Small Decline Seen in Ob/Gyn Residency Applications in Abortion Ban States

In the first residency application cycle after Roe v. Wade was overturned, there was a small but significant decrease in the percentage of applicants to ob/gyn programs in states with abortion restrictions compared with previous years, Electronic Residency Application Service (ERAS) data showed.

For the 2023 cycle, there were 2,463 ob/gyn applicants, 85.4% of whom were women and 65.9% were white, which was a similar number of applicants to previous years. However, the number of applicants to programs with state-based abortion restrictions fell by a small but significant amount between the 2022 and 2023 match cycles (P<0.001), reported Maya Hammoud, MD, MBA, of the University of Michigan Medical School in Ann Arbor, and coauthors.

The first cycle post-Roe was also the first year ob/gyn implemented program signaling — where applicants have 3 gold and 15 silver tokens to express increased interest in a certain programs. There were no differences in program signals in states with bans or in the percentage of signals from out-of-state residents whose home state had a different level of abortion access (P=0.09), authors wrote in JAMA Network Open.

“Given that the goal of the program signaling initiative was to enable applicants to demonstrate their genuine interest amid rising application inflation, our findings in this first year may reflect an indication of true applicant intent and interest in specific programs rather than being reflective of the abortion restrictions,” the authors wrote on the slight decrease in applicants to abortion-restricted states.

“Obstetrics and gynecology remains a competitive specialty, with most residency positions filled with highly qualified applicants,” the authors concluded.

State abortion restrictions currently apply to an estimated 44% of ob/gyn residents.

“It was all reassuring to find out that actually there was not a large decrease to states with abortion bans versus not, which is obviously important for when we consider workforce issues for the future,” Hammoud told MedPage Today.

Doctors are likely to stay and practice where they train, so recruiting residents to all parts of the country is critical for healthcare access and equity. Hammoud pointed to maternal care deserts as an issue, where there are fewer physicians providing vital healthcare to women.

“If we are not able to attract people to go train there, we might actually compromise that even further,” she said.

Last summer, the ob/gyn specialty announced it was splitting from ERAS and forming its own independent residency application system, details of which were released last month. Hammoud said she is eager to see how the next years play out — especially once the independent ob/gyn application system goes into effect.

For the present study, the authors analyzed anonymized applicant and program data from September and October of each year from ERAS, with data provided by the Association of American Medical Colleges.

Eleven states had abortion bans and six had gestational limits for abortion as of September 9, 2022. If applicants applied to programs in multiple states with the same ban status they were counted once but if the states’ ban status varied, they were counted once per ban status.

The primary outcome was the difference in the percentage of unique residency applicants from 2019 to 2023 and secondary outcomes were the distribution of program signals by state abortion ban status.

Hammoud’s group noted that the new program signals changed the application landscape, limiting the comparisons between 2022 and 2023 match cycles. Another study limitation was the lack of adjustment for program-level variables in the analyses.