No, OBGYNs are not systematically fleeing states that banned abortion

The Hill

2 days ago

The Supreme Court's 2022 Dobbs decision ended decades of national judicial precedent protecting legal abortion.
As of today, 12 states enforce bans on nearly all abortions, and seven states are enforcing bans on abortions after six, 12 or 18 weeks' gestation. Also, numerous lawsuits have been filed attempting to restrict abortion access in states where it is still legal.
Although obstetricians and gynecologists have always had to operate under the risk of malpractice lawsuits, state-level abortion bans added a new layer of legal risk to delivering established standards of care.
In this climate, surveys have revealed evidence of obstetrician-gynecologist in states that have banned abortion feeling constrained or afraid. Reports and studies have documented a decline in OBGYN residency applications to programs located in those states. And numerous media outlets have run stories suggesting that OBGYNs are leaving states with abortion bans to practice where abortion is still legal.
Since obstetrician-gynecologist provide many different kinds of care — including contraceptive, delivery and postpartum care — these stories have raised serious concerns about the availability of all forms of reproductive health care throughout much of the country.
But in research just published in JAMA Network Open, we and our co-authors find no evidence of such an exodus of obstetrician-gynecologist physicians from states with abortion bans.
Using administrative records managed by the Centers for Medicare and Medicaid Services on all physicians who bill insurance, we looked at the movement of obstetrician-gynecologists between states with different abortion policy environments from just before the Dobbs decision to two years after. Out of all obstetrician-gynecologist who were practicing at the start of 2022 in states with abortion bans, 94.2 percent were still practicing in September 2024. This percentage is statistically indistinguishable from the 94.8 percent of obstetrician-gynecologists who have remained in states where abortion is threatened and the 95.8 percent who have remained in states where it is protected.
OBGYNs also continued to move into states with abortion bans at similar rates to other states. From the start of 2018 to the end of 2024, the total number grew by 8.3 percent in states with abortion bans, by 10.5 percent in states where it is threatened and by 7.7 percent in states where it is protected. Trends in the number of practicing obstetrician-gynecologists were also comparable to those in the number of physicians in other specialties in states where abortion is banned.
We also considered trends in the practice locations of recent residency graduates and subspecialists in maternal-fetal medicine, as well as trends in the share of OBGYNs who are female and who are licensed to practice in more than one state. All were similar between states, regardless of abortion's legality.
Our findings are not unique. In December 2024, an independent group of researchers using a different data set came to the exact same conclusions. And in March, researchers showed that the number of obstetrician-gynecologists in states with bans has increased since Dobbs, though perhaps at a slower rate than in a group of states with mixed status.
So why has a narrative that obstetricians are leaving and avoiding states with abortion bans become so prominent? A closer look at the media coverage reveals that different reporters have interviewed the same small handful of 15 or so physicians who left states with bans. Those interviews, coupled with survey evidence on the strain physicians are facing, have led to conclusions that doctors are fleeing states with bans. But it just isn't true.
Evidence on trends in residency applications also needs additional context. While states with bans have seen larger declines in obstetrician-gynecologist residency applications than states without bans, nearly all such positions continue to be filled at pre-Dobbs levels. Broader doctor shortage issues that predate the Dobbs decision, including those leading to closures of hospital labor and delivery departments, have been conflated with the effects of the Supreme Court ruling as well.
We pursued this research because it is crucial to understand all of the facts to make progress on the availability and quality of reproductive health care. Focusing on a physician exodus that is not actually happening distracts us from addressing the real, plentiful problems with the delivery of medical care. Our findings imply that while removing abortion bans would likely improve the quality of care that obstetricians can provide by giving them the ability to follow established standards of care, it is unlikely to shift the economic and structural forces driving maternal ward closures and doctor shortages.
When it comes to the availability of care, those are the forces that deserve policy attention.
Our study is by no means the final word. Physicians feeling constrained by abortion bans may be 'sheltering in place' for now, with decisions of where to live and work shaped by other factors. The coming years could well see different trends.
But at this point, ensuring high-quality reproductive health care in states affected by abortion bans will require supporting the obstetricians who, at heightened personal risk, continue to provide essential care to the best of their ability.
Becky Staiger is an assistant professor in health policy and management in the School of Public Health at the University of California, Berkeley. Valentin Bolotnyy is a Kleinheinz Fellow at Stanford University's Hoover Institution.