Training After Dobbs: Geographic and Policy-Related Mobility Between Medical School and Obstetrics and Gynecology Residency.
Source: PubMed, NCBI / U.S. National Library of Medicine
To explore changes in geographic and policy-related mobility between medical school and Obstetrics and Gynecology (OBGYN) residency of matched resident cohorts following the Dobbs v. Jackson Supreme Court decision. In this cohort study, we compiled a novel dataset of 5,761 OBGYN residents from 261 programs across 2021-24 Match cycles in US states and DC, linking each resident to their medical school, residency program, and Match cohort year. The exposure was Dobbs, coded as pre- (2021-22) vs post- (2023-24) Match cohorts. Outcomes captured movement between medical school and residency locations, including in state, out of state - within region (Midwest, Northeast, South, West), out of region, and from abroad; and movement between state abortion policy environments (ban, restrictive, protective). We used linear probability models to assess post-Dobbs changes in mobility, controlling for class size within each residency-cohort combination. Following Dobbs, the share of residents crossing regional borders fell by 3.1 percentage points overall (95%CI [-5.4, -0.9]). In ban states, the proportion of residents coming from medical schools located in protective states decreased by 5.4 percentage points (95%CI [-8.6, -2.1]), while the share of residents from ban states increased by 5.0 percentage points (95% CI [0.4, 9.6]). Geographic and policy-related mobility between medical school and residency declined after Dobbs, with fewer graduates crossing regional borders and relocating from
Abstract
To explore changes in geographic and policy-related mobility between medical school and Obstetrics and Gynecology (OBGYN) residency of matched resident cohorts following the Dobbs v. Jackson Supreme Court decision. In this cohort study, we compiled a novel dataset of 5,761 OBGYN residents from 261 programs across 2021-24 Match cycles in US states and DC, linking each resident to their medical school, residency program, and Match cohort year. The exposure was Dobbs, coded as pre- (2021-22) vs post- (2023-24) Match cohorts. Outcomes captured movement between medical school and residency locations, including in state, out of state - within region (Midwest, Northeast, South, West), out of region, and from abroad; and movement between state abortion policy environments (ban, restrictive, protective). We used linear probability models to assess post-Dobbs changes in mobility, controlling for class size within each residency-cohort combination. Following Dobbs, the share of residents crossing regional borders fell by 3.1 percentage points overall (95%CI [-5.4, -0.9]). In ban states, the proportion of residents coming from medical schools located in protective states decreased by 5.4 percentage points (95%CI [-8.6, -2.1]), while the share of residents from ban states increased by 5.0 percentage points (95% CI [0.4, 9.6]). Geographic and policy-related mobility between medical school and residency declined after Dobbs, with fewer graduates crossing regional borders and relocating from protective to ban states. These results suggest emerging redistribution in the OBGYN training pipeline that may exacerbate inequities in future reproductive healthcare access. Despite stable fill rates of OBGYN residency slots since Dobbs, this study suggests reduced geographic and policy-related mobility between medical school and OBGYN residency, which may exacerbate inequities in future reproductive healthcare access.