Since the landmark U.S. Supreme Court decision in June 2022 that overturned the constitutional right to abortion, nationwide debates and policy shifts have dramatically reshaped the landscape of reproductive healthcare. The ruling, formalized in the case Dobbs v. Jackson Women’s Health Organization, prompted 14 states to ban nearly all abortions, while six others enacted gestational limits ranging between six to 12 weeks. This seismic shift was widely expected to provoke a mass exodus of obstetrician-gynecologist (OB-GYN) physicians from states imposing these restrictions. However, emerging data collected and analyzed by researchers at the University of California, Berkeley, unveil a more complex and unexpected reality.
Rebecca Staiger, an assistant professor of health policy and management at UC Berkeley’s School of Public Health, alongside her co-first author Val Bolotnyy, probed the tangible effects of the Dobbs decision on OB-GYNs’ practice locations. Their research team harnessed an extensive federal database containing administrative records of more than 60,000 practicing OB-GYNs across the United States. Contrary to dire media reports of a widespread professional exodus, their analysis demonstrates that the number of OB-GYNs in states enacting abortion bans has not diminished as anticipated. Instead, their findings reveal modest increases in these states, challenging prevailing narratives and prompting a reassessment of how physicians respond to legal constraints in reproductive health care.
Published in the prestigious journal JAMA Network Open on April 21, 2025, the study provides a comprehensive descriptive cohort analysis that spans two years after the decisive Dobbs ruling. By stratifying states according to their abortion policy environment—banned, threatened, or protected—the research group meticulously tracked the shifts in OB-GYN workforce distribution. Remarkably, states with abortion bans exhibited an 8.3% growth in OB-GYN numbers, while states with threatened abortion policies saw an even larger increase of 10.5%. In states maintaining protected abortion access, the workforce grew by 7.7%. The researchers emphasize that these variations do not indicate any statistically significant migration away from restrictive states. Instead, the data hint at a subtle but distinct trend where OB-GYN retention in threatened states might be higher than in protected ones, a counterintuitive outcome that defies simplistic assumptions.
The implications of these findings ripple across multiple dimensions of reproductive healthcare delivery and medical workforce dynamics. First, they challenge the dominant narrative fueled by anecdotal accounts and press reports depicting a professional flight from states that outlaw abortion. While it is conceivable that some individual physicians have chosen to relocate, such instances do not translate into a systemic reorganization of the OB-GYN workforce. This suggests powerful countervailing forces influencing physician retention, including established patient relationships, community ties, and the professional upheaval associated with relocating medical practices. The inertia of these factors may smooth the transition through disruptive policy landscapes rather than precipitate abrupt workforce shifts.
Delving deeper, the study illuminates the complex motivations shaping physician behavior in an era of heightened legal ambiguity and moral scrutiny. OB-GYNs face escalating concerns over legal liabilities and the constriction of clinical autonomy, factors projected to impel departure from hostile jurisdictions. Nevertheless, the empirical evidence underscores resilience among these clinicians and indicates a commitment to serving patients despite regulatory constraints. This nuanced picture raises critical questions about how physicians negotiate their ethical obligations, professional risks, and personal values in states where abortion access is curtailed.
The research methodology itself underscores the rigor and innovation vital to disentangling such a multifaceted issue. Utilizing the National Plan and Provider Enumeration System (NPPES), the study captures an exhaustive roster of practicing OB-GYNs, enabling precise longitudinal tracking unaffected by sampling bias. The approach offers a robust framework for monitoring workforce trends in response to policy shifts, marking a significant advancement over previous reports relying on survey data vulnerable to self-selection and recall bias. By anchoring conclusions in administrative records, the researchers elevate the discourse from speculative assertions to evidence-based insights.
Media coverage following the Dobbs decision has often amplified fears of declining reproductive healthcare capacity in affected states. Assertions of plummeting physician availability and patient access have evoked widespread alarm among advocacy groups, policymakers, and patients alike. Yet, the findings from Staiger and colleagues complicate this narrative by demonstrating continuity rather than decline in critical provider numbers. This discrepancy prompts a reevaluation of the assumptions underpinning public discourse and signals the necessity for nuanced, data-driven policy considerations addressing reproductive healthcare infrastructure.
The authors acknowledge that while the aggregate number of OB-GYNs has not declined precipitously, the study does not capture qualitative dimensions such as provider willingness to offer abortion-related services within restrictive environments. The presence of OB-GYNs alone does not guarantee unfettered access to comprehensive reproductive care. Future research must explore how practice patterns, service availability, and physician decision-making evolve within and across policy regimes to fully comprehend the post-Dobbs landscape. Such inquiries will enrich understanding of how legal restrictions translate into tangible healthcare experiences.
Staiger herself emphasizes the importance of subsequent mixed-methods research combining quantitative workforce data with qualitative investigations into physician motivations and political leanings. This holistic approach promises to illuminate not only who stays or leaves but the complex decision frameworks underpinning these moves. Understanding how individual political ideologies, risk perceptions, and community attachments influence relocation choices will be crucial for forecasting long-term workforce stability and ensuring equitable access to care.
Moreover, the findings resonate within broader discussions about medical professional autonomy and the intersection of law and clinical practice. The Dobbs decision introduces heightened legal entanglements for OB-GYNs, complicating adherence to established standards of care. How physicians navigate these evolving terrains, balancing legal compliance with patient advocacy, remains a pressing concern. The research sheds light on workforce stability amid such challenges, suggesting providers strive to adapt rather than abandon practice, a testament to professional dedication under duress.
This study’s revelations hold profound implications for healthcare policy and planning. Policymakers must recognize that the simplistic expectation of physician drain following restrictive abortion laws does not align with empirical reality. Instead, strategic resource allocation, professional support systems, and clear legal guidance are necessary to sustain reproductive healthcare delivery within varying legislative contexts. A nuanced appreciation of physician behavior can guide interventions promoting retention, morale, and quality care despite contentious political climates.
In conclusion, the investigation into OB-GYN practice locations before and after the Dobbs decision offers a clarifying lens on a deeply polarizing issue. By leveraging comprehensive administrative data and rigorous analysis, Staiger, Bolotnyy, and their colleagues reveal resilience within the physician workforce and challenge predominant assumptions of mass professional migration. Their work underscores the complexity of healthcare systems responding to legal transformations and calls for continued interdisciplinary research to unravel the evolving dynamics shaping reproductive health access in America.
Subject of Research: Obstetrician and Gynecologist physicians’ practice location trends following the Dobbs v. Jackson Women’s Health Organization decision overturning constitutional abortion rights.
Article Title: Obstetrician and Gynecologist Physicians’ Practice Locations Before and After the Dobbs Decision
News Publication Date: 21-Apr-2025
Web References:
- Dobbs v. Jackson Women’s Health Organization Supreme Court ruling: https://www.supremecourt.gov/opinions/21pdf/19-1392_6j37.pdf
- Federal physician database (NPPES): https://nppes.cms.hhs.gov/#/
References: Staiger R, Bolotnyy V, et al. Obstetrician and Gynecologist Physicians’ Practice Locations Before and After the Dobbs Decision. JAMA Network Open. Published April 21, 2025.
Keywords: Dobbs decision, abortion ban, OB-GYN workforce, physician migration, reproductive health policy, United States, medical practice location, healthcare access, legal constraints, health policy research
