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Abortion restrictions may be pushing new doctors to train in more liberal states

Sophia Landay applied to 75 different OB/GYN residency programs throughout the country. But not one was in a state with a strict abortion ban.Suzanne Kreiter/Globe Staff

As she prepared to graduate from medical school this year, Sophia Landay applied to 75 different OB/GYN residency programs throughout the country. Not one was in a state with a strict abortion ban.

And all of the 15 or so other prospective OB/GYNs in her class at UMass Chan Medical School matched in a state that was friendly to abortion, she said, with many telling Landay that it was an important part of their training.

As states around the country pursue divergent paths on abortion after the Supreme Court overturned Roe v. Wade a year ago, the medical community is bracing for shifts in where doctors — especially obstetrician-gynecologists — choose to train and work.

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Recent application data and anecdotal evidence suggest that newly minted doctors prefer to serve their residencies in states that are more permissive of abortion, so they can be trained in the procedure and related care. Because doctors tend to settle down near the place where they trained, states with abortion restrictions could face a severe shortage of maternal health providers in the years to come.

But for liberal states like Massachusetts, the change may further deepen the already abundant pool of medical talent, as residency programs see increases in the number and quality of applicants, and doctors working in restrictive states start to consider relocating.

Early data from the residency application process shows the degree of the shifts.

According to research published in April by the Association of American Medical Colleges’ Research and Action Institute, states with abortion bans saw a 10.5 percent drop in OB/GYN residency applications compared with the previous year. That was steeper than the 5.2 percent decline nationwide in the 2022-2023 application cycle.

Some programs in Massachusetts have already seen an increase in candidates. Total OB/GYN residency applications to Tufts Medical Center rose to more than 1,250 last year from about 1,000 in 2020 and 2021, a spokesperson said.

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Applications also rose for a fellowship in maternal-fetal medicine — an advanced post-residency training opportunity — from 80 or 90 in previous years to more than 100 this year, said Dr. Erika Werner, chair of obstetrics and gynecology at Tufts.

“It’s a position where you are learning to identify birth defects and offer people options about what they want to do,” Werner said. “Our counseling includes termination discussions in the second trimester.”

Dr. Luu Ireland, an obstetrician-gynecologist at UMass Memorial Medical Center, said she has seen the medical students she mentors “cross places for residency training off the list” because of abortion restrictions in certain states.

OB/GYN residency programs must make abortion training available to be accredited. And OB/GYNs must be trained in managing complications of early pregnancy, which could include abortion, to be board certified.

Yet a 2018 study found that only 64 percent of OB/GYN residency program directors reported routinely training their residents in abortion care. Some outsourced training to other states and institutions to meet requirements.

Nearly one-fifth of all OB/GYN residency programs are in states with the most restrictive abortion bans in the country, and dozens more programs fall in states with more modest restrictions, according to data collected from OB/GYN training organization the Ryan Program.

While some programs in abortion-restricted states are working to address barriers to abortion training, the increased proscriptions will inevitably reduce training in what medical experts consider a foundational part of OB/GYN education.

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“The same procedure is performed if a person has a miscarriage or abortion,” said Dr. Tara Kumaraswami, associate professor of obstetrics and gynecology at UMass Chan Medical School. “It’s a medical treatment. By reducing the training and access residents have, their numbers will go down in those restricted states.”

Limits in other states will mean more medical trainees are likely to come to Massachusetts to learn about abortion, but that, too, has a cost. Beth Israel Deaconess Medical Center this year began hosting residents from out of state to train in abortion, displacing general medical students who would have otherwise been exposed to such training in family planning.

“If you’re going into family practice or emergency medicine, all those people should be able to diagnose miscarriage and know the medical management,” said Dr. Celeste Royce, assistant professor of obstetrics and gynecology at Harvard Medical School and director of undergraduate medical education in the Department of OB/GYN at BIDMC. “If they aren’t exposed to it as medical students, they might not get it later on. It’s decreased capacity for learning for physicians of all stripes.”

While more medical residents are coming to states with liberal abortion regulations, there’s no evidence that established physicians are doing so in large numbers, at least not yet. Werner, of Tufts, said the Supreme Court decision is “making it very easy to recruit physicians. I was just talking to a candidate yesterday who’s leaving Georgia and looking for a job in Massachusetts. We are seeing more physicians considering job moves to states like Massachusetts.”

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Dr. Alireza Shamshirsaz left Houston last year to accept a job as director of the Maternal Fetal Care Center at Boston Children’s Hospital. The restrictions on care in Texas were among several factors in his decision, said Shamshirsaz, who was speaking for the Society for Maternal Fetal Medicine and the American College of Obstetricians and Gynecologists, not the hospital.

Shamshirsaz, who specializes in fetal surgery, sometimes treats twin pregnancies in which one twin has a defect that it cannot survive. To protect the healthy twin, parents often choose to abort the one who can’t survive. “I call that surgery life-saving,” he said. “You do it to give the best chance for the healthy baby to grow.”

But it’s not allowed in Texas.

Dr. Jillian A. Dodge decided to relocate from Texas to a place “where I wasn’t going to have to fight so hard to do what I felt was the right thing for my patients.”Craig F. Walker/Globe Staff

Dr. Jillian A. Dodge, an obstetrician-gynecologist, moved to Massachusetts from Ohio in July 2022. Ohio doesn’t have an extremely strict abortion ban — the procedure is allowed until 22 weeks of gestation — but other restrictions are in place, such as requiring patients to undergo in-person counseling 24 hours before the abortion.

The big difference, Dodge said, is cultural.

She was shocked to discover that many doctors in her group could not provide best-practice miscarriage care because they had never gone through the training and paperwork needed to prescribe mifepristone, one of two drugs used in medication abortions — but also in treating miscarriages.

A patient scheduled for a 7:30 a.m. abortion had to wait till 5 p.m., Dodge said, because the morning anesthesia team refused to participate. Dodge found she had to push hard to acquire simple devices and instruments routinely used in abortion and miscarriage care.

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Dodge decided to relocate to a place “where I wasn’t going to have to fight so hard to do what I felt was the right thing for my patients.”

That proved to be BayState Health in Springfield. As soon as she arrived, she felt the “mind-boggling” difference. Abortion was seen as health care.

In her first week on the job, Dodge counseled a patient who initially sought an abortion but then changed her mind at the last minute.

“I was so happy she could feel supported to seek the abortion and supported to change her mind,” Dodge said. She felt confident the patient’s decision to continue the pregnancy was her own choice, “and not because someone who disagreed with her decision made her feel bad or unsafe.”

Landay, the former UMass medical student who is now an OB/GYN resident at Beth Israel Deaconess Medical Center, fears the reduced access to training may mean the overall number of abortion providers nationwide may decrease.

Landay’s experience training under family planning providers is part of what inspired her to practice obstetrics and gynecology.

It also prompted her to help change the curriculum at the UMass Chan Medical School. Previously, training in abortion was offered in clinical settings to third- and fourth-year students, and only members of groups interested in those topics would typically seek out extra experiences and rotations. Now, all students are provided a one-hour lecture on contraception and abortion within the first two years of medical school.

“If medical students don’t get exposure to abortion education and training, there may be fewer people who are inspired to become abortion providers,” Landay said. “For me personally, that makes me more motivated to provide abortion care and advocate for access to abortion care. There may be fewer people who feel that way in the future, because it’s not the easiest path to take.”


Jessica Bartlett can be reached at jessica.bartlett@globe.com. Follow her @ByJessBartlett. Felice J. Freyer can be reached at felice.freyer@globe.com. Follow her @felicejfreyer.