Abstract

Objectives: The 2022 Dobbs v Jackson Women’s Health Organization US Supreme Court decision dramatically shifted the legal landscape in health care, leaving state legislatures to redefine the ethics of medical practice. As gold-standard medical procedures become banned and criminalized, physicians are facing heightened legal uncertainty and grappling with moral dilemmas of where and how to practice. This study aimed to quantitatively assess trends in legal concern among medical students and identify correlations with decision making regarding future medical training.

Methods: To assess the impact of the Dobbs decision on trainees, a 24-item RedCAP survey was distributed to 72 medical schools assessing both geographic residency preferences and level of legal concern surrounding 10 abortion provision scenarios. Level of concern was assessed on a 3-point Likert scale from “not at all concerned” to “very concerned.” To observe overall trends, an average level of concern score was computed by assigning numeric values to responses and averaging the scores for each respondent.

Results: In total, 2298 medical students completed the survey and were included in the analysis. Students identifying with she/her pronouns and as Asian or studying in abortion-protected states had significantly higher levels of concern. Moreover, respondents located in abortion-restricted states with high levels of legal concern were more likely than their peers to indicate wanting to move to abortion-protected states for residency.

Conclusions: Individuals with heightened proximity to reproductive healthcare may face greater ethical and moral dilemmas as they seek future career opportunities in a post–Roe v Wade world. These data suggest that they seem highly responsive to moving out of abortion-restricted states, indicating that the Dobbs decision, and the legal landscape it has created, may further exacerbate disparities in reproductive health care.