State-Level Disparities in Residency Applications After Dobbs v Jackson Women’s Health Organization

Importance: Preliminary analyses have suggested that state-level abortion policy following Dobbs v Jackson Women’s Health Organization (Dobbs) may affect the health care workforce, including residency applications. Objectives: To assess disparities in the residency application rate to programs in abortion-restricted states compared with programs in nonrestricted states following the Dobbs decision by gender of applicants across all medical specialties and to compare how these differences may vary by specialty. Design, Setting, and Participants: This cross-sectional study with interrupted time-series analysis used anonymized program-level residency application data from the Association of American Medical Colleges Electronic Residency Application Service (ERAS) from 2019 to 2023. Residency programs across all medical specialties with complete application data across the study period were included. The application cycle immediately prior to the Dobbs decision, 2020-2021, was the base year for analysis. Exposures: New or intensified state-level abortion restrictions enacted post-Dobbs in June until October 2022, the 2023 ERAS submission deadline. Main Outcomes and Measures: The primary outcome was the disparity in application rates to programs between restricted states and nonrestricted states. The application rate was calculated as the number of applications to each program per 100 000 total applications across all programs nationwide annually. Regression models explored the interaction between the exposure and application cycles, controlling for program fixed effects, program size, applicant degree type, and in-state applicants. Results: Among 4315 residency programs with 24 193 864 total applications (43.9% from women and 56.1% from men), the disparity in the application rate to programs in abortion-restricted states changed by −0.38 (95% CI, −0.70 to −0.05) among women and −0.56 (95% CI, −0.95 to −0.17) among men applying to residency, reflecting an absolute difference of −7833.2 (95% CI, −14 429.7 to −1030.7) applications from women and −12 789.2 (95% CI, −21 695.9 to −3882.4) applications from men to programs in abortion-restricted states. Differences were greater among abortion-related specialties, including obstetrics and gynecology, family medicine, internal medicine, and emergency medicine (−1.17 95% CI, −1.89 to −0.45 for women and −1.54 95% CI, −2.39 to −0.69 for men), and decreased among the most competitive specialties (ie, dermatology; neurosurgery; orthopedics; ear, nose, and throat; and plastic surgery) (−0.02 95% CI, −0.37 to 0.40 for women and −0.13 95% CI, −0.44 to 0.18 for men). Conclusions and Relevance: In this cross-sectional panel analysis of residency applications to 4315 programs, the Dobbs decision was associated with a significant decrease in residency applications in abortion-restricted states compared with nonrestricted states among both women and men. These findings provide early evidence that Dobbs may be associated with state-level disparities in the overall health care training pipeline and workforce.