By Kellen Mermin-Bunnell and Ariana Traub.

In June 2022, the Dobbs v. Jackson Women’s Health Organization decision overruled the federal right to abortion. This decision has long-standing implications not just for reproductive healthcare but for all healthcare in the US. Since the decision, individual states have created their own laws protecting, limiting, or banning abortion. Laws vary widely by state, meaning healthcare professionals and trainees must abide by different laws depending on where they live. These laws have become an important factor medical students must grapple with when applying to residency, the next stage in their medical training. Residency applicants must now consider access to comprehensive medical education and reproductive health services for themselves and their patients in program selection. This study surveyed third-year and fourth-year medical students to assess Dobbs’s impact on the 2022–2023 residency application cycle, and the personal and ideological factors trainees must reconcile as they choose where and how to continue their path towards becoming practicing physicians.

This study comprised respondents from 32 states applying to a variety of specialties. The majority of respondents said that changes in abortion access would likely influence their decision regarding where to apply, where to start a family, contraceptive planning, and which specialty to apply to. The majority of respondents also indicated that they were unlikely to apply to a state with abortion restrictions. While some students were emboldened by the Dobbs decision to apply into Ob-Gyn, others decided the specialty was too politically rife and decided to apply to a specialty with less political intrusion.

Applying to residency is as much about career advances as it is a personal decision. Residency is often the time people start families. Therefore, many respondents discussed their desire of wanting access to reproductive healthcare not just for their patients, but also for themselves and their family. Respondents said that Dobbs was impacting when and where they wanted to start a family, as well as their contraceptive planning

This study represented students from varying backgrounds and with diverse values. Respondents who identify as cis-gender female, non-heterosexual and non-Catholic were most driven to apply to states where abortion is protected. The respondents applying only to programmes in states with abortion restrictions predominantly identified as Catholic and cis-gender male. The relationship found between religious affiliation and post-Dobbs residency decisions points to the strong influence religion has even among medical professionals.

There is no question that medical practice in the US is often tied to interests—political, religious, legal—other than those of patients. The Dobbs decision goes against the core principles of bioethics and of medical practice that trainees learn. We are taught to provide evidence-based, individualized patient care that respects the informed decisions our patients make about what medical treatments they wish to receive. However, legislation that prevents us from caring for patients by offering them all evidence-based treatment options in order to obtain comprehensively-informed consent prevents us from meeting fundamental minimum requirements of adequate medical care. The next generation of physicians are now grappling with this insult to the core of what it means to be a doctor, and this is reflected in their choices of where to complete residency.

Paper title: Abortion restrictions and medical residency applications

Authors: Kellen Mermin-Bunnell^1*, Ariana M Traub^1*, Kelly Wang², Bryan Aaron³, Louise Perkins King^4,5, Jennifer Kawwass⁶

*KMB and AMT are co-first authors and contributed equally.

Affiliations:

1. Emory University School of Medicine, Atlanta GA, USA
2. Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York, USA
3. University of Michigan Medical School, Ann Arbor, Michigan, USA
4. Harvard Medical School, Boston, Massachusetts, USA
5. Brigham and Women’s Hospital, Boston, Massachusetts, USA
6. Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA

Competing interests: None declared

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• Instagram: @nellmmb @ariana_traub @jfkawwassmd