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States with abortion bans may see an unappreciated consequence when it comes to their physician workforce: fewer medical students, especially those interested in obstetrics and gynecology, are choosing to do their residency training there.

This could mean a looming shortage of doctors practicing in those states, of residency graduates end up practicing in the same state in which they trained.

"I think those states are going to have fewer doctors," said Atul Grover, MD, PhD, executive director of the Association of American Medical Colleges (AAMC) Research and Action Institute, who co-authored that examined what could be the start of a worrisome trend.

In an interview with MedPage Today, Grover noted that "if nothing else changes, if this is a trend, [states with restrictive policies] are likely to have even fewer ob/gyns available than they do now. And we know that a lot of states already have what are basically maternal care deserts."

The report showed that while the number of U.S. medical school graduates who applied to programs in all states declined by 2% in 2022-2023 compared with the previous application cycle, it declined by 3%, or about 400 physicians, in , including Alabama, Arkansas, Idaho, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, South Dakota, Tennessee, Texas, West Virginia, and Wisconsin.

Applicants for ob/gyn residency slots were down 5.2% nationally compared with 4.6% the prior year, before the U.S. Supreme Court decision in Dobbs v. Jackson Women's Health Organization in June 2022, and applicants fell by a whopping 10.5% in the 13 states that ban abortions.

When looking just at applicants for programs in states with gestational limits on abortion as opposed to outright bans, ob/gyn applications were down 6.4% compared with the prior application cycle.

Grover cautioned that the AAMC report is based on a limited set of data over 1 year, and that the trend could be a fluke -- not that he believes that.

"It's not a huge difference, but it's significant, and it's something we can keep an eye on as to whether there's a trend," he said, adding that he hopes it spurs residency programs, medical schools, and state licensing agencies to start collecting data not only on where students are going for training or practice, "but why they are choosing or not choosing particular locations."

If the trend continues, it will impact programs in those states that are banning or curtailing earlier abortions, not just for the numbers of trainees, but the ability to get more suitable expertise for the programs, he said. "You may want someone who is an exceptional scientist in some programs, and other programs may say, 'I've got a large Somali population.'"

"If you don't have the ability to choose from the best and the brightest, because people are avoiding your state because of its policies, then that hurts -- and not just young female patients of childbearing age, it potentially hurts all the patients in your state," he noted.

The AAMC report also showed the largest drop in applicants for emergency medicine residency training programs -- 21.4% -- which followed the 2021-2022 drop from the prior year of 18.8%.

However, Grover said it's doubtful this year's decline is at all related to abortion bans, because the trend is national, and other factors are at play, such as medical students expressing concerns about private equity companies buying up emergency medicine practices and cutting doctors' salaries.

"They want to go into a career that they can have for 35 to 40 years, and they get scared off by things like that," Grover said.

Furthermore, a 2021 report concluded that the specialty of emergency medicine is facing a likely oversupply of physicians in 2030.

Asked if he thought policymakers in those 13 states with abortion bans were aware of the potential long-term implications for their physician workforce, Grover said, "I hope they look at this and at least are willing to consider this as part of their policy decisions going forward."

While the report is hardly definitive, Grover noted, it's important that the AAMC let policymakers know. "Look, we don't know a lot, but this is what we do know. And I really hope that it spurs some researchers to dig deeper into the data and to collect more data."

Grover and co-authors said the report focused on U.S. medical school graduates, "who historically have the greatest chance of matching into specialties and programs of their choice compared with DO and international medical graduate applicants."

They are also "likely to be most sensitive to practice and training restrictions in states with total abortion bans or gestational limits on abortion," they added.

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