Isabella Rosario Blum was wrapping up medical school and considering residency programs to become a family practice physician when she got some frank advice: If she wanted to be trained to provide abortions, she shouldn\u2019t stay in Arizona.<\/p>\n

Blum turned to programs mostly in states where abortion access \u2014 and, by extension, abortion training \u2014 is likely to remain protected, like California, Colorado, and New Mexico. Arizona has enacted a law banning most abortions after 15 weeks.<\/p>\n

\u201cI would really like to have all the training possible,\u201d she said, \u201cso of course that would have still been a limitation.\u201d<\/p>\n

In June, she will start her residency at Swedish Cherry Hill hospital in Seattle.<\/p>\n

According to new statistics from the Association of American Medical Colleges, for the second year in a row, students graduating from U.S. medical schools were less likely to apply this year for residency positions in states with abortion bans and other significant abortion restrictions.<\/p>\n

Since the Supreme Court in 2022 overturned the constitutional right to an abortion, state fights over abortion access have created plenty of uncertainty for pregnant patients and their doctors. But that uncertainty has also bled into the world of medical education, forcing some new doctors to factor state abortion laws into their decisions about where to begin their careers.<\/p>\n

Fourteen states, primarily in the Midwest and South, have banned nearly all abortions. The new analysis by the AAMC<\/a> \u2014 a preliminary copy of which was exclusively reviewed by KFF Health News before its public release \u2014 found that the number of applicants to residency programs in states with near-total abortion bans declined by 4.2%, compared with a 0.6% drop in states where abortion remains legal.<\/p>\n

Notably, the AAMC\u2019s findings illuminate the broader problems abortion bans can create for a state\u2019s medical community, particularly in an era of provider shortages: The organization tracked a larger decrease in interest in residencies in states with abortion restrictions not only among those in specialties most likely to treat pregnant patients, like OB-GYNs and emergency room doctors, but also among aspiring doctors in other specialties.<\/p>\n

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\u201cIt should be concerning for states with severe restrictions on reproductive rights that so many new physicians \u2014 across specialties \u2014 are choosing to apply to other states for training instead,\u201d wrote Atul Grover, executive director of the AAMC\u2019s Research and Action Institute.<\/p>\n
The AAMC analysis found the number of applicants to OB-GYN residency programs in abortion ban states dropped by 6.7%, compared with a 0.4% increase in states where abortion remains legal. For internal medicine, the drop observed in abortion ban states was over five times as much as in states where abortion is legal.<\/p>\n
In its analysis, the AAMC said an ongoing decline in interest in ban states among new doctors ultimately \u201cmay negatively affect access to care in those states.\u201d<\/p>\n
Jack Resneck Jr., immediate past president of the American Medical Association, said the data demonstrates yet another consequence of the post-Roe v. Wade<\/em> era.<\/p>\n
The AAMC analysis notes that even in states with abortion bans, residency programs are filling their positions \u2014 mostly because there are more graduating medical students in the U.S. and abroad than there are residency slots.<\/p>\n
Still, Resneck said, \u201cwe\u2019re extraordinarily worried.\u201d For example, physicians without adequate abortion training may not be able to manage miscarriages, ectopic pregnancies, or potential complications such as infection or hemorrhaging that could stem from pregnancy loss.<\/p>\n
Those who work with students and residents say their observations support the AAMC\u2019s findings. \u201cPeople don\u2019t want to go to a place where evidence-based practice and human rights in general are curtailed,\u201d said Beverly Gray, an associate professor of obstetrics and gynecology at Duke University School of Medicine.<\/p>\n
Abortion in North Carolina is banned in nearly all cases after 12 weeks. Women who experience unexpected complications or discover their baby has potentially fatal birth defects later in pregnancy may not be able to receive care there.<\/p>\n
Gray said she worries that even though Duke is a highly sought training destination for medical residents, the abortion ban \u201cimpacts whether we have the best and brightest coming to North Carolina.\u201d<\/p>\n
Rohini Kousalya Siva will start her obstetrics and gynecology residency at MedStar Washington Hospital Center in Washington, D.C., this year. She said she did not consider programs in states that have banned or severely restricted abortion, applying instead to programs in Maryland, New Hampshire, New York, and Washington, D.C.<\/p>\n
\u201cWe\u2019re physicians,\u201d said Kousalya Siva, who attended medical school in Virginia and was previously president of the American Medical Student Association. \u201cWe\u2019re supposed to be giving the best evidence-based care to our patients, and we can\u2019t do that if we haven\u2019t been given abortion training.\u201d<\/p>\n
Another consideration: Most graduating medical students are in their 20s, \u201cthe age when people are starting to think about putting down roots and starting families,\u201d said Gray, who added that she is noticing many more students ask about politics during their residency interviews.<\/p>\n
And because most young doctors make their careers in the state where they do their residencies, \u201cpeople don\u2019t feel safe potentially having their own pregnancies living in those states\u201d with severe restrictions, said Debra Stulberg, chair of the Department of Family Medicine at the University of Chicago.<\/p>\n
Stulberg and others worry that this self-selection away from states with abortion restrictions will exacerbate the shortages of physicians in rural and underserved areas.<\/p>\n
\u201cThe geographic misalignment between where the needs are and where people are choosing to go is really problematic,\u201d she said. \u201cWe don\u2019t need people further concentrating in urban areas where there\u2019s already good access.\u201d<\/p>\n
After attending medical school in Tennessee, which has adopted one of the most sweeping abortion bans in the nation, Hannah Light-Olson will start her OB-GYN residency at the University of California-San Francisco this summer.<\/p>\n
It was not an easy decision, she said. \u201cI feel some guilt and sadness leaving a situation where I feel like I could be of some help,\u201d she said. \u201cI feel deeply indebted to the program that trained me, and to the patients of Tennessee.\u201d<\/p>\n
Light-Olson said some of her fellow students applied to programs in abortion ban states \u201cbecause they think we need pro-choice providers in restrictive states now more than ever.\u201d In fact, she said, she also applied to programs in ban states when she was confident the program had a way to provide abortion training.<\/p>\n
\u201cI felt like there was no perfect, 100% guarantee; we\u2019ve seen how fast things can change,\u201d she said. \u201cI don\u2019t feel particularly confident that California and New York aren\u2019t going to be under threat, too.\u201d<\/p>\n
As a condition of a scholarship she received for medical school, Blum said, she will have to return to Arizona to practice, and it is unclear what abortion access will look like then. But she is worried about long-term impacts.<\/p>\n
\u201cResidents, if they can\u2019t get the training in the state, then they\u2019re probably less likely to settle down and work in the state as well,\u201d she said.<\/p>\n
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