State Laws on Reproductive Health and Graduating Medical Students' Choice of Specialty and Residency Location

To explore the relationship between state restrictions on reproductive health access and students' decision-making regarding specialty choice and residency location.

The authors analyzed 2024 Graduation Questionnaire (GQ) data from medical students graduating from U.S. MD-granting medical schools pursuing all specialties. Abortion restrictiveness classifications were based on the Guttmacher Institute's U.S. Abortion Policies and Access After Roe map.

Over half (7,855/15,513; 50.6%) and one-third (5,255/15,520; 33.9%) of students reported that state laws about reproductive health services influenced where they applied for residency and their choice of specialty, respectively, to some degree. Women were approximately twice as likely to report reproductive laws influenced their decisions, compared with men (specialty choice: relative risk [RR], 2.04; 95% confidence interval [CI], 1.94-2.15; residency location: RR, 1.70; 95% CI, 1.64-1.77; both P < .001). Students completing medical school in abortion protective (RR, 1.15; 95% CI, 1.12-1.19) or intermediate (RR, 1.14; 95% CI, 1.07-1.21) states were more likely to report being influenced by state laws when deciding where to pursue residency, compared with students in restrictive states (both P < .001). Students pursuing obstetrics and gynecology (ObGyn), family medicine (FM), or emergency medicine (EM) residencies were more influenced by state laws when choosing their specialty (ObGyn: RR, 2.45; 95% CI, 2.35-2.56, P < .001; FM: RR, 1.65; 95% CI, 1.56-1.74, P < .001; EM: RR, 1.11; 95% CI, 1.02-1.20, P = .02) and where to apply for residency (ObGyn: RR, 1.87; 95% CI, 1.83-1.93, P < .001; FM: RR, 1.30; 95% CI, 1.25-1.36, P < .001; EM: RR, 1.08; 95% CI, 1.02-1.15, P = .01), compared with students pursuing other specialties.

This study provides further evidence that restrictions on abortion care are likely to impede efforts to develop a future physician workforce capable of reducing health care inequities and improving maternal health outcomes.