EDITORS’ NOTE: The following post first appeared in MedPage Today.
For thousands of medical students, years of hard work will culminate this week as Match Day 2023 marks the end of their undergraduate medical education and the start of their residency program. Many newly minted physicians will soon pack up their belongings and move to new institutions in new cities and states across the U.S. Yet, this year’s Match is already different from years past. For the first time since 1973, Match 2023 applicants have compiled their match and rank lists with the knowledge that the U.S. no longer protects the constitutional right to abortion. Roe v. Wade is no longer the law of the land.
This devastating development came after years of accelerating threats to abortion rights and access. Even before the June 2022 Dobbs v. Jackson Women’s Health decision formally ended nearly 50 years of Roe, state legislatures had been enacting record-high numbers of abortion restrictions. Now, post-Roe, states are working to reinstate historical trigger bans and devise new laws and policies to restrict abortion at the state and national levels — including the current action to revoke the use of mifepristone (Mifeprex) for medication abortion.
Such policy trends hold far-reaching implications for the U.S. healthcare system — including consequences for the physician workforce. Namely, how will overturning Roe v. Wade impact the geographical preferences and clinical practice decisions of current and future physicians?
New Findings on Post-Roe Practice Location Preferences
Our recent study published in the Journal of General Internal Medicine begins to answer this question. In a survey of more than 2,000 current and future physicians on social media, we found that most (82.3%) would prefer to work or train in states with preserved abortion access. In fact, more than three-quarters (76.4%) of respondents would not even apply to states with legal consequences for providing abortion care. The same holds true for states with early or complete bans on abortion or Plan B. In other words, many qualified candidates would no longer even consider working or training in more than half of U.S. states.
Perhaps unsurprisingly, those who intend to provide abortion care (27.1%) generally preferred to practice in less restrictive environments. However, similar preferences persisted across other medical specialties and subspecialties, underscoring the essential truth that abortion rights and access affect the entire physician workforce and, thus, the whole healthcare system.
The reasons for physicians’ practice location preferences include, but are not limited to, patient care. While 77.8% of respondents report that their preferences are influenced by patient access to abortion care, others also prioritize preserved access for themselves or their partner (56.1%) or other family members (42.5%). This should not surprise us: physicians are human beings, too, with healthcare needs and personal lives that are not wholly defined by their career choices.
Impact on the Healthcare System
Our findings reveal alarming discrepancies between the environments physicians prefer to work in and the current political realities of most U.S. states. Yet, this is not simply about physicians’ preferences: it is about sustaining the physician workforce and protecting access to care.
Even before Dobbs, the U.S. faced a physician workforce shortage — including a shortage of abortion clinicians — that was projected to impact states unevenly. Many of the same states that now have abortion restrictions were previously predicted to be hard hit by future deficits. Placed within this context, our data suggest that abortion-restricted states may face even more severe shortages post-Dobbs if physicians follow through on these geographic preferences.
Multiple studies have demonstrated the correlation between abortion restrictions and higher maternal mortality rates, especially among women of color. The reasons for this are highly complex but attributable, in part, to the coexistence of other harmful policies like limited Medicaid coverage and fewer maternity care providers. Already, whereas 39% of counties in abortion-restricted states are considered maternity care deserts — in which access to maternity care is limited or absent — relatively fewer counties in abortion-protected states (25%) share that designation. Adding a disproportionate physician workforce shortage to this burden will compound the stress on the healthcare system in these states and, in turn, exacerbate entrenched health disparities. Thus, laws and policies that restrict abortion not only pose a serious threat to the one in every five pregnancies that end in abortion every year but also stand to harm patients seeking various types of primary and specialty care in restrictive states.
The impact of abortion restrictions will extend beyond the clinical practice decisions of reproductive healthcare providers — states will likely see an shortage of clinicians across every medical field, from orthopedic surgery to dermatology to oncology. Though future studies should explore this ripple effect further, one can imagine how a potential exodus may compound physician burnout and exacerbate countless more disparities, like the burden of chronic disease.
The fallout of the Dobbs decision will adversely affect our health and our patients’ lives. As physicians, we must unequivocally oppose policies that disrupt healthcare for everyone, including state bans on abortion. At the same time, we must ardently support our colleagues who are living and working in restrictive states so that they may continue accessing the training they need as physicians and the care they deserve as patients. If we do not, our current workforce shortages will only worsen, foretelling a crisis that would endanger us all.
This is a watershed moment for the U.S. healthcare system. As the current and future physician workforce, we must all take these threats seriously.
Sarah McNeilly is a medical student at the Albert Einstein College of Medicine in New York City, and a leader with Medical Students for Choice. Morgan S. Levy is a medical student in the MD and Master’s in Public Health program at the University of Miami Miller School of Medicine. Simone A. Bernstein, MD, is a resident physician at Washington University School of Medicine in St. Louis, and a co-founder of Inside the Match. Jessi A. Gold, MD, MS, is an assistant professor and director of Wellness, Engagement, and Outreach in the Department of Psychiatry at Washington University in St. Louis, and a member of the MedPage Today editorial board. Vineet Arora, MD, MAPP, is the Herbert T. Abelson professor of medicine and dean of Medical Education at the Pritzker School of Medicine at the University of Chicago.