States With Abortion Bans See Continued Decrease in U.S. MD Senior Residency Applicants

A 2023 analysis by the AAMC Research and Action Institute found that fewer new graduates of U.S. medical schools applied to residency programs in states that banned or restricted access to abortion than to residency programs in states where abortion remained legal. That analysis was performed after the U.S. Supreme Court issued its decision on Dobbs v. Jackson Women’s Health Organizationin June 2022, immediately prior to the submission of residency applications through the Electronic Residency Application Service® (ERAS®) for the 2022-2023 application cycle. The ERAS program is a centralized online application service created and maintained by the AAMC as a resource for applicants, program directors, designated institutional officials, and deans of medical schools. The following analysis is an update of the 2023 data snapshot, Training Location Preferences of U.S. Medical School Graduates Post Dobbs v. Jackson Women’s Health. 

The new data analysis finds continued reductions in applicants to residency programs located in states with abortion bans two years after the Dobbs decision (during the 2023-2024 application cycle). As of April 1, 2024, 14 stateshave enacted full bans on abortion (up from 13 in 20231 ). Because these policy decisions appear to affect where physicians plan to practice, state governments and health care leaders need to consider the potential impact of those decisions on the physician workforce. This analysis examines residency applicant and application data by separating states into three cohorts: those with abortion bans, those with gestational limits, and those without gestational limits or abortion bans. While the number of unique medical school graduates, referred to as “U.S. MD seniors,” who applied to residency programs declined slightly in 2023-2024 from the previous application cycle, states with complete abortion bans saw greater decreases in the number of U.S. MD senior applicants than states with gestational limits or no restrictions. Continued disproportionate decreases in the number of applicants to programs in states with limits or restrictions were observed across all specialties in aggregate. 

In this analysis, and in the 2023 analysis, the authors chose to focus on U.S. MD seniors, who historically have the greatest chance of matching into specialties and programs of their choice compared with osteopathic physicians (DOs) and international medical graduate (IMG) applicants; U.S. MD seniors are likely to be most sensitive to practice and training restrictions in states with total abortion bans or gestational limits on abortion.2   

Compared to previous years, U.S. MD seniors submitted fewer applications per person in the 2023-2024 cycle. The reduction in applications per person resulted in applicants (on average) applying to programs across fewer states than in previous years, which should be considered when interpreting the figures below.  

Despite a decrease of only 72 U.S. MD senior applicants this cycle compared to last year, the number of total applications submitted by all U.S. MD seniors decreased by over 100,000. The average state saw a 10.1% decline in U.S. MD senior applicants, but the change varied by state — ranging from a decrease of 19.3% to an increase of 30.3%. The reduction in applications per applicant has been a stated goal of the ERAS® program and residency program directors, yet a disproportionate decrease in applicants to programs in states with abortion bans is still observable. 

For the second year in a row, decreases were observed in the total number of U.S. MD senior applicants to programs in states across ban status, with larger decreases in states with complete bans (Figure 1). Overall, the number of unique U.S. MD senior applicants to residencies in states with abortion bans decreased from the previous cycle by 4.2%, compared with a smaller decrease in states where abortions remained legal (0.6%). 

States’ abortion-ban status may be correlated with program number and size, but these findings suggest that applicants may be responding to something independent of program size, particularly given two years of similar patterns. In other words, while states with more severe restrictions are often less populous (and have fewer residency programs) than other states, U.S. MD applicants may be selectively reducing their likelihood of applying to programs in states with more state-imposed restrictions on health care regardless of the number of available residency programs. The relative decrease in applicants to programs in states with abortion restrictions compared with the number of applicants to programs in states where abortion remains legal was also greater in 2024 than in 2023. 

