Association of State Legislation Restricting Reproductive and LGBT Rights With Infectious Diseases Fellowship Match...

Infectious diseases (ID) fellowship match rates have declined over the last decade. Previous studies have identified factors that influence interest in ID and fellowship match rates, but the association of state legislation restricting reproductive and/or lesbian, gay, bisexual, and transgender (LGBT) rights with ID fellowship match rates is unknown.

All adult ID fellowship programs in the United States from 2017 to 2025 were categorized as located in states, districts, or territories with or without restrictions on reproductive and/or lesbian, gay, bisexual, and transgender rights. Programs were also categorized by academic status as academic, university-affiliated community, or pure community programs. Match rates were compared between programs when stratifying by state restrictions, academic status, and both status using χ² tests.

In 6 of the 9 years studied, match rates of adult ID fellowship programs were higher to a significant degree for academic programs in permissive states than for those in restrictive states (2017-2018, 2021-2023, 2025; P = .002 to P = .02). In the same period, there were no differences in match rates between university-affiliated community programs or pure community programs in states with and without restrictions.

The presence of legislation restricting reproductive and/or LGBT rights was associated with significantly reduced match rates in academic programs but not in university-affiliated community programs or pure community programs. Academic fellowship programs represent the majority of ID fellowship programs and must make note of this when recruiting fellows.