States With Abortion Bans See Continued Decrease in U.S. MD Senior Residency Applicants

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Changes in the number of applicants to specialties whose patients are most likely to be affected, including emergency medicine, family medicine, internal medicine, obstetrics and gynecology (OB/GYN), and pediatrics, were examined separately from all other specialties combined. In these categories, the largest drop in unique applicants across all states in the 2023-2024 application cycle was seen in pediatrics (-8.5%; -171 applicants); and a 1.8% (-141 applicants) drop was seen in internal medicine (Table 1). Unlike in the 2023 report analyzing the 2022-2023 applicants, there was a small overall increase in the number of unique U.S. MD senior applicants in OB/GYN and emergency medicine in the 2023-2024 residency application cycle. Nonetheless, the numbers of unique applicants for both OB/GYN and emergency medicine in 2024 were lower in states with complete abortion bans than in those without bans.  

Similar to the trend seen for all residency applicants, the decrease in unique U.S. MD senior OB/GYN applicants year over year was largest in states with complete bans (-6.7%) while states without restrictions saw a small increase in unique applicants (0.4%) (Figure 2).  

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Unique residency applicants are a potentially early and more sensitive indicator of physician interest than other available indicators because the desire to match into a specialty of choice is likely greater than the desire to avoid training in states with major restrictions on reproductive health care. Put simply, applicants are likely to want to match somewhere — even the least desirable location — rather than nowhere. The examination of two years of data suggests that restrictions on women’s health care may continue to disproportionately decrease the likelihood that U.S. MD seniors will apply for residencies in states with the most restrictive practice environments. 

As noted previously, the decline in residency program applications submitted by U.S. MD senior applicants dropped substantially following more than five years of growth. This decrease has been an intentional goal of both the AAMC ERAS® program as well as individual specialties; multiple specialties have worked with the centralized application service to reduce the number of applications submitted by applicants though signaling and other approaches.3   

Despite these changes, nearly all residency positions in OB/GYN were filled again this year, and a similar number of U.S. MD seniors matched into first-year positions this year and last year.4 Residency positions for most large specialties also filled at rates similar to previous years. Across all applicant types (MD, DO, and IMG) in 2024, the number of unique OB/GYN applicants increased slightly from 2023; DOs saw a considerable increase in unique applicants, while IMGs applying to OB/GYN programs decreased across state groupings (Figure 3). 

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The implications of fewer applicants across specialties applying to programs in states with abortion bans has been discussed extensively since June 2022.5 6 7 8 9 Nationally, the total number of MD, DO, and IMG residency applicants continues to exceed the number of training slots available; residency programs in states with complete abortion bans continue to fill their residency positions. However, this additional year of findings suggests that the continued decreased interest of U.S. MD seniors in training in states with abortion bans or restrictions may negatively affect access to care in those states; any impact will likely first affect communities who already have limited access to care (such as rural, lower socioeconomic, and marginalized racial and ethnic groups).  

It is important to note that these analyses allow us to follow the trends in residency applications but do not provide definitive information about U.S. MD seniors’ motivations and reasons for applying to specific programs. Forthcoming analyses of data from the AAMC’s Graduation Questionnaire will include questions related to graduates’ views on reproductive health laws in states.  

These findings suggest that residency programs and states will need to collect more data about their trainees and licensees to better understand how state abortion bans may be affecting their ability to attract qualified trainees and physicians in the future. 

Methods  

All analyses were conducted using ERAS® data from 2019 to 2024. This snapshot examines the changes in the number of individual applicants across application cycles and abortion-ban status; data at the application level were not examined for this analysis. The data are a subset of applicant data as of March 1 each year. The sample population was U.S. MD senior applicants in Figures 1 and 2, and Table 1, and they exclude applicants who attended Canadian medical schools, IMGs, and DOs.  

State abortion-ban status is from KFF as of April 1, 2024. States with abortion bans are Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, Oklahoma, South Dakota, Tennessee, Texas, and West Virginia. States with gestational limits are Arizona, Florida, Georgia, Iowa, Kansas, Nebraska, North Carolina, Ohio, South Carolina, Utah, and Wisconsin. States where abortion is legal are Alaska, California, Colorado, Connecticut, Delaware, District of Columbia, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, Oregon, Pennsylvania, Rhode Island, Vermont, Virginia, Washington, and Wyoming.