One year after abortion law, fewer med students applying to become doctors in Nebraska

When it came time for Tyne Tyson to apply to residency programs, the aspiring OB-GYN’s thoughts drifted back to spring 2022, when she asked Nebraska lawmakers to scrap a bill seeking to ban abortion.

“The hostility for health care providers – it shocked me,” she said. “The lack of care towards women, towards our patients. And it just made me feel like, ‘How could I be a good doctor if I was living in a state where the government was against me taking care of my patients?’”

She applied to her home program at Creighton University School of Medicine, she said, but ranked it “very low.”

The Legislature ultimately passed a law banning abortion after 12 weeks of pregnancy, narrowly approving it in May 2023.

Since then, the state has seen a 12% drop in the number of graduating medical students who applied to Nebraska’s residency programs, according to data obtained by the Flatwater Free Press. And the number of people applying to OB-GYN programs here has plummeted, dropping 25% in the past year (from 253 applicants to 191) even as OB-GYN medical residency applicants ticked up slightly nationwide.

Whether the 12-week abortion law is affecting these drops in Nebraska isn’t clear. Medical schools list other factors, including a concerted effort to encourage students to submit fewer applications. And the governor noted that Nebraska’s leading health care center had no issue filling all of its residency openings.

Nearly every state experienced declines in residency applications.

Marion Miner, policy director with Nebraska Catholic Conference, pointed to several instances where states with a broad right to abortion had larger declines than states with restrictions.

“It seems pretty evident that there’s something else going on here,” Miner said in an email. “The laws don’t seem to be the issue.”

But students and doctors who spoke to the Flatwater Free Press said Nebraska’s more restrictive abortion law, which also restricted gender-affirming care for minors, has been a factor for some students.

“I think, in general, physicians across specialties … especially young physicians … do not want to practice in states where their ability to counsel patients and treat them as unique individuals is hindered by government interference,” said Elizabeth Constance, a reproductive endocrinologist and Nebraska Medical Association board member.

For the second year in a row, states with abortion bans or restrictions saw bigger decreases in applicants than states without, according to the AAMC Research and Action Institute.

In Nebraska, 487 fewer MD students applied in 2024 to the state’s medical residency programs – specialty-specific training for med school graduates – than did in 2023, an 11.6% drop. 

Pediatrics and OB-GYN programs saw starker declines, each falling by roughly 25%, according to Nebraska-specific specialty data the Flatwater Free Press requested from AAMC.

“It is likely that states with larger rural and/or underserved populations, and those that already have difficulties recruiting, will feel the impact of these restrictive health care laws the fastest,” said Kendal Orgera, who co-authored the analysis.

Nebraska’s 12% drop is similar to some other states, like Texas and Tennessee, where newly restrictive abortion laws went into effect after the U.S. Supreme Court overturned Roe v. Wade. But several states that didn’t pass restrictions saw sizable drops, too. Colorado saw a 10.6% drop. The biggest decrease was in New Mexico, at about 19%.

One likely factor in the broad decline in applications: An effort to encourage students to submit fewer of them. Students can now use a set number of “signals” to express interest in a particular program or region. Programs can consider those signals when offering interviews.

“Students are aiming for a critical number of interviews to assure that they match,” University of Nebraska Medical Center spokesman John Keenan said in an email. “If, through signaling, they can hit that number at places they really want to go, that will result in a drop in applications to the medical programs they are less interested in.”

In the 2024 cycle – the first that signaling was integrated into the application system for specialties and programs that opted in – there was an 8% decrease in the number of applications submitted per applicant, according to AAMC data. There were increases each of the previous four years.

A disproportionate number of medical schools are on the U.S. coasts, and it was already difficult to recruit those students to the Midwest, Keenan said. Noting that applications were down across the country, Keenan said UNMC can’t say whether Nebraska’s abortion law impacted applicants’ decisions.

“We have no way to track why someone did not apply to our program.”

Despite the drop in applications, UNMC continues to attract high-quality residents and fellows, and the college is in the process of increasing the number of those positions, he said.

