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

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 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 those 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 suggest large potential ramifications of abortion bans for access to maternal healthcare in these states, many of which are existing maternity care deserts. They also indicate that training and practice environment can be a large determinant of residency location, and possibly of future practicing location, for OB-GYNs.