Trends in Obstetrics and Gynecology Residency Applications in the Year After Abortion Access Changes

Abstract

his cross-sectional study assesses changes in the percentage of applicants to gynecology residency programs in states that implemented abortion restrictions after the US Supreme Court's Dobbs v Jackson Women’s Health Organization decision.

Key Points

Question

Has there been a change in the percentage of applicants to obstetrics and gynecology (OBGYN) residency programs in states with strict abortion laws?

Findings

In this cross-sectional study of 2463 OBGYN residency program applicants, between 2022 and 2023, there was a small but significant decrease in the percentage of applicants to programs in states with stricter abortion laws.

Meaning

The findings suggest early evidence of a decline in the number of unique applicants to OBGYN residency programs in states with strict abortion laws.

Abstract

Importance

State-specific abortion restrictions currently affect the training of approximately 44% of obstetrics and gynecology (OBGYN) residents in the US. Examination of where future trainees apply for residency is important.

Objective

To assess changes in the percentage of applicants to OBGYN residency programs by state based on abortion restrictions in place after the Dobbs v Jackson Women’s Health Organization (hereafter, Dobbs v Jackson) US Supreme Court decision and examine whether applicants’ preference for programs, as suggested by the distribution of application signals that express higher interest, was associated with abortion bans.

Design, Setting, and Participants

This serial cross-sectional study used anonymized data for all applicants to OBGYN residency programs in the US during September and October from 2019 to 2023. Data were obtained from the Association of American Medical Colleges Electronic Residency Application Service.

Exposures

Applications and program preference signals sent to OBGYN residency programs, analyzed by applicants’ self-reported demographics.

Main Outcomes and Measures

The primary outcome was differences in the percentage of unique applicants to OBGYN residency programs from 2019 to 2023, with programs categorized by state-based abortion restrictions after the Dobbs v Jackson decision. Secondary outcomes included the distribution of program signals by state abortion ban status.

Results

A total of 2463 applicants (2104 [85.4%] women) who applied to OBGYN programs for the 2023 residency match cycle were the focal sample of this study. While overall applicant numbers remained stable between 2019 and 2023, the number of applicants differed significantly by state abortion ban status in the 2022 ( F _2,1087 = 10.82; P < .001) and the 2023 ( F _2,1087 = 14.31; P < .001) match cycles. There were no differences in the number of signals received by programs in states with bans after controlling for known covariates such as number of applications received and program size, and there were no differences in the percentage of signals sent by out-of-state applicants to programs in states with different abortion laws than their home states ( F _2,268 = 2.41; P = .09).

Conclusions and Relevance

In this cross-sectional study, there was a small but statistically significant decrease in the number of applicants to OBGYN residency programs in states with abortion bans in 2023 compared with 2022. However, applicant signaling data did not vary by states’ abortion ban status. While OBGYN residency programs almost completely filled in 2023, continued monitoring for the potential consequences of state abortion bans for OBGYN training is needed.