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Changes in the number of applicants to specialties whose patients are most likely to be affected, including emergency medicine, family medicine, internal medicine, obstetrics and gynecology (OB/GYN), and pediatrics, were examined separately from all other specialties combined. In these categories, the largest drop in unique applicants across all states in the 2023-2024 application cycle was seen in pediatrics (-8.5%; -171 applicants); and a 1.8% (-141 applicants) drop was seen in internal medicine (Table 1). Unlike in the 2023 report analyzing the 2022-2023 applicants, there was a small overall increase in the number of unique U.S. MD senior applicants in OB/GYN and emergency medicine in the 2023-2024 residency application cycle. Nonetheless, the numbers of unique applicants for both OB/GYN and emergency medicine in 2024 were lower in states with complete abortion bans than in those without bans.  

Similar to the trend seen for all residency applicants, the decrease in unique U.S. MD senior OB/GYN applicants year over year was largest in states with complete bans (-6.7%) while states without restrictions saw a small increase in unique applicants (0.4%) (Figure 2).  

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Unique residency applicants are a potentially early and more sensitive indicator of physician interest than other available indicators because the desire to match into a specialty of choice is likely greater than the desire to avoid training in states with major restrictions on reproductive health care. Put simply, applicants are likely to want to match somewhere — even the least desirable location — rather than nowhere. The examination of two years of data suggests that restrictions on women’s health care may continue to disproportionately decrease the likelihood that U.S. MD seniors will apply for residencies in states with the most restrictive practice environments. 

As noted previously, the decline in residency program applications submitted by U.S. MD senior applicants dropped substantially following more than five years of growth. This decrease has been an intentional goal of both the AAMC ERAS® program as well as individual specialties; multiple specialties have worked with the centralized application service to reduce the number of applications submitted by applicants though signaling and other approaches.3   

Despite these changes, nearly all residency positions in OB/GYN were filled again this year, and a similar number of U.S. MD seniors matched into first-year positions this year and last year.4 Residency positions for most large specialties also filled at rates similar to previous years. Across all applicant types (MD, DO, and IMG) in 2024, the number of unique OB/GYN applicants increased slightly from 2023; DOs saw a considerable increase in unique applicants, while IMGs applying to OB/GYN programs decreased across state groupings (Figure 3). 

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The implications of fewer applicants across specialties applying to programs in states with abortion bans has been discussed extensively since June 2022.5 6 7 8 9 Nationally, the total number of MD, DO, and IMG residency applicants continues to exceed the number of training slots available; residency programs in states with complete abortion bans continue to fill their residency positions. However, this additional year of findings suggests that the continued decreased interest of U.S. MD seniors in training in states with abortion bans or restrictions may negatively affect access to care in those states; any impact will likely first affect communities who already have limited access to care (such as rural, lower socioeconomic, and marginalized racial and ethnic groups).  

It is important to note that these analyses allow us to follow the trends in residency applications but do not provide definitive information about U.S. MD seniors’ motivations and reasons for applying to specific programs. Forthcoming analyses of data from the AAMC’s Graduation Questionnaire will include questions related to graduates’ views on reproductive health laws in states.  

These findings suggest that residency programs and states will need to collect more data about their trainees and licensees to better understand how state abortion bans may be affecting their ability to attract qualified trainees and physicians in the future. 

Methods  

All analyses were conducted using ERAS® data from 2019 to 2024. This snapshot examines the changes in the number of individual applicants across application cycles and abortion-ban status; data at the application level were not examined for this analysis. The data are a subset of applicant data as of March 1 each year. The sample population was U.S. MD senior applicants in Figures 1 and 2, and Table 1, and they exclude applicants who attended Canadian medical schools, IMGs, and DOs.  

State abortion-ban status is from KFF as of April 1, 2024. States with abortion bans are Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, and West Virginia. States with gestational limits are Arizona, Florida, Georgia, Iowa, Kansas, Nebraska, North Carolina, Ohio, South Carolina, Utah, and Wisconsin. States where abortion is legal are Alaska, California, Colorado, Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Washington, and Wyoming.