After Dobbs, medical residency applications dropped sharply in states with abortion restrictions

University of Washington

When the Supreme Court overturned the constitutional right to abortion in June 2022, the immediate consequences for patients were well documented. What has taken longer to measure is the downstream effect on who becomes a doctor, and where.

A study published in JAMA Network Open now provides some of the clearest evidence that the Dobbs decision is reshaping the geography of medical training. Applications to residency programs in states that enacted new abortion restrictions dropped significantly after the ruling, and the decline was not limited to obstetrics and gynecology. Family medicine, internal medicine, and emergency medicine all saw decreases.

Perhaps most surprisingly, male applicants changed their behavior at a greater rate than female applicants.

A longer baseline, a clearer signal

Previous studies had documented shifts in OB/GYN residency applications after Dobbs. This study, led by Dr. Anisha Ganguly at the University of North Carolina and co-authored by University of Washington health economist Anirban Basu, extends the analysis in two important ways.

First, the researchers looked back to 2019 to establish what application rates were doing before the ruling. They found that applications to programs in states that would eventually restrict abortion access had been tracking closely with applications to non-restricting states. The trends moved in parallel until the ruling, then diverged. That parallel pre-trend strengthens the case that the change was caused by the ruling itself, not by pre-existing regional differences in attractiveness.

Second, the study distinguished between male and female applicants. The result was counterintuitive: men shifted their applications away from restricted states at an even higher rate than women.

Women saw it coming, men caught up

The gender finding has a plausible explanation. Women, the researchers argue, had already been reading signals about reproductive health care access before Dobbs. Many states had laws targeting abortion providers that predated the Supreme Court decision. Female applicants may have been factoring those conditions into their decisions for years, creating a baseline gap that the data captured.

The Dobbs ruling, by making the restriction landscape explicit and national news, appears to have newly increased awareness among men. Men were not just responding to a policy they personally found objectionable. Many were also considering access to reproductive care for their partners and future families, as well as concerns about professional autonomy in states where performing certain medical procedures could carry criminal penalties.

Beyond OB/GYN: the primary care pipeline

The decline extended well beyond obstetrics. Family medicine, internal medicine, and emergency medicine all saw reduced applications to programs in restricted states. That finding matters because these specialties produce the physicians most communities rely on for everyday care. A family medicine doctor manages prenatal visits. An internist diagnoses pregnancies. An emergency physician handles miscarriage complications.

If fewer top applicants choose to train in restricted states, the consequences extend beyond reproductive health. The residency match system fills virtually all available slots regardless of applicant preferences. Programs in restricted states are still matching residents. But if the pool of applicants is smaller or weaker, the quality of the match may suffer. And residents tend to practice where they train. An applicant who ends up in a restricted state reluctantly is more likely to leave after residency than one who chose it.

One group showed no significant change: applicants to highly competitive specialties like orthopedic surgery and dermatology. Those applicants apply broadly and have little choice about where they end up. In specialties with many programs, like internal medicine, applicants have more flexibility to let policy preferences influence their decisions.

What institutions can do

The researchers see some options for programs in restricted states. Institutions can offer travel benefits for reproductive care, as some private employers have already done. They can strengthen parental leave and lactation policies. And they can establish partnerships with programs in other states to ensure residents still receive training in miscarriage management and pregnancy termination.

Financial incentives can also work, though the economics literature suggests they need to be substantial to change physician behavior.

None of these measures address the underlying policy tension. But for residency programs trying to attract the strongest applicants, acknowledging the landscape and offering concrete support may be the most viable short-term strategy.