Despite Abortion Restrictions, Ob/Gyn Remains Competitive Residency

Ob/gyn residency remained a competitive specialty in this year's Match, despite the tumultuous landscape for reproductive healthcare following last year's Supreme Court decision that resulted in a patchwork of abortion access.

Applications to ob/gyn were indeed down slightly, to 2,100 people -- a 3% decrease from the 2,161 applicants the year prior, according to data from the National Resident Matching Program (NRMP). But only three of the 1,503 available positions went unfilled in the Match, and were quickly claimed in the Supplemental Offer and Acceptance Program (SOAP), according to Bryan Carmody, MD, of Eastern Virginia Medical School in Norfolk, who actively shares Match data and analysis online.

"Ob/gyn has been a highly competitive specialty for the past several years. The vast majority of applicants simply aren't in a position to rule out half of the programs in the country -- unless they're willing to choose a different career path," Carmody told MedPage Today.

While the majority of ob/gyn applicants would prefer to practice in states that have abortion access -- a preference cited by 82.3% of respondents in a recent survey published in the Journal of General Internal Medicine -- they "don't really have the ability to vote with their feet," Carmody said.

Morgan Levy, a medical student in the MD/MPH program at the University of Miami Miller School of Medicine and a co-author of the survey, said personal preference isn't everything in the match process.

"I think there's also a more nuanced conversation about the fact that there are many trainees who recognize the fact that there are going to be challenges practicing in these areas," Levy told MedPage Today. "However, it is still extremely, extremely important to make sure that people in every state have access to good healthcare."

Despite the slight dip in applications nationally, applications to some ob/gyn programs in states with abortion protections rose.

Ian Fields, MD, ob/gyn residency program director for the Oregon Health & Science University (OHSU) School of Medicine in Portland, said residency applications to OHSU, which benefits from Oregon state abortion protections, increased by 15%.

He said he expects to see higher numbers of applications in states without abortion restrictions in the coming years.

OHSU rolled out a program to offer training for residents in states with abortion restrictions. Guest residents will come to OHSU for 2 to 4 weeks for training in abortion care and complex family planning. The program hosted its first resident in late 2022.

"It's a refreshing perspective to be in a place with no judgment and such strong support around this type of health care," the resident said in a press release.

Fields said OHSU plans to have a full slate of 12 to 14 visiting trainees this year. The program is free to residents due to OHSU's fundraising efforts.

"Right now, we're just trying to sort of fill an urgent need," Fields said. "I think the next step is coordination of that and working together to figure out some type of national program."

Fields noted that it's already the case nationally that residents can opt out of performing surgical and medical abortions for religious or moral reasons, according to the American College of Obstetricians and Gynecologists (ACOG). However, they still must train in abortion aftercare.

"It's a requirement for every program, regardless of whether you're in a restrictive state, to provide clinical and didactic experience in complex family planning," Fields said. "Residents still have to learn how to counsel patients about medical and surgical abortion, they have to be able to discuss and get education on contraception, and they have to be able to manage the complications of abortion care."

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