Changes by State in Ob/Gyn Workforce Post Dobbs

A look at healthcare workforce patterns in states where abortion access is either banned or restricted following the Dobbs decision, which ended federal abortion rights, found evidence of an exodus of women’s health providers. 

“[The] findings provide early confirmation of reports that clinicians have migrated from states most impacted by the Dobbs decision,” Jane M. Zhu, a researcher at Oregon Health & Science University, Portland, Oregon, and her co-authors wrote in the research letter published online in JAMA Internal Medicine. 

Previous studies of any post-Dobbs drain on women’s care in certain states have been either anecdotal or survey-based, the authors wrote, whereas theirs is empirical. Reasons for migrations away from restrictive states are thought to be due to possible legal ramifications for giving the full range of care to patients and the moral injury to clinicians as a result.

The study examined clinician labor supply in 12 states where the strictest abortion laws nationally were enacted after the Dobbs decision. Controls in the study were the 14 states with existing abortion legislation that was unchanged post Dobbs. Indiana was excluded because its laws only recently changed, in 2024. 

State-level ob/gyn workforce rates were derived from the National Plan and Provider Enumeration System for years 2018 through 2024 and were set against every 100,000 reproductive-aged females (age 15-49 years) in the state, as determined by the American Community Survey for years 2017-2021. The total number of women’s health practitioners per 100,000 reproductive-aged females in each state was the primary outcome.

The authors found that pre-Dobbs, the supply patterns of women’s health specialists were similar in the 12 most restrictive and 14 control states. Practitioner supply increased overall across all 26 states post Dobbs, yet compared with the control group, the most restrictive states had a 4.2% decrease in practitioners per 100,000 reproductive-aged females (-3.0%; 95% CI, -5.9% to -0.2%; P =.04), a statistically significant decrease.

“While clinicians leaving states with abortion bans will reduce access to care, abortion bans create barriers to a range of reproductive health services needed by many Americans, by dictating the care that can be provided.” Maria Rodriguez, a co-author on the study, told Medscape Medical News. Rodriguez directs The Ohio State University’s Center for Women’s Health in Columbus.

Jonas Swartz, MD, MPH, an ob/gyn who practices across state lines in North Carolina and Virginia, told Medscape Medical News that, while abortion is not banned in either state, some of his patients in North Carolina, where it is tightly restricted, must cross the state line to Virginia to receive the care they need.

“ North Carolina implemented a 12-week abortion ban in 2023, so it changed the breadth of care that we were able to provide for patients,” Swartz said. “When I’m in Virginia, every single time, I see patients who have come for care, but are from North Carolina. Sometimes I see patients there who need to get care in a hospital setting, so it does remarkably disrupt practice.” 

Some of the states that have imposed bans or restrictions since the Dobbs decision are historically among the worst for maternal-fetal outcomes nationally. Between 2018 and 2021, Texas, Tennessee, and Florida had the highest maternal mortality rates pre-Dobbs. After Dobbs, these states also became among those with the strictest abortion laws. 

It begs the question whether an exodus of providers in these states could make the situation for women there worse, since women’s health outcomes were already failing, even before adding stricter abortion controls. 

“We know that there are some states that already have lower numbers of women’s health specialists, so losing some of them could make a huge difference in terms of access to maternal health, abortion, care, and other services that ob/gyns provide,” Julia Strasser, PhD, told Medscape Medical News. 

Strasser is an assistant research professor at the Fitzhugh Mullan Institute for Health Workforce Equity and is the director of the Jacobs Institute of Women’s Health, both at George Washington University, Washington, DC. Strasser was not involved in Zhu et al’s study.

Strasser is the lead author of a similar study published in December 2024 that contradicts the one in JAMA Internal Medicine. Strasser et al found that, in the 2 years post-Dobbs, the ruling did not have a significant impact on workforce levels across the states. 

This is not alarming, according to Strasser, who noted that the two studies were based on different administrative data sets, neither of which allowed for follow-up questions to establish a context for the decisions the people made to move to another state.

“State level movement is unusual,” Strasser said. “Most of the workforce stays where it is most of the time so we’re trying to find an unusual thing,” Strasser said. She added that it’s also difficult to empirically measure the reasons why physicians move or stay in a place, noting, “It could be for any number of reasons.”

“Past research has found that a complex constellation of factors drives physician movement, including state licensure, job availability, income, spousal job opportunities, and social support,” Strasser et al wrote in their study.

While Rodriguez said that, “The ob/gyns leaving states with abortion restrictions is a late-stage effect of these policy changes,” Swartz said the gravity of having to make the decision over whether to stay or go is not an automatic one. 

“My perspective has changed now,” Swartz said. “I used to be like, ‘Well, why would anyone ever stay in Texas? That seems like a horrible place to practice.’ But after our abortion restrictions happened in North Carolina, I really understood that this is a community that I’m committed to and in Texas, those are the communities they are committed to. It’s where their families are established and that’s where their practice is. If everyone leaves, what are we going to do for our patients?”

Zhu, Rodriguez, Swartz, and Strasser had no conflicts of interest.

Whitney McKnight is a freelance medical writer based in the Lexington, Kentucky, metro area.