Isabella Rosario Blum was wrapping up medical school and considering residency programs to become a family practice physician when she got some frank advice: If she wanted to be trained to provide abortions, she shouldn't stay in Arizona.
Blum turned to programs mostly in states where abortion access -- and by extension, abortion training -- is likely to remain protected, like California, Colorado, and New Mexico. Arizona has enacted a law banning most abortions after 15 weeks.
"I would really like to have all the training possible," she said, "so of course that would have still been a limitation."
In June, she will start her residency at Swedish Cherry Hill hospital in Seattle.
According to new statistics from the Association of American Medical Colleges (AAMC), for the second year in a row, students graduating from U.S. medical schools were less likely to apply this year for residency positions in states with abortion bans and other significant abortion restrictions.
Since the Supreme Court in 2022 overturned the constitutional right to an abortion, state fights over abortion access have created plenty of uncertainty for pregnant patients and their doctors. But that uncertainty has also bled into the world of medical education, forcing some new doctors to factor state abortion laws into their decisions about where to begin their careers.
Fourteen states, primarily in the Midwest and South, have banned nearly all abortions. -- a preliminary copy of which was exclusively reviewed by KFF Health News before its public release -- found that the number of applicants to residency programs in states with near-total abortion bans declined by 4.2%, compared with a 0.6% drop in states where abortion remains legal.
Notably, the AAMC's findings illuminate the broader problems abortion bans can create for a state's medical community, particularly in an era of provider shortages: The organization tracked a larger decrease in interest in residencies in states with abortion restrictions not only among those in specialties most likely to treat pregnant patients, like ob/gyns and emergency room doctors, but also among aspiring doctors in other specialties.
"It should be concerning for states with severe restrictions on reproductive rights that so many new physicians -- across specialties -- are choosing to apply to other states for training instead," wrote Atul Grover, MD, PhD, executive director of the AAMC's Research and Action Institute.
The AAMC analysis found the number of applicants to ob/gyn residency programs in abortion-ban states dropped by 6.7%, compared with a 0.4% increase in states where abortion remains legal. For internal medicine, the drop observed in abortion-ban states was over five times as much as in states where abortion is legal.
In its analysis, the AAMC said an ongoing decline in interest in ban states among new doctors ultimately "may negatively affect access to care in those states."
Jack Resneck Jr., MD, immediate past president of the American Medical Association, said the data demonstrates yet another consequence of the post-Roe v. Wade era.
The AAMC analysis notes that even in states with abortion bans, residency programs are filling their positions -- mostly because there are more graduating medical students in the U.S. and abroad than there are residency slots.
Still, Resneck said, "we're extraordinarily worried." For example, physicians without adequate abortion training may not be able to manage miscarriages, ectopic pregnancies, or potential complications such as infection or hemorrhaging that could stem from pregnancy loss.
Those who work with students and residents say their observations support the AAMC's findings. "People don't want to go to a place where evidence-based practice and human rights in general are curtailed," said Beverly Gray, MD, an associate professor of obstetrics and gynecology at Duke University School of Medicine.
Abortion in North Carolina is banned in nearly all cases after 12 weeks. Women who experience unexpected complications or discover their baby has potentially fatal birth defects later in pregnancy may not be able to receive care there.
Gray said she worries that even though Duke is a highly sought training destination for medical residents, the abortion ban "impacts whether we have the best and brightest coming to North Carolina."
Rohini Kousalya Siva, MD, MPH, will start her obstetrics and gynecology residency at MedStar Washington Hospital Center in Washington, D.C., this year. She said she did not consider programs in states that have banned or severely restricted abortion, applying instead to programs in Maryland, New Hampshire, New York, and Washington, D.C.
"We're physicians," said Kousalya Siva, who attended medical school in Virginia and was previously president of the American Medical Student Association. "We're supposed to be giving the best evidence-based care to our patients, and we can't do that if we haven't been given abortion training."
Another consideration: Most graduating medical students are in their 20s, "the age when people are starting to think about putting down roots and starting families," said Gray, who added that she is noticing many more students ask about politics during their residency interviews.
And because most young doctors make their careers in the state where they do their residencies, "people don't feel safe potentially having their own pregnancies living in those states" with severe restrictions, said Debra Stulberg, MD, chair of the Department of Family Medicine at the University of Chicago.
Stulberg and others worry that this self-selection away from states with abortion restrictions will exacerbate the shortages of physicians in rural and underserved areas.
"The geographic misalignment between where the needs are and where people are choosing to go is really problematic," she said. "We don't need people further concentrating in urban areas where there's already good access."
After attending medical school in Tennessee, which has adopted one of the most sweeping abortion bans in the nation, Hannah Light-Olson, MD, will start her ob/gyn residency at the University of California San Francisco this summer.
It was not an easy decision, she said. "I feel some guilt and sadness leaving a situation where I feel like I could be of some help," she said. "I feel deeply indebted to the program that trained me, and to the patients of Tennessee."
Light-Olson said some of her fellow students applied to programs in abortion-ban states "because they think we need pro-choice providers in restrictive states now more than ever." In fact, she said, she also applied to programs in ban states when she was confident the program had a way to provide abortion training.
"I felt like there was no perfect, 100% guarantee; we've seen how fast things can change," she said. "I don't feel particularly confident that California and New York aren't going to be under threat, too."
As a condition of a scholarship she received for medical school, Blum said, she will have to return to Arizona to practice, and it is unclear what abortion access will look like then. But she is worried about long-term impacts.
"Residents, if they can't get the training in the state, then they're probably less likely to settle down and work in the state as well," she said.
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