Gov. Jim Pillen said there was more to the story than “cherry-picked statistics,” touting UNMC’s successes, including that more students applied to the medical school for the upcoming school year than last year – 2,073, compared to 1,912 the year prior, an 8.4% increase.

He and Keenan both said that all of UNMC’s residency and fellowship slots – more than 700 – were filled in the first round.

“Nebraska has many opportunities for those seeking meaningful careers in medicine, and clearly a growing number of prospective students want to come here,” Pillen said in a statement, adding that “Nebraskans support strong protections for life.” 

“We can create a culture of life and love and grow Nebraska at the same time.”

Taylor Miller, a spokesperson for CHI Health, said its 60-plus residency slots are also filled. The fields that saw the steepest declines in Nebraska – family medicine, pediatrics and OB-GYN – are on the lower end of the pay scale, Miller said.

“Medical school is expensive and many graduates are choosing to pursue higher paying specialties of medicine that will help them pay off their debt,” Miller said.

Based on two years of data showing that states with abortion restrictions are seeing bigger drops, Orgera said she believes those policies are negatively impacting the number of applicants.

Constance worries young physicians, who often stay and practice where they train, will start leaving Nebraska after finishing residency.

Any impacts of a decline in interest in states with abortion bans and restrictions will likely first hit communities where access to care is already limited, according to the AAMC analysis.

Roughly half of Nebraska’s 93 counties don’t have birthing facilities or maternity care providers, according to March of Dimes.

“The risk is worsening of the maternity care deserts in the state, and then not having physicians trained in performing procedures in emergent, life-saving situations,” Constance said.

Since restrictions passed in Nebraska, students have asked about the political climate and what happens if laws get more restrictive, according to Mary Kinyoun, an academic OB-GYN who recruits residents to Nebraska.

“Nothing’s promised when there’s this interference in what kind of health care we can provide within our specialty – it’s always something that’s in the back of our minds, and we’re worried,” Kinyoun said.

She suspects the law will more likely influence out-of-state students than those with strong ties to Nebraska.

Shaker Dukkipati, who graduated from UNMC’s MD/PhD program and is headed to a combined pediatrics residency and neurology fellowship at Columbia University, said he hasn’t heard of anyone who chose to apply or not apply to states because of abortion restrictions.

“This also did not personally affect my decision-making,” he said in an email. “This is not to say that this was not present, just that I am not specifically aware of these decisions.”

Hannah Manoj and Emma Poulas, both Nebraska natives and fourth-year medical students at UNMC, will be applying to residency this year. They plan to apply in Nebraska, despite both having concerns about the law.

Manoj hopes to go into a psychiatry program. She has researched training for transgender health care in psychiatry fellowship programs, and said she deeply cares about access to gender-affirming care.

“Part of me wants to stay and advocate and actively work against these laws, to advocate better for my patients and make sure they have access to these types of care in the future, even if it’s an uphill battle,” Manoj said.

But if she wasn’t from Nebraska, she noted, she likely wouldn’t make the same decision.

Poulas, who will apply to OB-GYN programs, said she has decided to avoid specific states with restrictions – but not her home state – in order to protect herself and provide the care she wants to provide.

“I don’t want to feel like I’m not able to get the training that I need, and also then be in a place where my patients aren’t being able to be taken care of safely,” she said.

In her training, she has seen firsthand the “devastating” conversations doctors have with patients impacted by the new law, including those who want to have a child. Nebraska’s still on her list, she said, because it’s her home and she has built relationships at UNMC.

She’s collecting signatures in hopes that Nebraskans will vote to enshrine the right to abortion up to the point of fetal viability in the state Constitution this fall.

“I do feel optimistic that things might change, if we give the opportunity to voters,” she said.

Tyson, who grew up in North Carolina, didn’t match with an OB-GYN program. She’s now an internal medicine resident in South Carolina, where a six-week ban is in effect. Long term, she said, she’s not sure she can stay in a state with those restrictions – both as a doctor, and as a woman who wants children someday.

“It’s really important to me to be a good doctor … We put a lot of ourselves into our career, we really want to do a good job,” she said.