- There was no population-level ob/gyn exodus away from abortion-restrictive states post-Roe.
- Ties to patients and local community and the significant effort and disruption associated with relocation may be at play.
- Residency trends may be a more apt assessment of abortion bans' influence on workforce trends.
In the post-Roe v. Wade era, ob/gyns continued to practice in similar locations as before, according to a descriptive cohort study.
From the quarter right before the June 2022 Dobbs v. Jackson Women's Health Organization decision through the end of the study in September 2024, 95.8% of ob/gyns remained in states that protect access to abortion, 94.8% remained in states threatening bans, and 94.2% remained in states with abortion bans, reported Becky Staiger, PhD, of the University of California Berkeley, and colleagues.
In this sample of 60,085 ob/gyns, the mean increase in the per-quarter number of ob/gyns from before to after Dobbs was 8.3% in states with total abortion bans, 10.5% in states with gestational age limits or threatened abortion bans, and 7.7% in states with abortion protections, they noted in JAMA Network Open.
"The only statistically significant difference suggested that the share of physicians who are ob/gyns decreased less in threatened states than in protected ones, opposite to the expected finding if ob/gyns were leaving states where abortion is threatened," the authors wrote.
They also found that there were "no appreciable differences among recent ob/gyn residency graduates in the likelihood of moving to total ban states," nor differences by subspecialty or gender.
"These results may suggest that concerns prompting ob/gyns to consider relocation are thus far being offset by other forces, such as ties to patients and local community and the significant effort and disruption associated with relocation," Staiger and team wrote.
They did note that while trends in the number of ob/gyns in each type of state did not meaningfully differ after Dobbs, this study doesn't speak to "the evolution of other aspects of reproductive healthcare" -- like quality of care, practitioners' moral distress, or quality of ob/gyn training.
"Although these findings do not provide insight into changes in the quality of care provided, they suggest that there are no major changes in the supply of ob/gyns associated with the Dobbs decision," they concluded.
In an invited commentary, Blair Darney, PhD, MPH, of Oregon Health & Science University in Portland, and co-authors argued that residency training is "the central inflection point to track workforce impacts of abortion bans," because it is not an open job market and because residency location determines ob/gyn training on critical skills like abortion and miscarriage management.
Past research has shown that access to abortion training is important to ob/gyn residency applicants and that states with abortion bans saw a small decline in the numbers of ob/gyn residency applications. Still, ob/gyn residency slots in abortion-restrictive states still get filled because "there are applicants who would prefer training in a ban state to not training at all," Darney and colleagues wrote.
They noted that some programs in abortion-restrictive states have found ways to connect their trainees with programs in other states to learn abortion procedures, though much of the onus and cost falls on the resident -- not their residency program -- and there are still legal and logistical challenges to doing this.
"This resident-driven approach exacerbates disparities in technical skill between residents and programs with resources and institutional support to travel out-of-state and those without," they pointed out.
Darney and team recommended that future research on "the workforce impacts of abortion bans should consider trainees earlier in their careers, [complex family planning] subspecialists, and differentiate the nuances of abortion bans."
For this study, Staiger and colleagues identified all practicing ob/gyns within the National Plan and Provider Enumeration System (NPPES), a registry of healthcare practitioners in the U.S., from January 2018 through September 2024.
Of the 60,085 ob/gyns included in the sample, 59.7% were women, 12.9% were recent residency graduates, and 3.8% were maternal-fetal medicine specialists.
State abortion policies were assigned as either total ban, threatened states with gestational bans, and protected states unlikely to enact an abortion ban.
At the time of analysis, 14 states had total bans (Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, and West Virginia), and 11 were considered threatened states (Arizona, Florida, Georgia, Iowa, North Carolina, Nebraska, Ohio, South Carolina, Utah, Wisconsin, and Wyoming); the rest had abortion protections.
In terms of limitations, the authors noted that the study only looked at the 2 years post-Dobbs, which only captures short-term changes in physician behavior. They didn't have access to physician characteristics like political party affiliation that may impact their choice to move or stay put. Even though NPPES has verified locations for physicians that bill to public or private insurance, it's still possible that some error exists, though there is no evidence it would impact the results in a significant way.
Disclosures
Staiger had no disclosures.
Co-authors reported receiving personal fees from the Planned Parenthood Federation of America, the Center for Reproductive Rights, the U.S. Congressional Budget Office, the Urban Institute, and the Society of Family Planning.
Darney reported grants from the NIH and personal fees from the Society of Family Planning, Contraception, and the American College of Obstetricians and Gynecologists.
Other editorialists reported grants from the NIH, the Society of Family Planning, the Lalor Foundation, and the Collins Foundation.
Primary Source
JAMA Network Open
Source Reference: Staiger B, et al "Obstetrician and gynecologist physicians' practice locations before and after the Dobbs decision" JAMA Netw Open 2025; DOI: 10.1001/jamanetworkopen.2025.1608.
Secondary Source
JAMA Network Open
Source Reference: Liberty A, et al "How should we study and interpret workforce impacts of abortion restrictions?" JAMA Netw Open 2025; DOI: 10.1001/jamanetworkopen.2025.6136.
No comments:
Post a Comment
Note: Only a member of this blog may post a comment.