No, Dobbs hasn’t caused “sweeping changes” in where doctors practice medicine
The Chronicle for Higher Education recently published “Medical Students Fought to Get Training in Abortion Care. Then Came ‘Dobbs.'” Author Heidi Landecker paints a grim picture of medical students who just want to practice “ethical medicine” (perform abortions), but struggle to get training in states that have been able to restrict elective abortion since Dobbs. She suggests this barrier is causing physicians and medical students to avoid studying or practicing in pro-life states, in large enough numbers to exacerbate access to healthcare for those states’ residents.
These suggestions are inaccurate. Here’s a quick video as to why, but if you’d like more details (and links to citations) scroll below.
Has Dobbs resulted in more limits on abortion training?
Defining “abortion training”
Landecker hints at what she means by “abortion training” in the first paragraph.
Procedural abortion, used later in pregnancy in the case of, for example, a fatal fetal diagnosis, or when a woman’s health — or life* — is in danger, wasn’t taught at all.
Heidi Landecker
She’s not describing life-saving procedures or medications in early pregnancy, which are taught in residency programs in every state and affirmed by pro-choice and pro-life OBGYNs alike. She’s also not describing post-viability preterm induction of labor or emergency c-sections, which would be used to protect a mother’s life later in pregnancy.
Instead, Landecker focuses on what she’s calling “procedural abortion” later in pregnancy, which will be either D&E (dismemberment abortion) or induced fetal demise (typically by injecting a feticide into the heart) followed by induction of labor. In later pregnancy, either of these methods will be a 2-3 day process, with the first day or two spent dilating the woman’s cervix before the “extraction” on the final day. These are not processes done in medical emergencies, when induction of live birth or emergency c-section would be far faster.
These procedures are also not only done for fatal fetal diagnosis, as Landecker (and so many before her) suggests. Later abortions are regularly performed on healthy fetuses carried by healthy women without medical emergency. The evidence abounds.
Whatever the reasons for performing “procedural abortions,” Landecker implies Dobbs has made it more difficult for interested medical students to get this training.
The relationship between Dobbs and abortion training
To substantiate her perspective, Landecker turns to Jody Steinauer, founder of Medical Students for Choice (in the early 1990s) and now director of the Bixby Center for Global Reproductive Health a major abortion advocacy group.** Steinauer offers the quote that echoes Landecker’s headline: “It’s like finally medicine saw abortion and complex contraception care as critical. And then Dobbs happened.”
Landecker doesn’t clarify the implied relationship between Dobbs and more limits on abortion training. For example, she doesn’t point to any medical schools that were offering abortion training before Dobbs and have since stopped.
Almost the opposite, she goes on to describe how abortion training has increased substantially in the last few decades: in 2013 about a third of medical schools didn’t offer formal abortion training, whereas today it’s down to about 10%. Since COVID there are also now virtual training options. In fact, paradoxically, Landecker argues, “Dobbs is changing education in abortion care, making it more pervasive, with more states paying for that teaching.”
Has Dobbs resulted in “sweeping changes” in where physicians practice medicine?
Landecker describes an “alarmingly” “sweeping change” in where people practice medicine. She bases these claims in part on several studies.
“A study last year … found that 82.3 percent of practicing physicians and doctors in training preferred to practice or study in states with access to abortion.”
The study Landecker references is Practice Location Preferences in Response to State Abortion Restrictions Among Physicians and Trainees on Social Media. The authors recruited a “non-probabilistic sample of physicians and trainees” from physician and student Facebook groups, Instagram stories on influential medical accounts, and Twitter hashtags #MedTwitter #MedStudentTwitter.
The authors acknowledge study limitations including “self-selection bias and a non-representative sample of U.S. physicians,” and explain “Our results may not generalize to physicians not using social media.” This is an understatement.
Compared to all physicians and trainees, those who use social media will likely be disproportionately younger and more left-leaning, both demographics that skew pro-choice. These sample selection problems apply even before the self-selection bias of who among such a group opts in to a survey about abortion access.
This limitation is reflected in the fact that 27% of survey respondents (560 of 2063) were current or future abortion providers. Consider OBGYNs are more likely than physicians generally to provide abortions, and consider Guttmacher found only 7% of OBGYNs provide abortions. A survey response with 3-4x as many abortion providers is a glaring disproportion.
“A study published in November found that the post-Dobbs ‘reduction in obstetrics and gynecology work force could significantly exacerbate maternity-care deserts.'”
Here Landecker references is Effects of the Dobbs v Jackson Women’s Health Organization Decision on Obstetrics and Gynecology Graduating Residents’ Practice Plans. The authors survey only residents graduating from residencies with Ryan Program abortion training programs (offering modules such as “An Introduction to Reproductive Justice”). The authors acknowledge “residents who elect to participate in the Ryan Program may be more likely to be invested in abortion care in their future careers.”
The study finds, unsurprisingly, that some of these residents prefer to live in states with lax abortion laws: not quite 1 out of 5 reported changing their intended practice location after Dobbs. The study’s authors interpret this result to mean pro-life states will see a significant reduction in the obstetrics and gynecology workforce.
“Alarmingly, last year the Association of American Medical Colleges found a drop of greater than 10 percent … in fourth-year med students’ applications for ob-gyn residencies in states with abortion bans.”
Landecker is referring to Training Location Preferences of U.S. Medical School Graduates Post Dobbs v. Jackson Women’s Health. Here is how Landecker describes the study results:
And alarmingly, last year the Association of American Medical Colleges found a drop of greater than 10 percent from the previous cycle in fourth-year med students’ applications for ob-gyn residencies in states with abortion bans. The year before that, the number of applications in that specialty went up.
Heidi Landecker
Landecker doesn’t mention that AAMC found that 2023 saw a drop in not only OBGYN applications, but all specialities, and not only in pro-life states, but in all states, regardless of abortion policy.
Here are more quotes from the AAMC findings:
- Given the small scale of changes in the number of applicants year to year, there was only a small effect observed in abortion-ban states from 2021-2022 to 2022-2023.
- All residency positions in OB/GYN were filled this year and with a similar number of U.S. MD seniors as last year.
- Most large specialties also filled at rates similar to previous years, with the exception of emergency medicine (which saw a significant decrease in the number of U.S. MD senior applicants nationwide).
- Nationally, the number of residency applicants continues to exceed the number of training slots available, so residency programs in states with complete abortion bans may continue to fill their residency programs.
In other words, if Dobbs had an effect on applications, it was a small variation in who was applying where, and didn’t actually decrease the number of OBGYN residency positions filled in any states.
Any word from doctors who don’t happen to be abortion activists?
Landecker’s article includes quotes from the current Executive Director, the Board President, and the President-Elect of Medical Students for Choice, as well as the deputy director of programs for Nurses for Sexual and Reproductive Health (which offers “the nation’s only hands-on abortion-training residency for registered nurses.”)
How does Landecker describe the perspectives of physicians and medical students who oppose abortion, or who at least aren’t specifically pro-choice activists?
She doesn’t. As far as we can tell from this article, they don’t exist.
*Here Landecker links to the infamous New Yorker article that implied a Texas mother died without access to abortion, mentioning only near the end of the lengthy piece that the mother had specified that, should there be an emergency, she wanted her unborn daughter’s life prioritized over her own.
**The Bixby Center’s website describes the organization as “one of the few research institutions to unflinchingly address abortion” and emphasizes the org’s work to expand the workforce of abortion providers, expand abortion access internationally, and create new methods of abortion.
