Impact of Dobbs v. Jackson Women’s Health Organization on Professional Decision Making among Urology Applicants

The effect of the Dobbs decision on 2023 Urology match applicants: 88% disapproved, and 1/5 eliminated programs from their rank list.[MeSH = “urology”, “abortion, induced”, “reproductive health”/ “reproductive health services”, “workforce”/ “health workforce”, “internship and residency”/ “medical residency”] Objective To examine the impact of the 2022 U.S. Supreme Court ruling Dobbs v. Jackson Women’s Health Organization, which declared there is no constitutional right to abortion, on professional decision-making in residency selection and ranking. Materials and Methods An IRB-exempt REDCap survey was distributed through the Society of Academic Urologists to all 508 applicants registered for the 2023 Urology Match following the rank list submission deadline on January 10, 2023. The survey closed on February 1, 2023. Responses were anonymized, aggregated, and characterized using descriptive statistics. Thematic mapping of open text comments was performed by two reviewers. Results The response rate was 42% (215/508). 88% of respondents disapproved of the Dobbs ruling. Twenty percent of respondents (15% male/24% female) eliminated programs in states where abortion is illegal. Fifty nine percent (51% male/70% female) would be concerned for their or their partner’s health if they matched in a state where abortion was illegal, and 66% (55% male/82% female) would want their program to assist them or their partner if they required abortion care during residency. Due to the competitive nature of Urology, 68% of applicants reported feeling at least somewhat obligated to apply in states where abortion legislation conflicts with their beliefs. Of the 65 comments provided by respondents, four common themes emerged: 1) Avoidance of states with restrictive abortion laws; 2) Inability to limit applications because of the competitiveness of urology; 3) Impacts on personal healthcare; and 4) Desire for advocacy from professional urology organizations. Conclusions The Dobbs ruling will impact the urology workforce by affecting urology applicants’ decision-making regarding residency selection and ranking. Although the competitiveness of the Urology Match pressures applicants to apply broadly, many are taking reproductive healthcare access into consideration.