Politics and Pediatrics: State Political Policies' Impact on Pediatrics Residency Application and Future Practice...

Understanding whether political policies influence residents' training and career decision-making is critical to address pediatric workforce concerns.

We surveyed pediatric residents on factors influencing residency application/ranking decisions (interns only) and future practice plans (all). Respondents reporting "state political policies" as an influence identified which specific topics affected them, the degree and direction of influence, and reasons for this influence. Responses were analyzed using standard descriptive statistics and compared by respondent demographics; open-ended responses were analyzed for common themes.

Six hundred and fifty-two residents from 18 US programs received surveys; 215 (33.0%) responded. Of 66 interns, 35 (53.0%) reported that state political policies influenced their application/ranking decisions. Most were somewhat/much less likely to apply/rank programs in states restricting abortion (n = 24, 68.6%), reproductive health care (n = 23, 65.7%), or gender-affirming care (n = 22, 62.9%). Many respondents (81%) indicated at least 1 political policy would influence future practice decisions; most were less likely to practice in states restricting reproductive health (n = 134, 76.6%), abortion (n = 129, 73.7%), gender-affirming care (n = 118, 67.4%), and lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual rights (n = 118, 67.4%). Common reasons included access to care and physician autonomy. Residents who self-identified as more progressive (odds ratios [OR] 0.11, 95% confidence intervals [CI] 0.02-0.49) or planned to start families within 3 to 5 years (OR 0.25, 95% CI 0.06-0.89) were less likely to plan future practice in states with restrictive policies.

State political policies significantly impact pediatric residents' decision-making around residency applications and ranking, as well as future practice decisions.