Reproductive Health Policy and Residency Application Patterns: Evidence from Abortion Bans following Dobbs v Jackson

• In Event: How Practice Environments Shape Physician Behavior and Workforce Decisions

Abstract

Residency decisions have large potential ramifications for the supply of health professionals in an area. Around half of residents continue to practice in the same state after completing their residency. As a result, policy changes that impact where individuals apply for residency may have meaningful impacts for healthcare access. This paper examines a policy change with the potential to impact the residency location decisions of obstetricians and gynecologists (OB-GYNs): the 2022 Supreme Court decision in Dobbs v. Jackson, which revoked constitutional protections for the right to an abortion. Following this ruling, thirteen states, a majority of which had existing maternity care deserts, immediately implemented full bans on abortions with large consequences for physicians performing abortions in those states. We use a triple difference-in-differences design to examine whether these ”trigger bans” enacted in the wake of Dobbs affect residency applications to OB-GYN programs in ban states. We find that in the years following the Dobbs decisions, applications to residency programs in ban states decrease by 12%. Examining mechanisms, we find suggestive evidence that this change is driven by a shift in where OB-GYN applicants choose to apply rather than a shift away from applying to OB-GYN programs in general. Subgroup analyses reveal that this decrease is driven entirely by female applicants. These results indicate that training and practice environment may be a large determinant of residency location, and possibly of future practicing locations, for OB-GYNs. If these effects persist long-term, this suggests that states with abortion bans could see large long-run decreases in the supply of OB-GYNs, reducing access to maternal healthcare more broadly. In addition, OB-GYN residency programs (and associated hospitals as an extension) in these states could experience long-run staffing shortages from a decline in OB-GYN residents. Future research should examine the impacts of such bans on location decisions among practicing physicians and longer-run health outcomes to better understand whether changes in residency-applications translate to changes in physician supply and ultimately to changes in health outcomes. This work is well-aligned with the broader APPAM conference theme. This study highlights how state-specific legislation that seeks to change access to a specific healthcare service, abortion, can have broader spillover effects on access to women’s health services by influencing the geographic preferences of early-career OB-GYNs. Moreover, the automatic passing of abortion-bans in certain states after Dobbs v. Jackson is a novel example of how states can leverage “trigger laws” built into existing legislation to translate a change in federal protections to a binding, state-specific, law.

Author

• Anjali Pai, Brown University
  Presenting Author