State-Level Abortion Bans and the OBGYN Workforce: A Review of Current Evidence

The US Supreme Court's June 2022 Dobbs v Jackson Women's Health Organization (hereafter Dobbs) decision radically changed the landscape of abortion care in the US. As states enacted near-total abortion bans with limited exceptions, critically ill pregnant patients were unable to obtain essential abortion care under their state's exceptions, sometimes leading to fatal outcomes. Obstetrics and gynecology (OBGYN) practitioners in states with abortion bans have reported that state laws prevented them from providing their pregnant patients with the standard of care, as well as widespread uncertainty around interpreting and operationalizing medical exceptions under state abortion laws. In light of these conditions, experts expressed concern that there would be a mass exodus of OBGYN practitioners from states that banned abortion, accompanied by influxes of these physicians into states with fewer restrictions. This Special Communication draws on published research to review what is known about the impact of abortion policy restrictions on the OBGYN workforce following the Dobbs decision.

This article focuses on 3 areas of impact: (1) state-level OBGYN movement; (2) moral distress and other work-related stressors; and (3) changes for training programs and trainees. Although studies published following the Dobbs decision indicated that certain physicians were moving, national-level data suggest minimal movement of OBGYN physicians across state policy environments. At the same time, numerous studies have found that OBGYN physicians practicing in states with abortion restrictions are experiencing moral distress, adverse mental health impacts, disrupted sleep, and burnout. Trainees are concerned about initiating residency in states with abortion restrictions, and training programs must grapple not only with potential shifts in applicants, but also in requirements to ensure out-of-state abortion training.

More than 3 years after Dobbs, the OBGYN workforce is under tremendous strain. OBGYN practitioners are essential providers of abortion care, maternal health, contraception, and complex gynecological conditions, and it is critical to understand how the post-Dobbs abortion policy environment continues to impact the OBGYN workforce and, by extension, patients.