Is Louisiana’s abortion ban costing the state future doctors? New data shed light. (2024)

Hannah Doran never wanted to leave New Orleans.

The 33-year-old physician stuck close to home for college and started a family in Mid-City, the same neighborhood where she grew up. When she applied to medical school, she sent in just one application— to LSU Health New Orleans.

But when it came timeto apply for an OB-GYN residency, Louisiana wasn’t even a consideration.

“I knew that if I stayed here, there's no way I was going to be able to meet the standard of ethics that I aspire to,” said Doran. “I didn't want that added stress of being like, ‘Am I going to have to risk my license or go to jail just to follow my conscience?'"

Doran is part of a growing number of doctors on the front lines of women's health care who are factoring state abortion laws into their decisions about where to learn and practice medicine. According to a May analysis from the Association of American Medical Colleges, Louisiana and other states with abortion bans show a drop in residency applicants in comparison to states where abortion is less restricted.

For residents who do choose Louisiana programs, the required training in abortion and miscarriage care takes them thousands of miles away for a short rotation with limited clinical experience.

Applicants drop

Over 100 fewer people applied for OB-GYN residencies in Louisiana in the 2023-2024 cycle, according to the AAMC analysis, a drop of nearly 18%.

Overall, residency applicants in all specialties decreased in Louisiana by 1,229, almost 15% from the prior year.

Although AAMC has encouraged medical students to be more targeted with applications, leading to a nationwide decrease, Louisiana’s drop in applicants is more significant. When grouped with other states that have abortion bans, the numbers show that the ability to practice the full scope of reproductive care may be influencing where residents train.

The number of applicants in states with near-total bans decreased by 4.2%, compared with a 0.6% drop in states where abortion is legal.

“People seem to be disproportionately decreasing their likelihood of applying to programs in Louisiana,” said Dr. Atul Grover, executive director of the AAMC’s Research and Action Institute. “We think that at least part of that is due to some of the restrictive laws around reproductive health care.”

In Louisiana, abortion is banned except to save the life of the mother or in the case of some fetal anomalies. Doctors, hospitals and patients have struggled to interpret the law. And that's a challenge many new doctors don't want to face while they’re trying to learn how to practice as an OB-GYN.

“You really have to be in peril for someone to get a medically indicated abortion, and that line of peril is very gray,” said Doran. “How almost dead do you have to be for me to provide this service to you?”

Louisiana’s five residency programs filled all of theirOB-GYN spots, according to AAMC data. But fewer applicants means programs had a smaller pool of new doctors to select from.

“They may have to take candidates that are less of a fit for their particular programs,” said Grover.

Louisiana Right to Life, an anti-abortion group that has pushed for limited access to abortion, said data in the study, which spanned the two years before and after Roe v. Wade fell, was too limited to draw conclusions. The group also noted that applicants decreased in other specialties, such as pediatrics and internal medicine.

"The percentage decrease in these specialties certainly cannot be directly linked with Louisiana's pro-life laws," said communications director Sarah Zagorski in an emailed statement.

Zagorski also said individual states with access to abortion, such as Massachusetts and California, also saw drops in OB-GYN applicants.

"The challenges are present across the country, whether in pro-life or pro-abortion states," said Zagorski in the statement.

Grover, the analysis author, acknowledged that the data is limited with only two years since the bans were instated.

"What you've got is a correlation, and I can't prove causation," said Grover. "Now, when you talk to medical students, they will certainly tell you this is a factor."

'Lost generation of providers'

Abortion training is a requirement for OB-GYN residency by the Accreditation Council for Graduate Medical Education, the accrediting body for medical training programs.

Prior to the ban, Louisiana residents mostly traveled to Shreveport’s Hope Medical Group for Women for abortion training, learning the same procedure used for miscarriages.

Now, LSU residents travel thousands of miles for a two-week rotation.

Residents at other programs in Louisiana can apply to out-of-state family planning rotations. But there are obstacles.

“They immediately have to learn a new medical record, learn a new hospital, learn new faculty and new colleague residents,"said Dr. Stacey Holman, associate professor of obstetrics and gynecology at LSU Health New Orleans.

Oregon Health & Science University’s Center for Women’s Health received three applications for their out-of-state rotation from Louisiana residents this year. Two will get training there during a four-week rotation in the coming year, said Dr. Alyssa Colwill, who leads the Ryan Residency Program at OHSU.

But their home programs may not provide them with a salary while they're away. And they have to get licensed in another state.

Over time, those barriers will lead to fewer Louisiana doctors with experience in miscarriages and treatment when an abortion is medically necessary, said Colwill.

“We’re further limiting the number of people that have all of the tools available to them to take care of patients in the safest way,” said Colwill. “I absolutely worry about having a lost generation of providers in the future.”

All four of LSU's graduating OB-GYN senior residents are leaving for other states, said Holman, a trend she has seen in other state programs.

Missing training

During a four-day training as a medical resident at Shreveport’s clinic in 2022, Dr. Lule Rault didn’t ask patients why they were getting an abortion. But the stories poured out anyway.

She saw pregnant teenagers who were getting their first-ever pelvic exam. There were people whose partners refused to wear condoms, or who said they wanted to have a family, then ghosted. One patient said a long-term partner lied about having a vasectomy.

“That one just really hurt me,” said Rault, then a fourth-year OB-GYN resident in New Orleans. “There’s so much reproductive coercion.”

By the time she finished her residency, Rault had been in New Orleans for eight years. She grew close to the patient population and put down her own roots. But she didn’t feel like she knew enough from her limited training, even before the abortion ban. To understand how to provide care for patients, including those who miscarry after 13 weeks, she had to leave.

For current residents who don't get more training, what they see in the hospital for miscarriages isn't enough to be skilled in the procedure.

“With the volume that they have, it's not nearly high enough to get adequate training,” said Rault, now completing a complex family planning fellowship on the West Coast. “None of them are going to graduate being able to do abortion procedures after the first trimester.”

Abortion opponents have said that doctors can still practice within the scope of the law. And in the past,Gov. Jeff Landry has said that people who don't like Louisiana's ban can move.

Doran never thought that would be her.

Last week she packed up and drove to Cleveland, where she will be an OB-GYN resident at MetroHealth Case Western Reserve University for the next four years.

She cried inside the century-old fixer-upper they purchased in Ohio, thinking about her hometown. It’s where her dream of becoming a doctor sprouted as she bartended and waited tables in her 20s, learning to listen to people. It’s where four complex pregnancies and a stillbirth moved her to pursue a specialty in obstetrics and gynecology.

“I went to medical school because I want to take care of my people, my community,” said Doran. “If I never go back it’s not because my heart isn’t there. It will be because I can’t.”