Alabama OB-GYN residencies dropped over 20% after Dobbs, state abortion ban, says analysis

Alabama’s near-total abortion ban seems to be discouraging medical students from applying to residency programs in the state.

A new analysis from the Association of American Medical Colleges found that applicants for OB-GYN residency programs in the state dropped 21.2% in 2023-24, the first full cycle after the U.S. Supreme  Dobbs v. Jackson Women’s Health Organization ruling in 2022, which allowed the Alabama ban to go into effect. The number of applications dropped slightly (4.8%) in 2022-2023.

There was a 13.1% drop in applicants for OB-GYN residencies in 2019-2020, the cycle following approval of Alabama’s Sanctity of Life Act, a 2018 constitutional amendment that recognizes “the sanctity of unborn life and the rights of unborn children, including the right to life.”

“When it comes to, especially, OB-GYN residencies, nobody wants to come out here because we can’t fulfill all of the requirements, which include being able to do abortions and manage miscarriage,” said Robin Marty, executive director of WAWC Healthcare, formerly West Alabama Women’s Center, which provided abortion care before Dobbs but now provides broad reproductive care for low-income individuals.

A medical residency is a postgraduate training program where doctors gain hands-on experience in a specific specialty under supervision. Lasting three to seven years, it follows medical school and prepares physicians for independent practice.

The Association of American Medical Colleges suggests that abortion bans can exacerbate provider shortages by decreasing interest in residencies in states with such restrictions, affecting specialties like OB-GYN and emergency medicine and other medical fields.

Across all specialties, there was a 18.9% drop in applicants in Alabama for the cycle following Dobbs. For emergency medicine, in which doctors may face the need to perform an abortion, there was also a 9% drop following Dobbs, but the most significant drops happened in the two cycles following the height of the COVID-19 pandemic, in the 2021-2022 and 2022-2023 cycle.

Medical students often avoid residencies in states with abortion restrictions due to both professional and personal considerations, preferring not to face these limitations themselves, according to a statement from Dr. AnnaMarie Connolly, chief of education and academic affairs of the American College of Obstetricians and Gynecologists (ACOG).

When medical students select residency programs, Connolly said they understand they are committing to work and live in that community for several years during their training, and they often continue to practice in the same community they train.

“Legislative interference that imposes restrictions on full-scope reproductive health care, including abortion care, discourages medical students from pursuing residency training in states with restrictions, directly hurting patients by reducing the physician workforce in the communities that often need clinicians the most,” Connolly said in a statement.

Marty said that this might not be an environment that future doctors want to raise their families in.

“That’s not even necessarily just if you are an OB-GYN. Are you a family practitioner? Are you in cardiac surgery? Cancer treatment? Are you in any of these things where you might be dealing with somebody who is pregnant, and then have to try to face the idea that you may not be able to provide the full spectrum of care that you believe is medical best practices,” Marty said.

Connolly said in her statement that residency programs in states with abortion bans strive to provide comprehensive, evidence-based training and that while interest in medical training in states with abortion bans could be decreasing, AAMC data show an increase in applicants to obstetrics and gynecology residencies.

“ACOG appreciates the dedication of future obstetrician-gynecologists who remain committed to the field despite legislative challenges,” she said.

Heidi Miller, Development Manager for Yellowhammer Fund, an Alabama abortion advocacy & reproductive justice organization, said she worried Alabama’s abortion ban might turn providers away from Alabama, but with a significant drop in applications, she’s worried what the problem will look like in five to 10 years.

“It’s just terrifying because we’re already in a health care access crisis and have been for quite some time, and it is only going to make that exponentially worse,” Miller said.

This story was originally published in the Alabama Reflector