By Julie Rovner, KFF Health News
When Isabella Rosario Blum graduated from medical school and was considering a residency program to become a family physician, she received this honest advice: If she wants to get her abortion education she shouldn't stay in Arizona.
Blum chose programs primarily in states where abortion access and, by extension, abortion education, are likely to continue to be protected, such as California, Colorado and New Mexico. Arizona has enacted a law banning most abortions after 15 weeks.
“I want to get all the training I can. Of course, that would still have been a limitation,” she said.
In June, I will begin my residency at Swedish Cherry Hill Hospital in Seattle.
For the second year in a row, students graduating from U.S. medical schools were less likely to apply for residency positions in states with abortion bans and other severe abortion restrictions this year, according to new statistics from the Association of American Medical Colleges. .
Since the Supreme Court overturned the constitutional right to abortion in 2022, the state's fight over abortion access has created a lot of uncertainty for pregnant patients and doctors. But this uncertainty has also affected the world of medical education, causing some new doctors to consider their state's abortion laws when deciding where to start their careers.
Fourteen states, mainly in the Midwest and South, have banned nearly all abortions. A new analysis from the AAMC (a preliminary copy of which was reviewed exclusively by KFF Health News prior to publication) found that states with near-abortion bans saw a 4.2 percent decline in the number of applicants to residency programs, compared to a 0.6 percent drop. % decrease in states where abortion is legal.
In particular, the AAMC's findings highlight the broader problems abortion bans could pose for the state's medical community, especially in an era of provider shortages. The organization tracked the largest declines in residency interest in states with abortion restrictions. Not only do they treat pregnant patients, including gynecologists and emergency room doctors, but they also provide care among aspiring doctors in other specialties.
“So many new doctors across specialties are choosing to apply out of state for training, which is a serious limitation on reproductive rights,” said Atul Grover, executive director of the AAMC Research and Action Institute. “It is a cause for concern in states where this is present.”
The AAMC analysis found that the number of applicants to obstetrics and gynecology residency programs decreased by 6.7% in states that banned abortion, compared to a 0.4% increase in states that legalized abortion. For internal medicine, the decline observed in states that banned abortion was more than five times higher than in states where abortion was legal.
The AAMC said in its analysis that the continued decline in interest in ban states among new doctors may ultimately “have a negative impact on access to care in those states.”
Jack Resneck Jr., immediate past president of the American Medical Association, said the data shows another consequence of post-AI.Roe vs. Wade age.
Even in states that have banned abortion, residency programs are filling the void, according to an AAMC analysis. This is primarily because there are more medical students graduating from the U.S. and abroad than there are residency positions.
Nonetheless, Resneck said, “We are very concerned.” For example, a doctor without proper abortion training may not be able to manage miscarriage, ectopic pregnancy, or potential complications such as infection or bleeding that may result from a miscarriage.
People 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 practices and common human rights are curtailed,” said Beverly Gray, associate professor of obstetrics and gynecology at Duke University School of Medicine.
In North Carolina, abortion is prohibited in almost all cases after 12 weeks. Women who experience unexpected complications or discover late in their pregnancy that their baby has a potentially fatal birth defect may not be able to receive care there.
Gray said she worries that the abortion ban “impacts whether we have the best and brightest talent coming to North Carolina,” even though Duke is a sought-after training site for medical residents.
Rohini Kousalya Siva will begin her obstetrics and gynecology residency at MedStar Washington Hospital Center in Washington, D.C., this year. She said she would not consider programs in states that ban or severely restrict abortion and instead applied to programs in Maryland, New Hampshire, New York and Washington, D.C.
“We are doctors,” said Kousalya Siva, who attended medical school in Virginia and previously served as president of the American Medical Students Association. “We need to provide patients with the best, evidence-based care, and we can’t do that if we don’t have abortion education.”
Another consideration: Most graduating medical students are “in their 20s, which is the age when people start thinking about putting down roots and starting a family,” Gray said. He added that he noticed more students asking questions about politics during residency interviews.
And because most young doctors begin their careers in the state where they do their residency, “people don’t feel safe in the state where they potentially get pregnant because of the severe restrictions,” said Debra Stulberg, chair of the Department of Family Medicine. University of Chicago.
Stulberg and others worry that this self-selection away from states with abortion restrictions will worsen physician shortages in rural and underserved areas.
“The geographic mismatch between where the need is and where people choose to go is really problematic,” she said. “There is no need for people to focus any more on urban areas that are already accessible.”
After attending medical school in Tennessee, which has adopted one of the nation's most sweeping abortion bans, Hannah Light-Olson will begin her obstetrics and gynecology residency at the University of California-San Francisco this summer.
It wasn't an easy decision, she said. “I feel guilty and sad that this is a situation I feel like I could have helped,” she said. she said “I am deeply indebted to the patients of Tennessee and to the program that trained me.”
Light-Olson said some of her fellow students have applied to anti-abortion state programs. “Because they think we need pro-choice providers in restrictive states more than ever.” In fact, she said, when she was convinced that there was a way for the program to provide abortion education, she even applied to programs in countries with bans.
“I felt there was no guarantee of 100% perfection. We’ve seen how quickly things can change,” she said. “I’m not particularly confident that California and New York won’t be threatened either.”
Bloom said that as a condition of receiving a medical school scholarship, he would be required to return to Arizona to practice, and it is unclear what access to abortions will be like then. But she's worried about the long-term effects on her.
“Residents, if you can’t get training in the state, you’re less likely to settle down and work in the state,” she said.
KFF Health News is one of the core operating programs of KFF, a national newsroom producing in-depth journalism on health issues and an independent source of health policy research, opinion polling and journalism. Learn more about KFF.
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