discussion of the topic for 50 years. To claim there's no argument is to admit unfamiliarity with even the most basic of sources on the topic.
Murder infringes on another’s bodily autonomy and causes harm
what happens to the nine month old, fully viable human life when a heart attack is inteintaly induced to kill it, or if it's brain is punctured and it's vacuumed up? is that harm? DO you think imagine a fully viable fetus can't feel pain when it's torn apart?
Opinion is just that, opinion. Also irrelevant since the case the opinion is based on is invalidated. I can make a rational argument for abortion. Regardless, the unborn are not legal persons and have no rights or legal protections as a result, unlike the pregnant woman. A fetus cannot even "feel" pain until the 3rd trimester, when abortions are generally not electively sought. Even if an abortion is performed at that point, anesthesia can be administered. Your post seems to be rather emotional.
thumpers run with the extreme dogma that all abortions take place at the last possible second of the 3rd trimester, when in reality the overwhelming number of elective abortions take place within the 1st trimester. it's all about planting their ignorant nonsecular flags to counter balance their social shortcomings, individual guilt, and personal histories of bad decisions.
lso irrelevant since the case the opinion is based on is invalidate
Lol. This is even getting sillier. If you believe that, than, logically, any argument that's been made where abortion has been banned is now irrelevant and invalid.
I'm beginning to think you don't understand what an argument is. That Roe was overturned after 50 years doesn't mean the arguments captured therein no longer exist, nor that what was "logical" for 50 years and suddenly became illogical one day 50 years later. Not to mention the humor inherent in a pro choice supported arguing that any argument contained in Roe is now irrelevant and invalid. Might want to think that through, logically.
Here's the thing most critical thinking, non fanatical adults can understand. "Rational, logical arguments" can be made on almost any topic. A critical thinker weighs the pros and cons and comes to the support the result that they expect will have the most net positive result. Only the close minded fanatic looks at an issue, and says "I have my opinion. There's no possible counter argument. It's so black and white that any other opinion is illogical and invalid"
can make a rational argument for abortion
Bully. The next step is to learn how to create rational arguments against the opinions you favor.
etus cannot even "feel" pain until the 3rd trimester. en if an abortion is performed at that point, anesthesia can be administered
so what? Why would it matter if anesthesia "can" be administered? There's no rational reason against torturing the fully developed fetus, right? That's your argument, don't backtrack now.
Has Roe been overturned? Then it is no longer relevant or applicable. So far all you're doing is posturing and deflecting, but not actually offering any rational or legal argument to restrict abortion. What difference does it make when when abortion is performed beyond medical intervention? If there's anesthesia or even sedation, there is no pain or "torture." What is the rational reason to "torture" a woman with a pregnancy and birth she does not want?
I have noticed some seem to think loose or no restrictions on abortion will mean late term abortions will become the norm, when that is not likely the case.
religious extremists always gravitate to the extreme scenarios. I want these thumper fucks to try and remove the individual freedom of bodily autonomy from 51% of the voters. fuck with my family and watch what happens next.
This keeps getting better. You realize Blackmun's acknowledgement of the state interests in protecting life wasn't overturned right? I get the impression you don't actually get what an argument is or what a Court does.
The real funny part is if you actually apply the logic supporting your dismissal of all arguments contained in Roe to your own claims, then every single one of your claims can be dismissed as irrelevant and invalid because they they've been rejected by courts. Everything you've ever said on this topic can be dismissed as irrelevant under that standard. You've managed to destroy your own argument all by yourself, which isn't easily accomplished.
there's anesthesia or even sedation, there is no pain or "torture."
Since you don't believe there's any possible reason to even consider regulating the abortions of fully developed fetuses, why would that matter? Even acknowledging the existence of fetal pain as an issue to be considered means you can't even live up to your own claim.
Still waiting for you to present a rational and legal argument to restrict abortion. I dismiss your attempts to deflect from that challenge. Neither have you explained the "states interest," which is nothing more than a deflection and buzz word in itself. The state do not legally define or specify this so called interest. All the determination of state interest did is throw a bone to the states so they can have some say regarding abortion restrictions. There's still no reason for it too, especially since abortion restrictions only harm the pregnant woman.
we can organize a pool for the closest guess to that event...
The new analysis by the AAMC — exclusively reviewed by KFF Health News before its public release — found that the number of applicants to residency programs in states with near-total abortion bans declined by 4.2 %, compared with a 0.6% drop in states where abortion remains legal.
Interesting start to a study but it seems the study did not actually attempt to prove the correlation.
Not sure why it would matter to most Residents since most are not in the OB/Gyn field. Unless of course they have allowed themselves to be radicalized by the programming institution they attended.