Will abortion restrictions impact Utah’s health care workforce?

University of Utah researchers found that OB-GYN residents who previously intended to work in states that implemented abortion bans following the Dobbs decision were more likely to change their plans.

As abortion policies in the U.S. become increasingly patchworked after the U.S. Supreme Court handed the ability to decide restrictions — and protections — to states, new OB-GYNs are making career decisions based on states’ reproductive laws, new research from the University of Utah found.

Of the more than 300 OB-GYN residents who responded to a survey constructed by complex family planning fellow Alex Woodcock, nearly one in five said they had altered their intended practice state following the Dobbs decision, and those who initially planned to practice in states that restricted abortion were eight times as likely to have decided to work somewhere else.

Woodcock’s findings were published in the journal Obstetrics & Gynecology last week.

Abortion remains legal up to 18 weeks in Utah, which is classified as “restrictive” by the Guttmacher Institute — meaning it has multiple restrictions and a later gestational age ban. Woodcock used the institute’s classifications of state abortion policies in analyzing survey responses.

A quarter of OB-GYN residents who were planning to practice in states labeled “restrictive” changed their minds, according to the paper. But Utah also has a trigger law held up in court, which, if enacted, would move the state to the “most restrictive” category, under which nearly 40% of residents sought a new state for work.

(Francisco Kjolseth | The Salt Lake Tribune) Alex Woodcock, an OB-GYN fellow at the University of Utah, poses for a portrait on Monday Sept. 25, 2023. Woodcock is publishing a paper in an academic journal on future plans of the most recent graduating class of OB-GYN residents nationally after the Dobbs decision.

The OB-GYN residency program at the University of Utah — the only one in the state — has already had to work harder to recruit, Woodcock said. And if the trigger law were to go into effect, Utah could hemorrhage reproductive medical workers, upending women’s health care in the state.

“The fewer qualified OB-GYNs, and whatever specialty we have, we’re going to get greater wait times to see specialists, then in turn, perhaps greater morbidity and mortality for females,” Woodcock said. “So I think one is just going to follow the other.”

Doctors in the OB-GYN field care for parents and fetuses during pregnancy and through delivery, offer guidance in creating birth control plans, and treat a variety of health conditions related to menstruation and women’s reproductive organs.

[The story continues below these graphics.]

As part of an optional open-ended question, Woodcock asked OB-GYN residents: Please describe how the Dobbs v. Jackson Women’s Health Organization decision impacted your professional plans.

Approximately half of residents who responded said they were unwilling to live in a state with restrictions, and a quarter of those applying to fellowship programs, like Woodcock’s, reported that they either ranked programs in restrictive states lower or didn’t consider them at all.

Here’s how some of the unnamed residents responded to optional open-ended questions in Woodcock’s research:

Don’t want to live in an abortion-restrictive state

Number of responses: 90

“First, despite my convictions that states that restrict abortion still need fierce advocates to fight for pregnant people, I don’t have enough fight left in me to stay in a state that does not support my work as a physician. I cannot see myself ever moving back to a state that restricts abortions as extensively as [abortion-restricted state] does. Additionally, it has motivated me to continue to provide abortions throughout my career, even as I pursue fellowship in something else. I need to keep contributing to this important work, even as I leave a place in such great need.”

Didn’t rank —or ranked lower — fellowships in states with restrictions

Number of responses: 36

“Years prior to Dobbs, I knew I wanted to be a gynecologist. I was applying and interviewing to fellowships right after the Dobbs decision. The Dobbs decision impacted which interviews I accepted and how I ranked programs because I knew I did not want to practice in a state with abortion restrictions. I did not want to have the additional abortion restrictions on top of all the difficulties of taking care of patients (e.g. young pregnant patient with cervical cancer). Women’s healthcare is challenging and frustrating as is, and I think my burnout would become unbearable if I were not able to provide the care that my patient wants.”

Concerned about personal or partner health in restrictive states

Number of responses: 14

“My immediate professional plans have not been affected in any way as I intended to remain in [an abortion-protective state] for fellowship training and early attending years. However, it has definitely affected where I will seek to settle my family as part of my 5-10-year plan. I will choose to establish my personal and professional life in a state with more liberal laws re: reproductive health for patients.”

Lamented not being able to work in their home state

Number of responses: 14

“I will be a first-year family planning fellow next year. As someone who wants to provide abortion care in the Southeast and having my community and family support in the Southeast, the Dobbs v. JWHO [Jackson Women’s Health Organization] decision had a major impact on where I sought fellowship, and I think will have a big impact on my early career. I want to advocate for abortion care in more hostile environments, however, I want to gain experience and expertise in the field first. I worry that I can only do that in the first years of my career if I practice in a state that protects abortion care to later gestational ages.”

More motivated to advocate for abortion access

Number of responses: 35

“I did not originally plan to stay in the same state as my residency for work. There are other reasons for me to do so as well, but part of the decision was made based on my perception of the need for strong advocacy in my future state of practice. It is the most vulnerable state in the local region with regard to abortion protections and statewide advocacy is needed. The Dobbs decision and resulting legal restrictions make me not want to practice in a state where I could potentially be criminalized for doing what I think is medically appropriate.”

More motivated to provide abortions

Number of responses: 47

“It has encouraged me even more to be able to provide abortion care for my patients. I chose my future practice/hospital because of its ability for me to provide abortion care on a daily basis.”

Read the full paper here.